脂质和炎症特征对非 ST 段抬高急性冠状动脉综合征患者富含脂质斑块形态变化的影响：光学相干断层成像术和血管内超声随访研究。
The effect of lipid and inflammatory profiles on the morphological changes of lipid-rich plaques in patients with non-ST-segment elevated acute coronary syndrome: follow-up study by optical coherence tomography and intravascular ultrasound.
机构信息
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
出版信息
JACC Cardiovasc Interv. 2010 Jul;3(7):766-72. doi: 10.1016/j.jcin.2010.05.001.
OBJECTIVES
The aim of this study was to determine the relationship between the morphological changes of nonculprit lipid-rich plaques and several clinical profiles in patients with non-ST-segment elevated acute coronary syndrome (NSTEACS).
BACKGROUND
Identification of coronary lesion with morphological characteristics of rupture-prone plaques is still difficult.
METHODS
Eighty-two consecutive patients with NSTEACS who underwent percutaneous coronary intervention were enrolled. The changes in total atheroma volume (TAV) of residual nonculprit lipid-rich plaques and the changes in the corresponding fibrous cap thickness (FCT) were assessed by intravascular ultrasound and optical coherence tomography, respectively, at baseline and after 9 months.
RESULTS
The percentage changes in TAV (mm(3)) of lipid-rich plaques and in the corresponding FCT (microm) over the 9-month follow-up period were 3.1 +/- 11% and 15 +/- 17%, respectively. There was no significant correlation between the changes in TAV and those in FCT. The change in TAV showed a significant correlation with reduction of the low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio (r = 0.42, p < 0.01). In contrast, the change in FCT showed no correlation with LDL/HDL ratio but had a significant positive correlation with changes in high-sensitivity C-reactive protein (r = 0.44, p < 0.01). Furthermore, in multivariate logistic analysis, statin use was an independent predictor of changes in well-stabilized plaques that showed both TAV reduction and FCT increase.
CONCLUSIONS
The changes in TAV and FCT of coronary plaques over a 9-month observation period were related to 2 different independent factors (i.e., reduction of LDL-cholesterol and high-sensitivity C-reactive protein, respectively). Furthermore, lipid-lowering therapy with statin has the potential to stabilize these parameters by both plaque reduction and FCT.
目的
本研究旨在探讨非 ST 段抬高型急性冠脉综合征（NSTEACS）患者非罪犯脂质丰富斑块的形态学变化与多种临床特征之间的关系。
背景
识别具有易破裂斑块形态特征的冠状动脉病变仍然具有挑战性。
方法
连续纳入 82 例接受经皮冠状动脉介入治疗的 NSTEACS 患者。分别采用血管内超声和光学相干断层扫描评估基线和 9 个月后残余非罪犯脂质丰富斑块的总动脉粥样斑块体积（TAV）变化和相应纤维帽厚度（FCT）变化。
结果
脂质丰富斑块的 TAV（mm3）和相应 FCT（μm）在 9 个月随访期间的百分比变化分别为 3.1±11%和 15±17%。TAV 的变化与 FCT 的变化之间无显著相关性。TAV 的变化与低密度脂蛋白/高密度脂蛋白（LDL/HDL）比值的降低呈显著相关性（r=0.42，p<0.01）。相反，FCT 的变化与 LDL/HDL 比值无相关性，但与高敏 C 反应蛋白（hsCRP）的变化呈显著正相关（r=0.44，p<0.01）。此外，多变量逻辑回归分析显示，他汀类药物的使用是斑块稳定变化的独立预测因子，表现为 TAV 降低和 FCT 增加。
结论
在 9 个月的观察期内，冠状动脉斑块的 TAV 和 FCT 变化与 2 个不同的独立因素相关（即 LDL 胆固醇的降低和 hsCRP 的升高）。此外，他汀类药物的降脂治疗有可能通过斑块减少和 FCT 增加来稳定这些参数。
Zotero 插件