Amano Tetsuya, Matsubara Tatsuaki, Uetani Tadayuki, Nanki Michio, Marui Nobuyuki, Kato Masataka, Yoshida Tomohiro, Arai Kosuke, Yokoi Kiminobu, Ando Hirohiko, Kumagai Soichiro, Ishii Hideki, Izawa Hideo, Hotta Nigishi, Murohara Toyoaki
Department of Cardiology, Chubu-Rosai Hospital, Nagoya, Japan.
JACC Cardiovasc Imaging. 2008 Jan;1(1):39-45. doi: 10.1016/j.jcmg.2007.09.003.
This study sought to determine lipid and fibrous volume of coronary atherosclerotic plaques in subjects with abnormal glucose regulation (AGR) by integrated backscatter (IB) intravascular ultrasound (IVUS) during percutaneous coronary intervention.
Abnormal glucose regulation, including impaired glucose regulation (IGR) and diabetes mellitus (DM), has emerged as an important determinant of cardiovascular risk. We hypothesized that AGR would be associated with coronary plaque instability.
Conventional intravascular ultrasound and IB-IVUS using a 40-MHz (motorized pullback 1 mm/s) intravascular catheter was performed in 172 consecutive patients. The percentage of fibrous area and the percentage of lipid area were automatically calculated by IB-IVUS. Three-dimensional analysis of IB-IVUS images was performed to determine the percentage of lipid volume (%LV) and fibrous volume (%FV). Following the World Health Organization criteria, the subjects were classified into the DM group, the IGR group, and the normal glucose regulation group. The cutoff point for the lipid-rich plaque was defined as %LV >44% or %FV <52%, which was the 75th percentile of %LV or the 25th percentile of %FV in this study population. Insulin resistance (IR) was defined as the homeostasis model assessment of insulin resistance (HOMA-IR).
There were no significant differences in the baseline characteristics except for glucometabolic parameters. The conventional IVUS analysis indicated that the DM group had a significantly increased plaque volume (and percent plaque volume). In the IB-IVUS analysis, as compared with the normal glucose regulation group, the DM and the IGR groups showed a significant increase in %LV (36 +/- 14% and 37 +/- 13% vs. 29 +/- 14%, p = 0.02) and a significant decrease in %FV (59 +/- 11% and 58 +/- 11% vs. 64 +/- 11%, p = 0.03). The lipid-rich plaque rate was significantly associated with an increasing HOMA-IR in the tertile (p = 0.008). On logistic regression analysis after adjusting for confounding and coronary risk factors, the DM group (odds ratio 3.52, 95% confidence interval 1.13 to 11.0, p = 0.03) and the IGR group (odds ratio 3.92, 95% confidence interval 1.13 to 13.6, p = 0.03) were significantly associated with the lipid-rich plaque.
Coronary lesions in patients with AGR are associated with more lipid-rich plaque content, which may be related to the increased IR in these patients.
本研究旨在通过经皮冠状动脉介入治疗期间的背向散射积分（IB）血管内超声（IVUS），确定葡萄糖调节异常（AGR）患者冠状动脉粥样硬化斑块的脂质和纤维体积。
包括糖调节受损（IGR）和糖尿病（DM）在内的葡萄糖调节异常已成为心血管风险的重要决定因素。我们假设AGR与冠状动脉斑块不稳定性有关。
对172例连续患者进行了常规血管内超声检查和使用40MHz（电动回撤速度1mm/s）血管内导管的IB-IVUS检查。通过IB-IVUS自动计算纤维面积百分比和脂质面积百分比。对IB-IVUS图像进行三维分析，以确定脂质体积百分比（%LV）和纤维体积百分比（%FV）。根据世界卫生组织标准，将受试者分为DM组、IGR组和正常葡萄糖调节组。富含脂质斑块的截断点定义为%LV>44%或%FV<52%，这是本研究人群中%LV的第75百分位数或%FV的第25百分位数。胰岛素抵抗（IR）定义为胰岛素抵抗的稳态模型评估（HOMA-IR）。
除糖代谢参数外，基线特征无显著差异。常规IVUS分析表明，DM组斑块体积（和斑块体积百分比）显著增加。在IB-IVUS分析中，与正常葡萄糖调节组相比，DM组和IGR组的%LV显著增加（36±14%和37±13% vs. 29±14%，p=0.02），%FV显著降低（59±11%和58±11% vs. 64±11%，p=0.03）。富含脂质斑块率与三分位数中HOMA-IR的增加显著相关（p=0.008）。在调整混杂因素和冠状动脉危险因素后的逻辑回归分析中，DM组（比值比3.52，95%置信区间1.13至11.0，p=0.03）和IGR组（比值比3.92，95%置信区间1.13至13.6，p=0.03）与富含脂质斑块显著相关。
AGR患者的冠状动脉病变与更多富含脂质的斑块内容物有关，这可能与这些患者IR增加有关。
