冠状动脉危险因素影响不稳定型心绞痛患者的斑块形态。

Coronary risk factors influence plaque morphology in patients with unstable angina.

作者信息

Gyongyosi M, Yang P, Hassan A, Weidinger F, Domanovits H, Laggner A, Glogar D

机构信息

2nd Department of Internal Medicine, University of Vienna, Austria.

出版信息

Coron Artery Dis. 1999 Jun;10(4):211-9. doi: 10.1097/00019501-199906000-00002.

DOI:10.1097/00019501-199906000-00002

PMID:10376199

Abstract

BACKGROUND

The risk of plaque disruption and subsequent thrombosis in patients with unstable angina depends on the plaque type and size.

DESIGN

Intravascular ultrasound (IVUS) was employed to illustrate the correlation between risk factors and plaque morphology in patients with unstable angina.

METHODS

In a prospective study of 60 of 95 patients consecutively admitted with unstable angina [41 men, aged 61.2 +/- 8.1 years (mean +/- SD)], qualitative (soft and hard plaque, thrombus, calcification, eccentricity, adaptive and constrictive remodeling) and quantitative [lumen, external elastic membrane (EEM) and plaque cross-sectional area (CSA) and plaque burden] IVUS data relating to the target lesion, and proximal and distal reference segments were analyzed and correlated with risk factors. Univariate and multivariate nominal logistic regression analyses and analyses of variance were used to determine the independent predictors for IVUS morphology.

RESULTS

For plaque composition univariate analysis showed a younger age (< 60 years) to be a predictor for adaptive remodeling (P = 0.019), and an older age to be a predictor for constrictive remodeling (P = 0.021). Hypercholesterolemia, smoking and sex were associated with a higher frequency of thrombus (P = 0.044, 0.038 and 0.043, respectively). Multivariate analyses revealed that only younger and older ages were independent predictors for adaptive and constrictive remodeling (P = 0.039 and P = 0.045). For plaque size, univariate and multivariate analyses demonstrated that diabetes mellitus and hypercholesterolemia were independent predictors for greater plaque (13.5 +/- 5.72 versus 10.17 +/- 4.6 mm2, P = 0.015, for diabetic versus non-diabetic patients; 12.0 +/- 5.35 versus 9.03 +/- 3.76 mm2, P = 0.010, for hypercholesterolemic versus normocholesterolemic patients) and EEM CSA (17.16 +/- 5.81 versus 14.3 +/- 5.1 mm2, P = 0.033, for diabetic versus non-diabetic patients; 16.57 +/- 5.49 versus 12.25 +/- 3.8 mm2, P = 0.001, for hypercholesterolemic versus normocholesterolemic patients) at the target lesion. Hypercholesterolemia was associated with significantly greater plaque and EEM CSA in both proximal and distal reference segments.

CONCLUSIONS

Multivariate analyses indicated that age, diabetes and hypercholesterolemia are independent predictors for plaque morphology in patients with unstable angina.

摘要

背景

不稳定型心绞痛患者斑块破裂及随后血栓形成的风险取决于斑块类型和大小。

设计

采用血管内超声（IVUS）阐明不稳定型心绞痛患者危险因素与斑块形态之间的相关性。

方法

对95例连续收治的不稳定型心绞痛患者中的60例进行前瞻性研究[41例男性，年龄61.2±8.1岁（均值±标准差）]，分析与靶病变、近端和远端参考节段相关的定性（软斑块和硬斑块、血栓、钙化、偏心性、适应性和缩窄性重塑）和定量[管腔、外弹力膜（EEM）和斑块横截面积（CSA）以及斑块负荷]IVUS数据，并将其与危险因素进行关联分析。采用单因素和多因素名义逻辑回归分析以及方差分析来确定IVUS形态的独立预测因素。

结果

对于斑块成分，单因素分析显示年龄较小（<60岁）是适应性重塑的预测因素（P = 0.019），年龄较大是缩窄性重塑的预测因素（P = 0.021）。高胆固醇血症、吸烟和性别与血栓形成频率较高相关（分别为P = 0.044、0.038和0.043）。多因素分析显示，只有年龄较小和年龄较大是适应性和缩窄性重塑的独立预测因素（P = 0.039和P = 0.045）。对于斑块大小，单因素和多因素分析表明，糖尿病和高胆固醇血症是靶病变处更大斑块的独立预测因素（糖尿病患者与非糖尿病患者相比，斑块面积为13.5±5.72 vs 10.17±4.6 mm2，P = 0.015；高胆固醇血症患者与正常胆固醇血症患者相比，斑块面积为12.0±5.35 vs 9.03±3.76 mm2，P = 0.010）以及EEM CSA（糖尿病患者与非糖尿病患者相比，EEM CSA为17.16±5.81 vs 14.3±5.1 mm2，P = 0.033；高胆固醇血症患者与正常胆固醇血症患者相比，EEM CSA为16.57±5.49 vs 12.25±3.8 mm2，P = 0.001）。高胆固醇血症与近端和远端参考节段中显著更大的斑块和EEM CSA相关。