光学相干断层成像下青年女性急性冠状动脉综合征患者的斑块特征分析
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摘要
目的:通过使用光学相干断层成像(OCT)分析青年女性急性冠状动脉综合征(ACS)患者冠状动脉斑块特征。方法:纳入北京安贞医院2014年12月至2018年1月,因ACS入院行OCT且年龄≤40岁的29例青年女性患者,通过冠状动脉造影及OCT对患者冠状动脉的狭窄程度及斑块特征进行分析,探讨青年女性患者的冠状动脉斑块特点。结果:29例青年女性患者的造影中,25例(86. 2%)累及LAD,其中18例(86. 2%)为单支病变。对29例青年女性患者的29处靶血管进行OCT检查,结果显示:26例(89. 7%)病变为TCFA病变,15例(51. 7%)病变观察到巨噬细胞聚集,6例(20. 7%)观察到微通道,9例(31. 0%)病变处合并斑块侵蚀,1例(3. 4%)合并斑块破裂。结论:青年女性ACS患者多同时合并多种危险因素,且其斑块易损性高,其发生冠状动脉事件的病理学基础可能为斑块侵蚀而非斑块破裂。
Objective: To analyse the characteristics of atherosclerotic plaque in young women with acute coronary syndrome( ACS) by optical coherence tomography( OCT). Methods: We evaluated the atherosclerotic plaque characteristics by OCT and coronary angiography in female ACS patients aged ≤40 years in Beijing Anzhen Hospital from December 2014 to January 2018. Results: Among the 29 young women,25( 86. 2%) patients had lesions in LAD,and 18( 86. 2%) patients had single-vessel lesions. OCT was performed on 29 target vessels of 29 young female patients. The result of OCT showed that 26( 89. 7%) OCT target vascular lesions were TCFA lesions,15( 51. 7%) lesions were observed macrophage aggregation,and 6 cases were observed.( 20. 7%) microchannels were observed,9( 31. 0%) lesions with plaque erosion,and 1( 3. 4%) with plaque rupture. Conclusions: Young women with ACS have multiple risk factors at the same time,and their plaques are highly vulnerable. The pathological basis of coronary events may be plaque erosion rather than plaque rupture.
Objective: To analyse the characteristics of atherosclerotic plaque in young women with acute coronary syndrome( ACS) by optical coherence tomography( OCT). Methods: We evaluated the atherosclerotic plaque characteristics by OCT and coronary angiography in female ACS patients aged ≤40 years in Beijing Anzhen Hospital from December 2014 to January 2018. Results: Among the 29 young women,25( 86. 2%) patients had lesions in LAD,and 18( 86. 2%) patients had single-vessel lesions. OCT was performed on 29 target vessels of 29 young female patients. The result of OCT showed that 26( 89. 7%) OCT target vascular lesions were TCFA lesions,15( 51. 7%) lesions were observed macrophage aggregation,and 6 cases were observed.( 20. 7%) microchannels were observed,9( 31. 0%) lesions with plaque erosion,and 1( 3. 4%) with plaque rupture. Conclusions: Young women with ACS have multiple risk factors at the same time,and their plaques are highly vulnerable. The pathological basis of coronary events may be plaque erosion rather than plaque rupture.
引文
[1]Mozaffarian D,Benjamin EJ,Go AS,et al.Heart disease and stroke statistics-2016 update:a report from the american heart association.Circulation,2016,133:e38-360.
[2]王淼,王薇,赵冬,等.北京地区青年人群心血管病危险因素10年变化趋势.心肺血管病杂志,2005,24:65-67.
[3]Vaccarino V,Parsons L,Every NR,et al.Sex-based differences in early mortality after myocardial infarction.National registry of myocardial infarction 2 participants.N Engl J Med,1999,341:217-225.
[4]Ortolani P,Solinas E,Guastaroba P,et al.Relevance of gender in patients with acute myocardial infarction undergoing coronary interventions.J Cardiovasc Med(Hagerstown),2013,14:421-429.
[5]Jang IK,Tearney GJ,Mac Neill B,et al.In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography.Circulation,2005,111:1551-1555.
[6]Yabushita H,Bouma BE,Houser SL,et al.Characterization of human atherosclerosis by optical coherence tomography.Circulation,2002,106:1640-1645.
[7]Barrett-Connor E,Wingard DL.Sex differential in ischemic heart disease mortality in diabetics:a prospective population-based study.Am J Epidemiol,1983,118:489-496.
[8]张海华,党爱民,高立健,等.青年女性冠心病患者冠状动脉病变特点及治疗分析.中国临床药理学杂志,2014:946-948.
[9]Incalcaterra E,Caruso M,Lo Presti R,et al.Myocardial infarction in young adults:risk factors,clinical characteristics and prognosis according to our experience.Clin Ter,2013,164:e77-82.
[10]Burke AP,Farb A,Malcom GT,et al.Coronary risk factors and plaque morphology in men with coronary disease who died suddenly.N Engl J Med,1997,336:1276-1282.
[11]肖羚.青年人急性心肌梗死的临床和冠状动脉造影特点分析.中国动脉硬化杂志,2006,14:709-711.
[12]Dey S,Flather MD,Devlin G,et al.Sex-related differences in the presentation,treatment and outcomes among patients with acute coronary syndromes:the global registry of acute coronary events.Heart,2009,95:20-26.
[13]Gurevitz O,Jonas M,Boyko V,et al.Clinical profile and longterm prognosis of women [14]Kramer MC,Rittersma SZ,de Winter RJ,et al.Relationship of thrombus healing to underlying plaque morphology in sudden coronary death.J Am Coll Cardiol,2010,55:122-132.
