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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2015, Vol. 12 ›› Issue (06) : 446 -452. doi: 10.3877/cma.j.issn.1672-6448.2015.06.007

所属专题： 文献；

心血管超声影像学

急性冠状动脉综合征患者斑块负荷与冠状动脉重构的相关性
沈红帅1, 宋达琳2,†(), 魏美连3, 康维强4   
  1. 1. 116044　大连医科大学
    2. 116044　大连医科大学；266071　青岛市市立医院老年内科；266071　青岛大学
    3. 266071　青岛大学
    4. 266071　青岛市市立医院老年内科
  • 收稿日期:2014-12-26 出版日期:2015-06-01
  • 通信作者: 宋达琳
  • 基金资助:
    2010—2012年青岛市发展项目(2010KZJ-7); 2015—2016年青岛市医药科研指导计划(2014-WJZD028)

Correlation between the plaque burden and remodeling in patients with acute coronary syndrome

Hongshuai Shen1, Dalin Song2,†(), Meilian Wei3, Weiqiang Kang4   

  1. 1. Dalian Medical University, Dalian 116044, China
    2. Dalian Medical University, Dalian 116044, China; Department of Geriatrics, Qingdao Municipal Hospital, Qingdao 266071, China; Qingdao University, Qingdao 266071, China
    3. Qingdao University, Qingdao 266071, China
    4. Department of Geriatrics, Qingdao Municipal Hospital, Qingdao 266071, China
  • Received:2014-12-26 Published:2015-06-01
  • Corresponding author: Dalin Song
  • About author:
    Corresponding authors: Song Dalin, Email:
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引用本文：

沈红帅, 宋达琳, 魏美连, 康维强. 急性冠状动脉综合征患者斑块负荷与冠状动脉重构的相关性[J]. 中华医学超声杂志（电子版）, 2015, 12(06): 446-452.

Hongshuai Shen, Dalin Song, Meilian Wei, Weiqiang Kang. Correlation between the plaque burden and remodeling in patients with acute coronary syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(06): 446-452.

目的

探讨急性冠状动脉综合征（ACS）患者斑块负荷（PB）与冠状动脉重构之间的潜在关系。

方法

选取2011年1月至2014年6月在青岛市市立医院行常规冠状动脉造影与血管内超声（IVUS）检查的ACS患者91例。其中正性重构[重构指数（RI）>1]60例，负性重构（RI<1）31例；PB<60%9例，60%≤PB<70%19例，70%≤PB<80%48例，PB>80%15例。采用独立样本t检验比较正性重构与负性重构ACS患者斑块横截面积（P-CSA）、管腔横截面积（L-CSA）、外弹力膜横截面积（EEM-CSA）、平均EEM-CSA、PB差异；采用单因素方差分析比较不同PB的ACS患者P-CSA、L-CSA、EEM-CSA、RI差异；采用Pearson相关分析分析PB、P-CSA、EEM-CSA、L-CSA、RI的相关性。

结果

正性重构与负性重构ACS患者P-CSA、L-CSA、EEM-CSA、PB的差异均无统计学意义，负性重构ACS患者平均EEM-CSA大于正性重构ACS患者，且差异有统计学意义[（13.24 ± 1.98）mm2 vs （17.30 ± 3.16）mm2，t=2.46，P<0.05]。不同PB的ACS患者RI的差异无统计学意义，P-CSA、EEM-CSA、L-CSA的差异均有统计学意义（F=24.56、28.97、7.14，均P<0.001），且随着PB增加，P-CSA、EEM-CSA均增加[P-CSA：（6.01 ± 1.68）、（9.12 ± 2.00）、（11.42 ± 2.05）、（14.05 ± 4.00） mm2，EEM-CSA：（11.43 ± 1.90）、（13.64 ± 2.93）、（15.14 ± 2.64）、（16.64 ± 4.08） mm2]，L-CSA减少[（5.44 ± 0.89）、（4.52 ± 0.99）、（3.72 ± 0.74）、（2.60 ± 0.63） mm2]。且PB与P-CSA、EEM-CSA呈正相关（r=0.76、0.50，P均<0.001），与L-CSA呈负相关性（r=-0.74，P<0.001）；RI与PB、P-CSA、L-CSA、EEM-CSA均无相关性。

结论

冠状动脉重构是一个非常复杂的动态过程，除PB以外，可能还存在其他因素影响重构的方向，另外RI作为血管重构的评估标准可能不甚理想。

关键词: 急性冠状动脉综合征, 超声检查，介入性, 斑块负荷
Objective

To discuss the potential relationship of plaque burden (PB) and coronary remodeling in acute coronary syndrome (ACS) patients.

Methods

Ninety-one patients with ACS in Qingdao Municipal Hospital during January 2011 to June 2014 underwent the conventional coronary angiography and intravascular ultrasonography (IVUS). The remodeling of 60 cases were positive (remodeling index [RI]>1) and those of 31 cases were negative (RI<1). All 91 patients were included in this study, including 9 cases (PB<60%), 19 cases (60%≤PB<70%), 48 cases (70%≤PB<80%) and 15 cases (PB>80%). The difference of plaque cross-sectional area (P-CSA), lumen cross-sectional area (L-CSA), external elastic membrane cross-sectional area (EEM-CSA), average EEM-CSA, PB between positive remodeling and negative remodeling were compared by independent-samples t test. ANOVA was used to compare P-CSA, L-CSA, EEM-CSA and RI among patients with different PB. The relevance of PB, P-CSA, EEM-CSA, L-CSA and RI were analyzed by Pearson correlation analysis.

