摘要
目的探讨光学相干断层成像(optical coherence tomography,OCT)技术在冠状动脉临界病变介入诊疗中应用。方法回顾性分析入选的2017年1月至2019年1月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病患者,经冠状动脉造影提示为冠状动脉临界病变者行光学相干断层成像检查患者的临床资料。记录患者一般资料、疾病史和药物服用情况,收集患者生化指标及OCT成像指标。结果(1)入选69例冠心病患者,共75处临界病变,其中左前降支52例(75.4%,52/69)、左回旋支4例(5.8%,4/69)、右冠状动脉(right coronary artery,RCA)19例(27.5%,19/69)。(2)对临界病变OCT的斑块特征分析,发现其中伴血栓7例、斑块破裂6例、薄纤维帽脂质斑块25例、巨噬细胞49例、微血管35例、胆固醇结晶35例、溃疡3例、内膜夹层6例。(3)经OCT测定的最小管腔面积(minimum lumen area,MLA)中位数2.9 mm2分组,MLA<2.9 mm2组的C反应蛋白[(2.92±2.44)mg/L与(1.98±1.30)mg/L,P=0.045)]、总胆固醇[(4.13±0.78)mmol/L与(3.74±0.75)mmol/L,P=0.041]、低密度脂蛋白胆固醇[(2.77±0.83)mmol/L与(2.22±0.78)mmol/L,P=0.007)]、小而密低密度脂蛋白胆固醇[(1.02±0.44)mmol/L与(0.80±0.34)mmol/L,P=0.024)]、脂蛋白a[(1.16±0.17)mg/L与(0.95±0.09)mg/L,P=0.042]均高于MLA≥2.9 mm2组,差异均有统计学意义。(4)根据是否行介入治疗分两组,其中行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)16例,未行PCI 59例;发现PCI组面积狭窄度[(68.58±4.90)%与(63.10±7.09)%,P=0.001]、直径狭窄度[(65.65±6.91)%与(60.77±8.41)%,P=0.024]、脂质斑块弧度[(245.3±41.0)°与(189.8±99.6)°,P=0.001]、脂质斑块长度[(19.11±6.40)mm与(14.72±9.30)mm,P=0.035]均较未行PCI组严重,差异均有统计学意义。(5)OCT指导的PCI组1年主要心血管不良事件发生率6.25%和未行PCI患者发生率5.08%,两者比较差异无统计学意义(P=0.317)。结论根据OCT对冠状动脉临界病�
Objective To explore the application of optical coherence tomography(OCT)in the interventional diagnosis and treatment of intermediate coronary disease.Methods Patients were enrolled during January 2017 to January 2019,in the Department of Cardiology,the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine.The patient whose diagnosis was confirmed as intermediate coronary artery lesion by coronary angiography then underwent coronary OCT examination.The general information,disease history,drug use,biochemical indicators and OCT imaging indicators were collected.Results(1)A total of 75 borderline lesions were detected in 69 patients with coronary heart disease,including 52 cases of left anterior descending artery(LAD)(75.4%),4 cases of left circumflex artery(5.8%,4/69),and 19 cases(27.5%,19/69)of right coronary artery(RCA).(2)According to the analysis of the plaque characteristics of borderline lesions OCT,7 cases were accompanied with thrombosis,6 cases with plaque rupture,25 cases with thin fiber cap lipid plaque,49 cases with macrophages,35 cases with microvascular,35 cases with cholesterol crystallization,3 cases with ulcer and 6 cases with intimal dissection.(3)The median of the minimum lumen area(MLA)determined by OCT was 2.9 mm2.In the MLA<2.9 mm2 group,C-reactive protein(CRP)((2.92±2.44)mg/L vs.(1.98±1.30)mg/L,P=0.045),total cholesterol(TC)((4.13±0.78)mmol/L vs.(3.74±0.75)mmol/L,P=0.041),low density lipoprotein cholesterol((2.77±0.83)mmol/L vs.(2.22±0.78)mmol/L,P=0.007),small and dense LDL((1.02±0.44)mmol/L vs.(0.80±0.34)mmol/L,P=0.024),lipoprotein a((1.16±0.17)mg/L vs.(0.95±0.09)mg/L,P=0.042)were significantly higher than those in MLA≥2.9 mm2 group.(4).According to the interventional strategy,patients were divided into two groups:percutaneous coronary intervention(PCI)group(N=16)and non-PCI group(N=59).The area stenosis(AS%)((68.58±4.90)%vs.(63.10±7.09)%,P=0.001),diameter stenosis(DS%)((65.65±6.91)%vs.(60.77±8.41)%,P=0.024),lipid plaque curvature((245.3±41.
作者
范例
陈启稚
许左隽
卞玲
王长谦
Fan Li;Chen Qizhi;Xu Zuojuan;Bian Ling;Wang Changqian(Department of Cardiology,the Ninth People's Hospital,Shanghai Jiaotong University School of Medicine,shanghai 200011,China)
出处
《中国综合临床》
2020年第6期539-544,共6页
Clinical Medicine of China
关键词
冠心病
光学相干断层成像
临界病变
脂质斑块
Coronary heart
Optical coherence tomography
Borderline lesions
Lipid plaque
