[糖尿病患者冠状动脉粥样硬化斑块的虚拟组织学血管内超声评估]

[Virtual histology intravascular ultrasound assessment of coronary atherosclerotic plaques in diabetic patients].

作者信息

Liu Yuan, Liu Xue-bo, Qian Ju-ying, Li Chen-guang, Dai Yu-xiang, Huang Zhe-yong, Ge Jun-ba

机构信息

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Jun;38(6):497-502.

PMID:21033129

Abstract

OBJECTIVE

To evaluate the components and characteristics of coronary atherosclerotic plaques in type 2 diabetic patients using virtual histology intravascular ultrasound (VH-IVUS).

METHODS

In vivo atherosclerotic plaques (over 50% angiographic diameter stenosis) of the three main coronary arteries were analyzed by gray-scaled IVUS with planar and volumetric VH-IVUS in consecutive patients examined between September 2008 and March 2009. Patients were divided into two groups: diabetic mellitus (DM) group with 22 patients (39 lesions) and non-DM group with 46 patients (69 lesions).

RESULTS

At the minimal lumen area (MLA) site, the percentage of NC (necrotic core) area (19.4% +/- 1.2% vs. 15.1% +/- 1.1%, P = 0.015) and dense calcium (DC) area (15.2% +/- 1.6% vs. 10.7% +/- 1.1%, P = 0.016) were significantly larger while fibrotic tissue (FT) area (56.7% +/- 2.3% vs. 64.8% +/- 1.8%, P = 0.007) was smaller in DM group than in non-DM group. Likewise, volumetric VH-IVUS analysis showed that the percentage of NC volume (21.3% +/- 1.3% vs. 16.5% +/- 1.1%, P = 0.008) and DC volume (16.6% +/- 1.4% vs. 11.3% +/- 1.1%, P = 0.003) were significantly larger while FT volume (55.1% +/- 2.1% vs. 63.9% +/- 1.8%, P = 0.003) was significantly smaller in DM group than in non-DM group. Moreover, significantly higher incidence of VH-TCFA (thin-cap fibro atheromas) was evidenced in the DM group than in the non-DM group (69.2% vs. 42.0%, P = 0.009). However, the remodeling index and the positive remodeling frequency were similar between the 2 groups.

CONCLUSION

Incidence of necrotic core, dense calcium plaque and vulnerable plaques in stenotic lesions was higher in DM patients than in non-DM patients.

摘要

目的

使用虚拟组织学血管内超声（VH-IVUS）评估2型糖尿病患者冠状动脉粥样硬化斑块的成分和特征。

方法

对2008年9月至2009年3月间连续检查的患者，通过灰阶血管内超声以及平面和容积VH-IVUS分析三条主要冠状动脉的体内动脉粥样硬化斑块（血管造影直径狭窄超过50%）。患者分为两组：糖尿病（DM）组22例患者（39处病变）和非DM组46例患者（69处病变）。

结果

在最小管腔面积（MLA）部位，DM组的坏死核心（NC）面积百分比（19.4%±1.2%对15.1%±1.1%，P = 0.015）和致密钙（DC）面积百分比（15.2%±1.6%对10.7%±1.1%，P = 0.016）显著更大，而纤维化组织（FT）面积（56.7%±2.3%对64.8%±1.8%，P = 0.007）更小。同样，容积VH-IVUS分析显示，DM组的NC体积百分比（21.3%±1.3%对16.5%±1.1%，P = 0.008）和DC体积百分比（16.6%±1.4%对11.3%±1.1%，P = 0.003）显著更大，而FT体积（55.1%±2.1%对63.9%±1.8%，P = 0.003）显著更小。此外，DM组薄帽纤维粥样斑块（VH-TCFA）的发生率显著高于非DM组（69.2%对42.0%，P = 0.009）。然而，两组之间的重构指数和正性重构频率相似。