血管内超声在冠状动脉非左主干临界病变中的应用
发布时间：2018-11-23 19:23
【摘要】：研究背景及目的:冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CAHD)简称冠心病(coronary heart disease,CHD),是当前对人类健康和生命安全具有严重威胁的主要疾病之一。近年来,随着生活质量的不断提高,高脂高热量饮食、运动量减少、吸烟等不健康生活方式随处可见,我国冠心病的发病率亦不断上升,且有年轻化的趋势。冠状动脉临界病变主要指的是冠状动脉造影(coronaryangiography,CAG)提示冠状动脉狭窄程度介于40%-70%的病变,在冠脉造影和冠脉介入治疗(percutaneous coronary intervention,PCI)中比较常见。尽管属于冠状动脉的早期病变,冠状动脉临界病变依然可能进展为心肌梗死甚至发生猝死,因此准确评估冠状动脉临界病变显得尤为重要。冠状动脉造影是公认的诊断冠心病并指导PCI的“金标准”,但是由于冠状动脉造影主要利用对比剂充盈冠脉管腔,显示的仅仅是管腔轮廓的三维图像,造影投射角度、弥漫性病变导致的参考血管节段异常、斑块的偏心性等因素均可导致冠状动脉造影无法准确评估病变,而H病变冠脉大多存在正性重构现象,当斑块面积达到血管管腔横截面的一半时,冠状动脉造影才能发现。这些都使得冠状动脉造影在准确评估临界病变方面有一定的局限性。血管内超声(intravascular ultrasound,IVUS)属于血管内成像技术的一种,不但能够清晰显示出冠脉管腔形态、血管壁和管腔的直径、病变长度、横截面积,而且还可以辨别斑块的性质和类型,进行斑块的定量及定性分析。既往研究发现,对于非左主干、直径2.5 mm的冠状动脉狭窄病变,当狭窄处测得的最小管腔面积(minimal lumen area,MLA)4 mm2可能会导致心肌缺血,而当MLA≥4 mm2时,延迟对病变的介入干预可能是安全的。IVUS通过评估冠脉狭窄程度间接推断是否发生心肌缺血。血流储备分数测定(Fractional Flow Reserve,FFR)则是直接评判冠脉狭窄功能性意义的可靠指标,是评价冠脉临界病变生理学的“金标准”。FFR是指当冠脉存在狭窄病变时,狭窄血管供应心肌区域能构获得的最大血流和同一心肌区域正常情况下理论上所能获得的最大血流的比值。多项研究显示在稳定型冠心病患者中,如FFR0.8,发生心肌缺血的可能性不大,这种情况下对狭窄病变延迟PCI治疗而应用规范的冠心病最佳药物治疗是安全可靠的。研究设计与方法:本研究分为两部分。第一部分对通过冠状动脉造影证实为冠状动脉非左主干临界病变的104例患者进行IVUS或FFR检查,随访1年,观察MLA≥4.Omm2对比FFR≥0.8指导下冠状动脉临界病变延迟PCI治疗的一年临床随访结果。第二部分,选取冠脉造影提示冠脉临界病变(40%-70%狭窄)且IVUS检查提示最小管腔面积(MLA)≥4.0mm2的25例ACS患者,延迟行冠状动脉介入治疗(PCI),采用冠心病优化药物治疗(OMT),随访1年,观察主要终点为靶血管重建(TVR),次要终点为主要心血管不良事件(MACEs)。结果:第一部分研究中,两组患者一般临床情况、冠状动脉造影情况差异无统计学意义(P0.05),两组间主要心血管不良事件的发生率无统计学差异(P=0.716)。第二部分研究中,1例NSTEMI患者因再次发生心肌梗死行血运重建,2例UA患者经药物治疗后仍反复发生心绞痛再次住院,靶血管重建发生率为4.00%,主要心血管不良事件发生率为16.00%。结论:IVUS及FFR均可以用于指导非左主干冠脉临界病变延迟介入治疗,其中IVUS可以用于指导急性冠脉综合征患者非左主干冠脉临界病变延迟介入治疗。
[Abstract]:Background and purpose: coronary heart disease (CAHD) is one of the main diseases which are a serious threat to human health and life safety. In recent years, with the improvement of the quality of life, the high-fat and high-calorie diet, the decrease of the amount of exercise, and the non-healthy lifestyle such as smoking can be seen everywhere, the incidence of coronary heart disease in our country is also rising, and there is a young trend. Coronary artery critical lesions mainly refer to coronary angiography (CAG), which suggests that the degree of coronary artery stenosis is between 40% and 70%, and is more common in coronary angiography and coronary intervention (PCI). In spite of the early pathological changes in the coronary arteries, the critical lesions of the coronary artery may still be progressing to myocardial infarction or even sudden death, so it is very important to accurately assess the critical coronary artery lesions. Coronary angiography is a well-established 鈥済old standard鈥，
本文编号：2352472
[Abstract]:Background and purpose: coronary heart disease (CAHD) is one of the main diseases which are a serious threat to human health and life safety. In recent years, with the improvement of the quality of life, the high-fat and high-calorie diet, the decrease of the amount of exercise, and the non-healthy lifestyle such as smoking can be seen everywhere, the incidence of coronary heart disease in our country is also rising, and there is a young trend. Coronary artery critical lesions mainly refer to coronary angiography (CAG), which suggests that the degree of coronary artery stenosis is between 40% and 70%, and is more common in coronary angiography and coronary intervention (PCI). In spite of the early pathological changes in the coronary arteries, the critical lesions of the coronary artery may still be progressing to myocardial infarction or even sudden death, so it is very important to accurately assess the critical coronary artery lesions. Coronary angiography is a well-established 鈥済old standard鈥，
本文编号：2352472
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