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Received:July 07, 2020 Published Online:May 20, 2021
Received:July 07, 2020 Published Online:May 20, 2021
中文摘要: 目的 探讨光学相干断层成像技术(OCT)在冠状动脉钙化(CAC)病变介入诊疗中应用。方法 选择2017年1月至2019年1月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病,行冠状动脉造影和OCT的患者116例为研究对象,OCT提示CAC病变126处。回顾性调查患者一般资料、疾病史和药物服用情况,记录患者生化指标及OCT成像指标。结果 (1)根据有无钙化斑块分为非钙化组68例(74个斑块)和钙化组48例(52个斑块),钙化组小而密LDL-C、尿酸水平高于非钙化组(P<0.05,P<0.01)。(2)OCT斑块特征分析发现,钙化斑块微血管化(55.77% vs 32.43%)、胆固醇结晶(61.54% vs 33.78%)和薄纤维帽粥样斑块(TCFA)(46.15% vs 22.97%)发生率高于非钙化斑块(P<0.05,P<0.01)。(3)对52个钙化斑块特征的OCT分析结果显示,钙化弧度为(108.1±72.6)°,钙化深度(57.27±89.46)μm,钙化厚度(0.85±0.37)mm,钙化长度(5.67±5.32)mm,最大钙化面积(2.68±2.82)mm 2。(4)在所有患者中对30处(非钙化组19处,钙化组11处)靶血管行介入治疗,发现PCI术后钙化组获得的最小管腔面积［(5.69±1.72)mm 2 vs (7.12±1.43)mm 2］、最大管腔面积［(8.71±1.27)mm 2 vs (10.58±2.52)mm 2］均小于非钙化组;钙化组需要的支架长度［(34.80±12.70)mm vs (24.60±5.18)mm］长于非钙化组;钙化组支架贴壁不良发生率(81.82% vs 36.84%)高于非钙化组,差异有统计学意义(P<0.05,P<0.01)。结论 CAC斑块具有易损特征,对于CAC病变的介入治疗应该应用OCT指导优化,以改善患者的预后。
中文关键词: 光学相干断层成像 冠状动脉粥样硬化性心脏病 钙化病变 胆固醇结晶
Abstract:Objective To explore the application of optical coherence tomography(OCT) in interventional diagnosis and treatment of coronary artery calcification(CAC).Methods A total of 116 patients with coronary heart disease undergoing coronary angiography and OCT in the Department of Cardiology of Shanghai Ninth People′s Hospital from January 2017 to January 2019 were selected as the research subjects.General information,disease history and drug administration of the patients were reviewed.And the biochemical indexes and OCT imaging were recorded and analyzed.Results According to the presence or absence of calcified plaques delineated by OCT,the patients were divided into non-calcified group (n=68,with 74 plaques) and calcified group (n=48,with 52 plaques).The levels of dense and small LDL-C and uric acid in calcified group were significantly higher than those in non-calcified group (P<0.05 ,P<0.01 ).The incidences of calcified plaque microvascularization (55.77% vs 32.43%),cholesterol crystallization (61.54% vs 33.78%) and thin cap fibrous atheroma (TCFA) (46.15% vs 22.97%) in calcified plaques were statistically higher than those in non-calcified plaques(P<0.05 ,P<0.01 ).In 52 calcified plaques,OCT showed that the average calcium radian (CR) was (108.1±72.6)°,calcium plaque depth was (57.27 ± 89.46)μm,plaque thickness was (0.85±0.37)mm,plaque length was (5.67±5.32)mm,and maximum plaque area was (2.68±2.82)mm2.After interventional treatment for 30 target vessels,including 19 cases in non-calcified group and 11 cases in calcified group,minimum lumen area［(5.69±1.72)mm2 vs(7.12±1.43)mm2］ and maximum lumen area［(8.71±1.27)mm2 vs(10.58±2.52)mm2］ in calcified group were significantly smaller than those in non-calcified group；the length of stent ［(34.8±12.7) mm vs(24.60±5.18) mm］ in calcified lesions was longer than that in non-calcified group;the incidence of poor stent adherence (incomplete stent apposition) in calcified group was statistically higher than that in non-calcified group (81.82% vs 36.84%,P<0.05 ,P<0.01 ).Conclusion CAC plaque has the characteristics of vulnerability.For the interventional treatment of calcified lesions,OCT should be used to guide the operation and optimization of procedure,so as to improve the long-term prognosis of patients.
keywords: Optical coherence tomography Coronary atherosclerotic heart disease Calcification lesion Cholesterol crystal
文章编号： 中图分类号：R541.4 文献标志码：A
基金项目:上海市科技委科研计划项目(184011950500)
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