Results

There were no significant differences in P-CSA, L-CSA, EEM-CSA and PB between patients with positive remodeling and negative remodeling. Average EEM-CSA of patients with negative remodeling were significantly greater than that of patients with positive remodeling [(13.24±1.98) mm2 vs (17.30±3.16) mm2, t=2.46, P<0.05]. P-CSA, EEM-CSA and L-CSA had significant differences (F=24.56, 28.97 and 7.14, P<0.001) while RI had not statistical significant difference among patients with different PB. With the increase of PB, P-CSA and EEM-CSA increased [P-CSA: (6.01±1.68), (9.12±2.00), (11.42±2.05) and (14.05±4.00) mm2, EEM-CSA: (11.43±1.90), (13.64±2.93), (15.14±2.64) and (16.64±4.08) mm2], L-CSA reduced [(5.44±0.89), (4.52±0.99), (3.72±0.74) and (2.60±0.63) mm2]. PB was positively correlated with P-CSA and EEM CSA (r=0.76, 0.50, P<0.001), but was negatively correlated with L-CSA (r=-0.74, P<0.001). RI had no relationship with PB, P-CSA, L-CSA and EEM-CSA.

Conclusions

Coronary artery remodeling is a very complicated dynamic process. Except the PB, other factors probably affect the direction of remodeling. RI is not suitable as the index for the assessment of vascular remodeling.

Key words: Acute coronary syndrome, Ultrasonography, interventional, Plaque burden
表1 正性重构与负性重构ACS患者一般临床资料比较
组别 例数 年龄（岁，±s） 性别（例，男性/女性） 高血压病史（例，是/否） 糖尿病史（例，是/否） 吸烟史（例，是/否）
正性重构组 60 58.4 ± 11.9 35/25 31/29 12/48 33/27
负性重构组 31 60.8 ± 8.7 26/5 18/13 7/24 11/20
? 检验值 ? t=-1.1 χ2=6.03 χ2=0.34 χ2=0.08 χ2=3.12
? P值 ? 0.28 0.01 0.56 0.77 0.08
表2 不同PB的ACS患者一般临床资料比较
组别 例数 性别（例，男性/女性） 年龄（岁，±s ） 高血压病史（例，是/否） 糖尿病史（例，是/否） 吸烟史（例，是/否）
PB<60% 9 4/5 61.1 ± 12.5 6/3 2/7 2/7
60%≤PB<70% 19 11/8 57.6 ± 11.9 11/8 6/13 8/11
70%≤PB<80% 48 34/14 58.6 ± 10.5 26/22 10/38 27/21
PB>80% 15 12/3 62.1 ± 10.5 6/9 1/14 7/8
? 检验值 ? χ2=4.25 F=0.61 χ2=1.88 χ2=3.16 χ2=3.97
? P值 ? 0.24 0.61 0.60 0.37 0.26
表3 正性重构与负性重构ACS患者血管内超声参数比较（±s）
组别 例数 P-CSA （mm2） L-CSA （mm2） EEM-CSA （mm2） 平均EEM-CSA （mm2） PB（%）
正性重构组 60 10.45 ± 2.73 3.90 ± 1.00 14.35 ± 2.88 13.24 ± 1.98 72.03 ± 9.14
负性重构组 31 11.59 ± 4.01 3.82 ± 1.31 15.41 ± 3.72 17.30 ± 3.16 73.87 ± 10.36
t值 ? -1.6 0.33 -1.5 2.46 -0.87
P值 ? 0.11 0.75 0.14 0.02 0.39
图4～6 急性冠状动脉综合征患者的血管内超声图像。重构指数=0.92，为负性重构，靶病变处斑块负荷为79.74%。图4为近端参考段；图5为靶病变处；图6为远端参考段
表4 不同PB的ACS患者血管内超声参数比较（±s）
组别 例数 P-CSA（mm2） L-CSA（mm2） EEM-CSA（mm2） RI
PB<60% 9 6.01 ± 1.68 5.44 ± 0.89 11.43 ± 1.90 1.18 ± 0.41
60%≤PB<70% 19 9.12 ± 2.00 4.52 ± 0.99 13.64 ± 2.93 1.24 ± 0.36
70%≤PB<80% 48 11.42 ± 2.05 3.72 ± 0.74 15.14 ± 2.64 1.27 ± 0.67
PB>80% 15 14.05 ± 4.00 2.60 ± 0.63 16.64 ± 4.08 1.21 ± 0.54
F值 ? 24.56 28.97 7.14 0.77
P值 ? 0.00 0.00 0.00 0.52
表5 ACS患者PB、P-CSA、EEM-CSA、L-CSA、RI相关性分析
项目 PB P-CSA EEM-CSA L-CSA RI
r值 P值 r值 P值 r值 P值 r值 P值 r值 P值
PB - - 0.75 0.00 0.50 0.00 -0.74 0.00 -0.05 0.67
P-CSA 0.75 0.00 - - 0.94 0.00 -0.21 0.04 -0.13 0.21
EEM-CSA 0.50 0.00 0.94 0.00 - - 0.13 0.21 -0.14 0.17
L-CSA -0.74 0.00 -0.21 0.04 0.13 0.21 - - -0.03 0.81
RI -0.05 0.67 -0.13 0.21 -0.14 0.17 -0.03 0.81 - -
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