通过光学相干断层扫描评估发现，亚临床甲状腺功能减退与冠状动脉疾病患者富含脂质的斑块有关。
Subclinical hypothyroidism is associated with lipid-rich plaques in patients with coronary artery disease as assessed by optical coherence tomography.
作者信息
Cai Xiao-Qing, Tian Feng, Han Tian-Wen, Shan Dong-Kai, Liu Yang, Yin Wei-Jun, Jing Jing, Xu Qiang, Chen Yun-Dai
机构信息
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Department of Cardiology, Chinese PLA Lanzhou General Hospital, Lanzhou, China.
出版信息
J Geriatr Cardiol. 2018 Aug;15(8):534-539. doi: 10.11909/j.issn.1671-5411.2018.08.007.
BACKGROUND
Subclinical hypothyroidism (SCH) has recently been acknowledged as an unconventional risk factor for coronary artery disease (CAD) and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH.
METHODS
Patients with coronary artery disease were enrolled in the study and divided into an SCH group (patients, = 26; plaques, = 35) and a non-SCH group (patients, = 52; plaques, = 66). They were divided 1: 2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography (OCT) imaging was performed on all patients, and images were analyzed by two independent investigators. Lipid-rich plaques (LRP), the precursor of vulnerable plaques, were defined as having more than one quadrant occupied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The presence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted.
RESULTS
The ratio of LRP in SCH group was significantly higher than that in non-SCH group (54% 30.3%, = 0.037). That was the case as well for the maximum lipid arcs value (181.5° ± 61.6° 142.1° ± 35.9°, = 0.046). While thin-cap fibroatheroma (TCFA) was detected, no difference was identified between the two groups in either TCFA ratio (20% 16.7%, = 0.579) or fibrous cap thickness (57.5 ± 14.0 63.5 ± 10.7 µm, = 0.319). Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar.
CONCLUSION
Higher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.
背景
亚临床甲状腺功能减退（SCH）最近被认为是冠状动脉疾病（CAD）的一种非传统危险因素，其预后较差，这可能与动脉粥样硬化斑块特征有关。我们开展本研究以观察合并SCH的CAD患者的冠状动脉斑块特征。
方法
将CAD患者纳入研究并分为SCH组（患者26例；斑块35个）和非SCH组（患者52例；斑块66个）。根据倾向匹配分析（包括年龄、糖尿病、性别、CAD严重程度和罪犯血管）按1:2进行分组。对所有患者进行光学相干断层扫描（OCT）成像，并由两名独立研究人员分析图像。富含脂质斑块（LRP），即易损斑块的前体，定义为脂质池占据一个以上象限。同时记录最大脂质弧。还识别出纤维斑块和钙化斑块。记录冠状动脉夹层、斑块侵蚀、血栓、巨噬细胞、钙化结节、薄帽纤维粥样瘤和微通道的存在情况。
结果
SCH组LRP比例显著高于非SCH组（54%对30.3%，P = 0.037）。最大脂质弧值情况也是如此（181.5°±61.6°对142.1°±35.9°，P = 0.046）。虽然检测到薄帽纤维粥样瘤（TCFA），但两组在TCFA比例（20%对16.7%，P = 0.579）或纤维帽厚度（57.5±14.0对63.5±10.7μm，P = 0.319）方面均未发现差异。其他OCT特征，如夹层、斑块侵蚀、血栓、巨噬细胞阴影和钙化结节也相似。
结论
SCH患者中较高比例的LRP和更大的脂质弧可能与合并SCH的CAD患者的斑块不稳定性和不良预后有关。
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