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目的探讨冠心病患者冠状动脉斑块超声影像学特征及其与血浆内皮素(ET)、一氧化氮(NO)的关系。方法44例冠心病患者分为不稳定型和稳定型心绞痛组,比较两组患者靶血管内超声特征及血浆ET和NO水平,进行相关研究。结果不稳定型心绞痛组血管内超声检出脂质斑块23例(23/28,82.1%),其罪犯病变的血管外弹力膜面积(EEMA)、斑块面积(PA)及管腔面积狭窄率(LAS)、重构指数(RI)明显大于稳定型心绞痛组,差异有显著性意义(均P<0.05)。两组间在纤维帽厚度、脂核或无回声带大小、脂核与斑块比之间存在统计学差异。血浆ET1与EEMA、RI呈正相关,NO与EEMA、RI呈负相关。结论易损斑块为偏心分布的低回声脂质斑块,具有较大的斑块面积和明显的正性重构;血浆ET1、NO参与了粥样硬化的形成,ET1、NO可望作为冠脉斑块易损性预测的参考指标。
Objective To investigate the characteristics of coronary artery plaque and its relationship with plasma endothelin (ET) and nitric oxide (NO) in patients with coronary heart disease. Methods Forty - four patients with coronary heart disease were divided into unstable angina group and stable angina pectoris group. The target intravascular ultrasound characteristics and plasma ET and NO levels were compared between the two groups. Results In the group of unstable angina pectoris, 23 cases (23/28, 82.1%) of the lipid plaques were detected by intravascular ultrasound. The area of extravascular elastic membrane (EEMA), plaque area (PA) LAS and RI were significantly higher than those in patients with stable angina pectoris (all P <0.05). There was a statistical difference between the two groups in the thickness of the fibrous cap, the size of the lipid or anechoic band, and the ratio of the lipid core to the plaque. Plasma ET1 and EEMA, RI was positively correlated, NO and EEMA, RI was negatively correlated. Conclusions Vulnerable plaques are hypoechoic lipid plaques with large plaque area and significant positive remodeling. Plasma ET1 and NO are involved in the formation of atherosclerosis. ET1 and NO are expected to be used as coronal Reference Index for Prediction of Vascular Plaque Susceptibility.