稳定型冠心病合并H型高血压患者血管内超声虚拟组织学冠脉斑块特征分析
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摘要
目的:研究稳定型冠心病合并H型高血压患者血管内超声虚拟组织学冠脉斑块特征。方法 52例稳定型冠心病且合并高血压患者,依据血浆同型半胱氨酸(Hcy)水平分为合并H型高血压组、合并非H型高血压组。所有患者行冠脉造影检查确诊,计算3支血管病变比例及Gensini评分;对冠脉靶病变进行血管内超声检查及虚拟组织学分析,研究两组血管重构及斑块病变特征。结果与合并非H型高血压组比较,合并H型高血压组冠脉3支血管病变比例增高(57.14%vs 41.67%)、Gensini评分增高(30.82±7.18 vs 26.35±4.27),差异有统计学意义(P<0.05);合并H型高血压组血管重构指数、正性重构比例、斑块脂质坏死组织面积、纤维脂质组织面积较合并非H型高血压组升高(P<0.05),斑块钙化组织面积、纤维组织面积两组比较差异无统计学意义(P>0.05)。相关分析显示血浆Hcy水平与3支血管病变比例、Gensini评分、血管重构指数、正性重构比例、脂质坏死组织面积、纤维脂质组织面积存在正相关关系。结论稳定型冠心病合并H型高血压患者,其高血浆Hcy水平不但影响冠脉病变的范围和严重程度,还可能进一步加重血管重塑及斑块组分的差异,造成斑块不稳定趋势。
Objective To study the coronary plaque features in patients with stable coronary heart disease and H-type hypertention by intravascular ultrasound(IVUS). Methods Fifty-two patients with stable coronary heart disease combined hypertension were divided into two groups based on plasma homocysteine(Hcy) level,including H-hypertension group and the non-H-type hypertension group. The clinical data of gender,age,body mass index,blood pressure and blood lipids were compared between the two groups. All patients underwent coronary angiography to calculate the proportion of three-vessel disease and Gensini score. The coronary plaque features were evaluated by IVUS and virtual histology. Results Compared with non-H-type hypertension group,there were more three-vessel diseases(57.14% vs 41.67%) and Gensini score(30.82±7.18 vs 26.35±4.27) in H-type hypertension group(P<0.05). Meantime,the vascular remodeling index,positive remodeling ratio,plaque lipid necrotic and fibrotic lipid tissue area,but not plaque calcification tissue area and fibrous tissue area,were significantly increased in the H-type hypertension group. There was a positive correlation between plasma Hcy and these indexes including three-vessel disease ratio,Gensini score,vascular remodeling index,positive remodeling ratio,lipid necrotic tissue area and fibrotic lipid tissue area by correlation analysis. Conclusion High-level of plasma Hcy in patients with stable coronary heart disease and H-type hypertension not only affect the extent and severity of coronary artery disease,but also may aggravate the differences in vascular remodeling and plaque components,resulting in plaque instability.
Objective To study the coronary plaque features in patients with stable coronary heart disease and H-type hypertention by intravascular ultrasound(IVUS). Methods Fifty-two patients with stable coronary heart disease combined hypertension were divided into two groups based on plasma homocysteine(Hcy) level,including H-hypertension group and the non-H-type hypertension group. The clinical data of gender,age,body mass index,blood pressure and blood lipids were compared between the two groups. All patients underwent coronary angiography to calculate the proportion of three-vessel disease and Gensini score. The coronary plaque features were evaluated by IVUS and virtual histology. Results Compared with non-H-type hypertension group,there were more three-vessel diseases(57.14% vs 41.67%) and Gensini score(30.82±7.18 vs 26.35±4.27) in H-type hypertension group(P<0.05). Meantime,the vascular remodeling index,positive remodeling ratio,plaque lipid necrotic and fibrotic lipid tissue area,but not plaque calcification tissue area and fibrous tissue area,were significantly increased in the H-type hypertension group. There was a positive correlation between plasma Hcy and these indexes including three-vessel disease ratio,Gensini score,vascular remodeling index,positive remodeling ratio,lipid necrotic tissue area and fibrotic lipid tissue area by correlation analysis. Conclusion High-level of plasma Hcy in patients with stable coronary heart disease and H-type hypertension not only affect the extent and severity of coronary artery disease,but also may aggravate the differences in vascular remodeling and plaque components,resulting in plaque instability.
引文
[1] 李建平,卢新政,霍勇,等.H型高血压诊断与治疗专家共识[J].中华高血压杂志,2016,8(3):243-248.
[2] 韦怡春,黄朝发,李菊香.同型半胱氨酸与心房颤动的研究进展[J].中华心血管病杂志,2017,45(6):550-552.
[3] 朱桂平,林忠伟,韩彬,等.稳定型冠心病合并高同型半胱氨酸血症患者冠脉病变特点分析[J].中国心血管病研究,2015,13(5):443-445.
[4] 血管内超声在冠状动脉疾病中应用的中国专家共识专家组.血管内超声在冠状动脉疾病中应用的中国专家共识[J].中华心血管病杂志,2018,46(5):344-351.
[5] WANG Xiaobin,QIN Xianhui,DEMIRTAS H,et al.Efficacy of folic acid supplementation in stroke prevention:a meta-analysis[J].Lancet,2007,369(9576):1876-1882.
[6] 裴娟慧,李茂荣,甘丰.血清同型半胱氨酸水平与冠心病严重程度的相关性研究[J].中华心脏与心率电子杂志,2017,5(2):98-100.
[7] 鄢高亮,王栋,乔勇,等.高同型半胱氨酸水平对冠心病严重程度及支架置入治疗预后的影响[J].中华心血管病杂志,2015,43(11):943-947.
