光学相干断层成像技术对急性冠脉综合征患者病变特点的分析研究

发布时间：2018-05-08 06:42

本文选题：急性冠脉综合征 + 光学相干断层成像　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:本研究旨在应用光学相干断层成像技术(optical coherence tomography,OCT)对急性冠脉综合征(acute coronary syndrome,ACS)患者的罪犯血管病变特点进行比较分析。方法:本研究入选2015年3月至2017年2月于河北医科大学第二医院心内五科就诊并行OCT检查的ACS患者。入院后收集其基线资料:年龄,体重,吸烟史,是否合并高血压、糖尿病,总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白(low density lipoprotein,LDL)、肌酸激酶同工酶(creatine kinase isoenzymeMB,CK-MB)、血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,Scr)水平、GRACE评分、CRUSADE评分。入院后行择期冠状动脉造影术及OCT检查,分析ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)和非ST段抬高型急性冠脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)患者病变特点,并记录检查过程中是否出现心肌缺血表现。收集术后72小时内Scr水平并与入院时基线水平相比较。随访30天,观察记录其主要心脏不良事件(major adverse cardiac events,MACE)发生情况。采用SPSS 20.0统计软件分析处理数据。以P0.05定义为差异有统计学意义。结果:1研究共入选23例患者,STEMI患者11例,NSTE-ACS患者12例,性别、年龄、体重、合并的危险因素(高血压、糖尿病、吸烟史)、TC、TG、LDL、CK-MB、BUN、Scr、术后72小时内Scr、CRUSADE评分等基线资料比较无统计学差异。STEMI患者GRACE评分高于NSTE-ACS患者(133.91±14.22 vs 111.17±11.34,P=0.000)。2 STEMI与NSTE-ACS患者比较,其斑块破裂(plaque rupture,PR)、斑块侵蚀(plaque erosion,PE)、易损性斑块的发生率无统计学差异(54.5%vs.16.7%P=0.057;18.2%vs.0 P=0.122;63.6%vs.66.7%P=0.879),而血栓形成的发生率有统计学差异(54.4%vs.8.3%P=0.016)。两组患者均未检出钙化结节(calcification nodule,CN)、冠状动脉痉挛及自发性冠状动脉夹层(spontaneous coronary artery dissection,SCAD)等病变。合并糖尿病的ACS患者的PR发生率显著高于未合并糖尿病者(71.4%vs.18.8%,P=0.015)。3与CAG比较,行OCT检查操作时间延长(28.98±3.19 vs.41.53±7.28P=0.000)、对比剂用量增多(74.09±15.46 vs.99.30±17.97 P=0.000),检查过程中心肌缺血发生率两者比较无显著差异(4.3%vs.8.7%P=0.55)。术后72小时内Scr水平较入院时基线水平比较无统计学差异(P=0.740),未见患者发生对比剂肾病。随访30天内,仅NSTE-ACS组有1例患者出现再发心绞痛,余患者未见MACE事件发生。结论:1应用OCT技术可以有效观察STEMI与NSTE-ACS患者的罪犯血管病变特点。2 STEMI与NSTE-ACS患者的病变特点存在差异。3 OCT检查在ACS患者中应用安全有效。
[Abstract]:Objective: to compare and analyze the characteristics of criminal vascular lesions in patients with acute coronary syndrome (ACS) by optical coherence tomography (Oct). Methods: from March 2015 to February 2017, patients with ACS underwent OCT examination in five departments of the second Hospital of Hebei Medical University. Baseline data were collected after admission: age, weight, smoking history, hypertension, diabetes mellitus, Total cholesterol (TC), triglyceride (TG), low density lipoprotein (density), creatine kinase isoenzyme (CK-MBN), blood urea nitrogenin (BUNA), serum creatinine (SCR), creatine kinase isoenzyme (creatine kinase isoenzyme), creatine kinase isoenzyme (creatine kinase isoenzyme), creatine kinase isoenzyme (creatine kinase isoenzyme), serum creatinine serum creatinine After admission, selective coronary angiography and OCT examination were performed to analyze the pathological characteristics of ST-segment elevation myocardial infarction (ST-segment elevation myocardial infraction) and non-ST-segment elevation acute coronary syndrome (non-ST-segment elevation acute coronary syndromeNSTE-ACSS) in patients with ST-segment elevation myocardial infarction (ST-segment) and non-ST-segment elevation acute coronary syndrome (non-ST-segment elevation acute coronary syndromeNSTE-ACSS). Myocardial ischemia was recorded during the examination. Scr levels were collected 72 hours after operation and compared with baseline levels at admission. After 30 days follow-up, the occurrence of major adverse cardiac events was observed and recorded. SPSS 20.0 statistical software was used to analyze and process the data. With P0.05 definition as the difference is statistically significant. Results A total of 23 patients with STEMI, 11 patients with NSTE-ACS, 12 patients with NSTE-ACS, gender, age, weight, and risk factors (hypertension, diabetes mellitus) were enrolled in the 1: 1 study. There was no significant difference in baseline data such as the score of CRUSADE within 72 hours after operation. The GRACE score of STEMI patients was higher than that of NSTE-ACS patients (133.91 卤14.22 vs 111.17 卤11.34 STEMI vs NSTE-ACS). There was no significant difference in the incidence of vulnerable plaques in plaque rupture, plaque erosion and plaque erosion. There was no significant difference in the incidence of vulnerable plaques. There was no statistical difference in the incidence of vulnerable plaques. There was no significant difference in the incidence of vulnerable plaques. There was no statistical difference in the incidence of plaque erosion. There was no statistical difference in the incidence of vulnerable plaques. There was no statistical difference in the incidence of vulnerable plaques. No calcification nodule, coronary spasm and spontaneous coronary artery dissection were detected in both groups. The incidence of PR in ACS patients with diabetes mellitus was significantly higher than that in patients without diabetes mellitus. Compared with CAG, the operation time of OCT examination was increased by 28.98 卤3.19 vs.41.53 卤7.28 P0.000, and the dosage of contrast agent was increased by 74.09 卤15.46 vs.99.30 卤17.97 P0.000. There was no significant difference in the incidence of myocardial ischemia between the two groups. There was no significant difference in Scr level within 72 hours after operation compared with baseline level at admission. No contrast nephropathy was found in the patients. Only one patient in NSTE-ACS group developed recurrent angina pectoris during 30 days follow-up. No MACE event occurred in other patients. Conclusion OCT technique can be used to observe the pathological features of criminals in patients with STEMI and NSTE-ACS. There is a difference in pathological characteristics between STEMI and NSTE-ACS. 3 OCT examination is safe and effective in ACS patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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