【摘要】 目的:比较血清肌钙蛋白I(cTnI)升高与否的急性冠状动脉综合征(ACS)患者的冠状动脉病变特点。方法:在行冠状动脉介入治疗前用血管内超声检测62例ACS患者的75处病变。根据血清cTnI是否升高将患者分为两组:cTnI升高组34例(cTnI>0.15ng/ml)和cTnI正常组28例(cTnI≤0.15ng/ml)。分析病变处与近端和远端参考段,包括血管外弹力膜面积、管腔面积及斑块负荷,并计算斑块面积和重塑指数,继之确定重塑方向(正、负、无重塑);此外对每组的软硬斑块进行识别和比较。结果:cTnI升高组重塑指数大于cTnI正常组(1.01±0.25对0.83±0.11,P<0.01),正重塑常见于cTnI升高组(46.5%对6.3%,P<0.001),负重塑常见于cTnI正常组(81.3%对39.5%,P<0.05)。cTnI升高组患者的病变斑块面积比cTnI正常组大[(11.9±5.2)mm2对(9.1±3.4)mm2,P<0.05];前者远端参考段斑块面积也比后者大[(5.5±3.4)mm2对(3.8±1.8)mm2,P<0.05]。cTnI升高组患者与cTnI正常组相比有增高的血栓形成率(P<0.05)。结论:cTnI升高的ACS患者存在较多血栓和正重塑,有较大的病变处斑块面积和远端参考段斑块面积。他们的冠状动脉病变较cTnI正常的患者严重、复杂。更多还原

【Abstract】 Objective:To investigate whether patients with acute coronary syndromes(ACS) and elevated troponin I(cTn I) have different qualitative and quantitative coronary plaque characteristics compared to those with ACS and without elevated cTnI by intravas-cular ultrasound (IVUS ). Methods: We studied 75 lesions of 62 patients with ACS using IVUS before coronary intervention. These patients were divided into two groups based on cTnI levels:elevated cTnI group (cTn I >0. 15 ng/ml,n =34) and normal cTnl group(cTn I>0. 15 ng/ml,n =28). The lesion site and a proximal or distal reference site were analyzed for external elastic membrane (EEM) area and Lumen area, calculating plaque area and remodeling ratio. The direction of arterial remodeling was determined. The soft and hard plaques were analysed and compared in each group. Results:The remodeling ratio (1.01±0.25 versus 0. 83±0. 11 ,p < 0. 01 ) , the plaque area ( 11.9±5.2 versus 9. 1±3.4 mm2,p<0.05) and the distal reference site plaque area(5.5±3.4 versus 3. 8±1. 8 mm2,p < 0. 05) were significantly greater in patients of elevated cTnI group than in patients of normal cTnI group . The remodeling distribution between two groups was different. Positive remodeling was more frequent in elevated cTn I group than in normal eTn I group (46. 5% versus 6.3%, p <0. 001 ) , whereas negative remodeling was more frequent in normal cTnI group(81. 3% versus 39. 5% ,p <0. 05). Thrombosis was more frequently developed in the elevated cTnI group (p <0. 05). Conclusions: Patients with ACS and positive admission troponin I developed much more thrombuses, and had a higher remodeling ratio,larger lesion site and distal reference segment plaque areas. These findings suggest more complex lesions and severer coronary disease in patients with ACS and elevated cTnI.更多还原