[8] 于淼,赵红丽,李潞.老年女性冠心病患者血清同型半胱氨酸水平的分析[J].中国实用医药,2013,8(11):8-10.
[9] 王杰,韦永强.老年冠心病患者血浆同型半胱氨酸水平的临床分析[J].临床荟萃,2011,26(9):797-798.
[10] 王勇,李其华,陶林.血清同型半胱氨酸水平与冠心病的关系[J].广西医科大学学报,2013,30(3):440-441.
[11] 廉瑞,杨闯,侯秀伟.同型半胱氨酸与冠心病关系及相关机制的研究进展实用[J].心脑肺血管病杂志,2018,26(4):5-8.
[12] 门满库,高延,侯云飞,等.H型高血压与急性冠脉综合征及同型半胱氨酸水平的相关性研究[J].临床医学研究与实践,2017,2(24):13-14.
[13] 杨莉莉,赵宇,邵海峰,等.H型高血压与急性冠脉综合征发病相关性及同型半胱氨酸水平研究[J].中国全科医学,2013,16(28):2609-2611.
[14] 郑卫峰,王晓阳,张守彦.冠心病患者血管内超声下斑块性质与H型高血压的关系[J].临床心血管病杂志,2014,30(10):847-849.
[15] CALVERT P A,BENNETT M R.Radiofrequency intravascular ultrasound and detection of the vulnerable plaque[J].Br Hosp Med (Lond),2012,73(12):682-686.
[16] 张宜春,徐岩,辜和平.脂蛋白(a)水平与VH-IVUS评价冠脉粥样硬化斑块成分的关联性分析[J].吉林大学学报,2016,42(1):115-119.
[17] CONTI C R.Finding the vulnerable plaque[J].Clin Cardiol,2010,33(6):320-321.
[18] 徐冉,吕健,李大鹏.急性冠状动脉综合征患者血清hs-CPR、Hcy、LP-PLA2与血管内超声虚拟组织学斑块特征的相关性研究[J].陕西医学杂志,2017,46(10):1410-1411.
[19] HUO Yong,LI Jianping,QIN Xianhui,et al.Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in china:the CSPPT randomized clinical trial[J].JAMA,2015,313(13):1325-1335.
[2] 韦怡春,黄朝发,李菊香.同型半胱氨酸与心房颤动的研究进展[J].中华心血管病杂志,2017,45(6):550-552.
[3] 朱桂平,林忠伟,韩彬,等.稳定型冠心病合并高同型半胱氨酸血症患者冠脉病变特点分析[J].中国心血管病研究,2015,13(5):443-445.
[4] 血管内超声在冠状动脉疾病中应用的中国专家共识专家组.血管内超声在冠状动脉疾病中应用的中国专家共识[J].中华心血管病杂志,2018,46(5):344-351.
[5] WANG Xiaobin,QIN Xianhui,DEMIRTAS H,et al.Efficacy of folic acid supplementation in stroke prevention:a meta-analysis[J].Lancet,2007,369(9576):1876-1882.
[6] 裴娟慧,李茂荣,甘丰.血清同型半胱氨酸水平与冠心病严重程度的相关性研究[J].中华心脏与心率电子杂志,2017,5(2):98-100.
[7] 鄢高亮,王栋,乔勇,等.高同型半胱氨酸水平对冠心病严重程度及支架置入治疗预后的影响[J].中华心血管病杂志,2015,43(11):943-947.
[8] 于淼,赵红丽,李潞.老年女性冠心病患者血清同型半胱氨酸水平的分析[J].中国实用医药,2013,8(11):8-10.
[9] 王杰,韦永强.老年冠心病患者血浆同型半胱氨酸水平的临床分析[J].临床荟萃,2011,26(9):797-798.
[10] 王勇,李其华,陶林.血清同型半胱氨酸水平与冠心病的关系[J].广西医科大学学报,2013,30(3):440-441.
[11] 廉瑞,杨闯,侯秀伟.同型半胱氨酸与冠心病关系及相关机制的研究进展实用[J].心脑肺血管病杂志,2018,26(4):5-8.
[12] 门满库,高延,侯云飞,等.H型高血压与急性冠脉综合征及同型半胱氨酸水平的相关性研究[J].临床医学研究与实践,2017,2(24):13-14.
[13] 杨莉莉,赵宇,邵海峰,等.H型高血压与急性冠脉综合征发病相关性及同型半胱氨酸水平研究[J].中国全科医学,2013,16(28):2609-2611.
[14] 郑卫峰,王晓阳,张守彦.冠心病患者血管内超声下斑块性质与H型高血压的关系[J].临床心血管病杂志,2014,30(10):847-849.
[15] CALVERT P A,BENNETT M R.Radiofrequency intravascular ultrasound and detection of the vulnerable plaque[J].Br Hosp Med (Lond),2012,73(12):682-686.
[16] 张宜春,徐岩,辜和平.脂蛋白(a)水平与VH-IVUS评价冠脉粥样硬化斑块成分的关联性分析[J].吉林大学学报,2016,42(1):115-119.
[17] CONTI C R.Finding the vulnerable plaque[J].Clin Cardiol,2010,33(6):320-321.
[18] 徐冉,吕健,李大鹏.急性冠状动脉综合征患者血清hs-CPR、Hcy、LP-PLA2与血管内超声虚拟组织学斑块特征的相关性研究[J].陕西医学杂志,2017,46(10):1410-1411.
[19] HUO Yong,LI Jianping,QIN Xianhui,et al.Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in china:the CSPPT randomized clinical trial[J].JAMA,2015,313(13):1325-1335.