The Heart Center of Chonnam National University Hospital, Gwangju, Korea.
Am J Cardiol. 2010 Nov 1;106(9):1241-7. doi: 10.1016/j.amjcard.2010.06.046. Epub 2010 Sep 9.
It is not well known which lesions are progressed or regressed in patients with angina pectoris who use statins. We assessed the impact of plaque components on plaque progression in patients with angina pectoris who used rosuvastatin 10 mg/day using virtual histology plus intravascular ultrasound. Sixty-six patients who underwent baseline and 9-month follow-up virtual histology plus intravascular ultrasound for nonintervened intermediate coronary stenosis were grouped according to plaque progression (increase of plaque plus media area, n = 22) or plaque regression (decrease of plaque plus media area, n = 44) at baseline minimum lumen area (MLA) site at follow-up and compared the various parameters including baseline plaque components between the 2 groups. Follow-up low-density lipoprotein cholesterol was not significantly different between the progression and regression groups (85 ± 30 vs 82 ± 24 mg/dl, p = 0.6). Baseline percent necrotic core (NC) area was significantly larger (26.1 ± 10.9% vs 17.6 ± 10.8%, p = 0.004) and baseline percent fibrofatty area was significantly smaller (8.1 ± 6.2% vs 14.2 ± 12.1%, p = 0.008) at the MLA site in the progression group compared to the regression group. Thin-cap fibroatheroma was observed more frequently in the progression group compared to the regression group (32% vs 9%, p = 0.020). Change of plaque plus media area from baseline to follow-up at the MLA site correlated with baseline percent NC area (r = 0.375, p = 0.002), baseline percent fibrofatty area (r = -0.388, p = 0.001), and baseline percent fibrotic area (r = -0.242, p = 0.050). Baseline percent NC area at the MLA site was an independent predictor of plaque progression at follow-up (odds ratio 1.265, 95% confidence interval 1.069 to 1.497, p = 0.006). In conclusion, NC is associated with plaque progression in patients when low-density lipoprotein cholesterol level is around 80 mg/dl at 9-month follow-up in patients with angina pectoris on rosuvastatin 10 mg/day.
尚不清楚在使用瑞舒伐他汀的心绞痛患者中，哪些病变是进展的，哪些是消退的。我们使用虚拟组织学+血管内超声评估了在使用瑞舒伐他汀 10mg/天的心绞痛患者中，斑块成分对斑块进展的影响。66 例因非介入性中间冠状动脉狭窄行基线和 9 个月随访虚拟组织学+血管内超声的患者，根据基线最小管腔面积（MLA）处斑块进展（斑块+中膜面积增加，n=22）或斑块消退（斑块+中膜面积减少，n=44）进行分组，并比较了两组之间的各种参数，包括基线斑块成分。随访时低密度脂蛋白胆固醇在进展组和消退组之间无显著差异（85±30 vs 82±24mg/dl，p=0.6）。基线坏死核心（NC）面积在进展组明显较大（26.1±10.9% vs 17.6±10.8%，p=0.004），基线纤维脂肪面积明显较小（8.1±6.2% vs 14.2±12.1%，p=0.008）。与消退组相比，进展组 MLA 处更常观察到薄帽纤维粥样斑块（32% vs 9%，p=0.020）。MLA 处斑块+中膜面积从基线到随访的变化与基线 NC 面积（r=0.375，p=0.002）、基线纤维脂肪面积（r=-0.388，p=0.001）和基线纤维面积（r=-0.242，p=0.050）呈正相关。MLA 处基线 NC 面积是随访时斑块进展的独立预测因素（优势比 1.265，95%置信区间 1.069 至 1.497，p=0.006）。总之，在每天服用瑞舒伐他汀 10mg 的心绞痛患者中，当低密度脂蛋白胆固醇水平在 9 个月随访时约为 80mg/dl 时，NC 与斑块进展相关。