[15]Missel E,Mintz GS,Carlier SG,et al.In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men:results from the prospective,multi-centre virtual histology intravascular ultrasound registry.Eur Heart J,2008,29:2141-2147.
[16]Finn AV,Nakano M,Narula J,et al.Concept of vulnerable/unstable plaque.Arterioscler Thromb Vasc Biol,2010,30:1282-1292.
[17]Libby P,Okamoto Y,Rocha VZ,et al.Inflammation in atherosclerosis:transition from theory to practice.Circ J,2010,74:213-220.
[18]Napoli C,Crudele V,Soricelli A,et al.Primary prevention of atherosclerosis:a clinical challenge for the reversal of epigenetic mechanisms?Circulation,2012,125:2363-2373.
[19]Ambrose JA,Srikanth S.Vulnerable plaques and patients:improving prediction of future coronary events.Am J Med,2010,123:10-16.
[20]Kume T,Akasaka T,Kawamoto T,et al.Assessment of coronary arterial thrombus by optical coherence tomography.Am J Cardiol,2006,97:1713-1717.
[21]Nighoghossian N,Derex L,Douek P.The vulnerable carotid artery plaque:current imaging methods and new perspectives.Stroke,2005,36:2764-2772.
[22]Uemura S.Invasive imaging of vulnerable atherosclerotic plaques in coronary artery disease.Circ J,2013,77:869-875.
[23]Farb A,Burke AP,Tang AL,et al.Coronary plaque erosion without rupture into a lipid core.A frequent cause of coronary thrombosis in sudden coronary death.Circulation,1996,93:1354-1363.
[24]Kubo T,Imanishi T,Takarada S,et al.Assessment of culprit lesion morphology in acute myocardial infarction:ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy.J Am Coll Cardiol,2007,50:933-939.
[25]Burke AP,Farb A,Malcom GT,et al.Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women.Circulation,1998,97:2110-2116.
[2]王淼,王薇,赵冬,等.北京地区青年人群心血管病危险因素10年变化趋势.心肺血管病杂志,2005,24:65-67.
[3]Vaccarino V,Parsons L,Every NR,et al.Sex-based differences in early mortality after myocardial infarction.National registry of myocardial infarction 2 participants.N Engl J Med,1999,341:217-225.
[4]Ortolani P,Solinas E,Guastaroba P,et al.Relevance of gender in patients with acute myocardial infarction undergoing coronary interventions.J Cardiovasc Med(Hagerstown),2013,14:421-429.
[5]Jang IK,Tearney GJ,Mac Neill B,et al.In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography.Circulation,2005,111:1551-1555.
[6]Yabushita H,Bouma BE,Houser SL,et al.Characterization of human atherosclerosis by optical coherence tomography.Circulation,2002,106:1640-1645.
[7]Barrett-Connor E,Wingard DL.Sex differential in ischemic heart disease mortality in diabetics:a prospective population-based study.Am J Epidemiol,1983,118:489-496.
[8]张海华,党爱民,高立健,等.青年女性冠心病患者冠状动脉病变特点及治疗分析.中国临床药理学杂志,2014:946-948.
[9]Incalcaterra E,Caruso M,Lo Presti R,et al.Myocardial infarction in young adults:risk factors,clinical characteristics and prognosis according to our experience.Clin Ter,2013,164:e77-82.
[10]Burke AP,Farb A,Malcom GT,et al.Coronary risk factors and plaque morphology in men with coronary disease who died suddenly.N Engl J Med,1997,336:1276-1282.
[11]肖羚.青年人急性心肌梗死的临床和冠状动脉造影特点分析.中国动脉硬化杂志,2006,14:709-711.
[12]Dey S,Flather MD,Devlin G,et al.Sex-related differences in the presentation,treatment and outcomes among patients with acute coronary syndromes:the global registry of acute coronary events.Heart,2009,95:20-26.
[13]Gurevitz O,Jonas M,Boyko V,et al.Clinical profile and longterm prognosis of women
[15]Missel E,Mintz GS,Carlier SG,et al.In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men:results from the prospective,multi-centre virtual histology intravascular ultrasound registry.Eur Heart J,2008,29:2141-2147.
[16]Finn AV,Nakano M,Narula J,et al.Concept of vulnerable/unstable plaque.Arterioscler Thromb Vasc Biol,2010,30:1282-1292.
[17]Libby P,Okamoto Y,Rocha VZ,et al.Inflammation in atherosclerosis:transition from theory to practice.Circ J,2010,74:213-220.
[18]Napoli C,Crudele V,Soricelli A,et al.Primary prevention of atherosclerosis:a clinical challenge for the reversal of epigenetic mechanisms?Circulation,2012,125:2363-2373.
[19]Ambrose JA,Srikanth S.Vulnerable plaques and patients:improving prediction of future coronary events.Am J Med,2010,123:10-16.
[20]Kume T,Akasaka T,Kawamoto T,et al.Assessment of coronary arterial thrombus by optical coherence tomography.Am J Cardiol,2006,97:1713-1717.
[21]Nighoghossian N,Derex L,Douek P.The vulnerable carotid artery plaque:current imaging methods and new perspectives.Stroke,2005,36:2764-2772.
[22]Uemura S.Invasive imaging of vulnerable atherosclerotic plaques in coronary artery disease.Circ J,2013,77:869-875.
[23]Farb A,Burke AP,Tang AL,et al.Coronary plaque erosion without rupture into a lipid core.A frequent cause of coronary thrombosis in sudden coronary death.Circulation,1996,93:1354-1363.
[24]Kubo T,Imanishi T,Takarada S,et al.Assessment of culprit lesion morphology in acute myocardial infarction:ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy.J Am Coll Cardiol,2007,50:933-939.
[25]Burke AP,Farb A,Malcom GT,et al.Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women.Circulation,1998,97:2110-2116.
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