Sabaté M, Kay I P, de Feyter P J, van Domburg R T, Deshpande N V, Ligthart J M, Gijzel A L, Wardeh A J, Boersma E, Serruys P W
Thoraxcenter, Heartcenter, Rotterdam, Dijkzigt Academisch Ziekenhuis Rotterdam, The Netherlands.
Am J Cardiol. 1999 Jul 15;84(2):135-40. doi: 10.1016/s0002-9149(99)00222-2.
The aim of this study was to determine the contribution of morphologic characteristics and location of plaque in remodeling of atherosclerotic coronary arteries. Consecutive intravascular ultrasound studies performed in native coronary arteries before an intervention were included in the study. Total vessel, lumen and plaque + media areas were measured at target lesion, and distal and proximal references. Remodeling index was calculated as target total vessel area/proximal reference total vessel area, and categorized into 3 groups based on relative total vessel-area ratio: (1) > 1.1 (group A, adequate remodeling); (2) 0.9 to 1.1 (group B, failure of compensatory enlargement); and (3) <0.9 (group C, coronary shrinkage). Eighty-nine narrowings were assessed in 80 intravascular ultrasound studies. Thirty-eight lesions (43%) were defined as soft and 51 (57%) as hard. Soft plaques were more prevalent in group A than in groups B and C (p = 0.001). Conversely, the arc of calcium was larger in group C lesions (p = 0.005). At distal segments, group A lesions were more prevalent than those in groups B and C, whereas at proximal segments group C lesions were more prevalent (p = 0.007). Multivariate analysis identified the arc of calcium and the location of plaque at distal segments as independent predictors of compensatory enlargement (odds ratio 0.94, 95% confidence interval 0.90 to 0.99; odds ratio 4.6; 95% confidence interval 1.4 to 15.7, respectively), whereas hard plaques were an independent predictor of coronary shrinkage (odds ratio 4.6; 95% confidence interval 1.7 to 12.5). In conclusion, composition and location of plaque appeared to be major determinants of vessel remodeling during the process of atherosclerosis.
本研究的目的是确定斑块的形态特征和位置对动脉粥样硬化性冠状动脉重塑的影响。本研究纳入了在干预前对天然冠状动脉进行的连续血管内超声研究。在目标病变处以及远端和近端参照部位测量血管总面积、管腔面积以及斑块+中膜面积。重塑指数计算为目标血管总面积/近端参照血管总面积，并根据相对血管总面积比值分为3组：（1）>1.1（A组，充分重塑）；（2）0.9至1.1（B组，代偿性扩张失败）；（3）<0.9（C组，冠状动脉狭窄）。在80项血管内超声研究中评估了89处狭窄病变。38处病变（43%）被定义为软斑块，51处（57%）为硬斑块。A组中软斑块比B组和C组更常见（p=0.001）。相反，C组病变的钙化弧更大（p=0.005）。在远端节段，A组病变比B组和C组更常见，而在近端节段C组病变更常见（p=0.007）。多因素分析确定钙化弧和远端节段斑块位置是代偿性扩张的独立预测因素（优势比分别为0.94，95%置信区间0.90至0.99；优势比4.6；95%置信区间1.4至15.7），而硬斑块是冠状动脉狭窄的独立预测因素（优势比4.6；95%置信区间1.7至12.5）。总之，在动脉粥样硬化过程中，斑块的组成和位置似乎是血管重塑的主要决定因素。
