【摘要】 目的　探讨冠状动脉重塑与冠心病临床表现的关系。方法　 40例急性冠状动脉综合征 (甲组 )和 32例稳定性冠心病 (乙组 )患者于介入治疗前行血管内超声 (IVUS)检查。测量冠状动脉病变处和近远端参考血管的外弹力膜横截面积 (EEMCSA)、管腔横截面积、斑块面积。计算冠状动脉重塑指数 (RI) =冠状动脉病变处EEMCSA /近远端参考血管处EEMCSA平均值。定义 :RI >1 0 5为正性重塑 ,RI<0 95为负性重塑 ,0 95 <RI <1 0 5为无重塑。结果　甲组以低回声软斑块多见(60 %和 31 % ) ,高回声硬斑块则在乙组中多见 (69%和 40 % ,P =0 0 1 5)。EEMCSA :甲组为 (1 5 37±2 88)mm2 、乙组为 (1 3 35± 2 87)mm2 ,P =0 0 0 4。斑块面积 :两组分别为 (1 0 94± 2 66)mm2 和 (9 30± 2 66)mm2 (P =0 0 1 1 ) ,两组的管腔横截面积和面积狭窄程度相似。RI:甲组大于乙组 (1 0 7± 0 1 5和 0 95± 0 1 3 ,P =0 0 0 1 ) ,正性重塑在前者更多见 (50 %和 2 5 % ) ,而负性重塑在后者较常见 (2 2 %和 53 % ) (P =0 0 2 1 )。结论　冠状动脉重塑与冠心病临床表现有关更多还原

【Abstract】 Objective To examine the relation between coronary arterial remodeling and clinical presentation of coronary heart disease Methods Forty patients with unstable (12 with recent myocardial infarction and 28 with unstable angina )and 32 with stable (12 with old myocardial infarction and 20 with stable angina)coronary syndrome underwent intravascular ultrasound (IVUS)before intervention Target lesions were classified as soft and hard plaques Quantitative measurements of cross sectional area(CSA)of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites Remodeling index( RI )was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites Positive remodeling was defined as RI >1 05, negative remodeling as RI <0 95 Results Soft plaques were observed more frequently in unstable than in stable coronary syndrome (60% vs 31%), whereas hard plaques were more common in stable coronary syndrome (69% vs 40%) ( P =0 015) The EEM CSA [(15 37±2 88) mm 2 vs (13 35±2 87) mm 2, P =0 004] and plaque CSA [(10 94±2 66) mm 2 vs (9 30±2 66) mm 2 , P =0 011] were significantly greater at target lesion in patients with unstable than in those with stable coronary syndrome, while lumen CSA and percent of area stenosis were similar in both groups RI was significantly higher (1 07±0 15 vs 0 95±0 13, P =0 001) and positive remodeling was more frequent in the patients with unstable coronary syndrome (50% vs 25%), whereas negative remodeling was more common in those with stable coronary syndrome (22% vs 53%, P =0 021) Conclusion This study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling更多还原