摘要目的 探讨急性冠状动脉综合征(ACS)患者参考段血管病变对血管内超声(IVUS)评估冠状动脉重构的影响.方法 对103例ACS患者行常规冠状动脉造影,IVUS检测103个靶病变和参考段血管处动脉粥样斑块形态学参数.重构指数(RI)为病变部位外弹力膜(EEM)面积与近端参考段EEM面积之比,RI>1为正重构(67例),RI≤1为负重构(36例).分析重构分组之间的斑块形态学特点,比较各参数在远端与近端参考段血管之间的差异和相关性.结果 仅1例患者未见参考段血管的病变.正性与负性重构组103处靶病变以及102处参考段血管位点问斑块负荷、管腔面积和EEM面积差异无统计学意义;与远端参考段血管比较,斑块负荷在近端参考段显著增加[(39.76±12.54)%对(32.38±3.97)%,P<0.001],斑块面积也明显增大[(6.14±3.20)mm2对(4.75±3.07)mm2,P=0.001].EEM面积在远端参考段扩增明显高于近端参考段[(14.99±4.12)mm2对(28.37±4.48)mm2,P<0.001].斑块负荷、斑块面积和管腔面积在近端与远端参考段之间均有显著正相关性(均为P<0.05).结论 ACS患者参考段血管弥漫性病变可能影响IVUS冠脉重构的评估;重构是一个动态过程,静态与系列方法结合评估冠脉重构可能更为准确.

abstractsObjective To investigate the influence of atherosclerotic reference segments on coronary remodeling by intravascular ultrasound(IVUS) in patients with acute coronary syndrome(ACS). Methods One hundred and three consecutively enrolled patients [male 68 cases,female 35 cases,average age (60 ±11) years] with ACS were undergone by coronary artery angiography and IVUS with time selecting operation. The remodeling index(RI) was defined as lesion external elastic membrane cross section aere (EEM CSA) divided by the mean reference EEM CSA at the culprit vessel. Positive remodeling was RI≥ (67 cases), negative remodeling was RI <1(36 cases). The parameters of plaque were analysed between two remodeling groups, as well as compared between distal and proximal references. Results Only one patients do not have plaque at reference sites. In the analysis of 103 lesions and 102 reference sites, there were not significant different in plaque burden,plaque CSA,lumen CSA and lesion EEM CSA between two groups. Distal plaque burden[(39. 76 ±12. 54)% vs (32.38 ± 13.97)%, P <0.001] and plaque CSA [(6.14 ± 3.20)mm2 vs (4. 75 ± 3. 07) mm2, P = 0. 001] were larger than those at proximal reference. EEM CSA at distal reference was smaller than proximal one[(14. 99 ± 4. 12)mm2 vs (28. 37 ± 4. 48)mm2 , P <0. 001]. Plaque burden, plaque CSA and lumen CSA persented positive corelation between distal and proximal reference sites. Conclusions The reference segments lay a severe diffuse atherosclerosis in the group of ACS, which may influence assessment of coronary remodeling. Coronary remodeling as a process, a accurate evaluation could be result from the combination of static and serial approach by IVUS.