【摘要】 目的:探讨急性冠脉综合征(ACS)行经皮冠状动脉介入(PCI)患者颈动脉斑块超声组织特征、心肌甘油三酯含量、微血管功能障碍变化及其相互关系。方法:选取ACS行急诊PCI治疗的患者180例,均行降脂、抗凝、急诊PCI治疗。PCI术前1 d和术后7 d均进行颈动脉斑块超声组织特征和心肌甘油三酯含量检测,并在PCI术后7 d进行血管造影,了解微血管功能情况。PCI术后患者均随访至少1年,统计心血管事件发生率。分析患者颈动脉斑块超声组织特征、心肌甘油三酯含量与微血管功能情况的关系,以及三者与术后1年心血管事件发生情况的关系。结果:与PCI术前比较,患者术后7 d颈总动脉内膜中层厚度(IMT)、低回声区占斑块面积百分率和斑块厚度与外膜比值、心肌甘油三酯含量均降低(P<0.05);与心肌blush分级≥2级患者比较,心肌blush分级<2级患者的术后7 d IMT、低回声区占斑块面积百分率和斑块厚度与外膜比值、心肌甘油三酯含量均升高(P<0.05)。Spearman相关分析结果显示,急诊ACS行PCI患者术后7 d IMT、低回声区占斑块面积百分率和斑块厚度与外膜比值、心肌甘油三酯含量与其心肌blush分级均呈负相关(r值分别为-0.788,-0.845,-0.812,P<0.05)。随访1年,患者心血管事件发生率为16.25%(13/80),与无心血管事件发生患者比较,出现心血管事件患者围术期IMT、低回声区占斑块面积百分率和斑块厚度与外膜比值、心肌甘油三酯含量均升高,而同期心肌blush分级则降低(P<0.05)。Spearman相关分析结果显示,急诊ACS行PCI患者围术期IMT、低回声区占斑块面积百分率和斑块厚度与外膜比值、心肌甘油三酯含量、心肌blush分级与其术后1年心血管事件发生率均密切相关(P<0.05)。结论:急诊ACS行PCI治疗有利于改善颈动脉斑块超声组织特征和微血管功能,降低心肌甘油三酯含量,从而减少心血管事件的发生风险。更多还原

【Abstract】 Objective:To investigate the changes of carotid plaque ultrasound tissue characteristics,myocardial triglyceride content,microvascular dysfunction and their relationships in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI).Methods:All 80 patients who received emergency PCI treatment in our hospital were selected as the research subjects.All patients were treated with lipid-lowering,anticoagulation and emergency PCI.The 1 d before PCI and 7 d after PCI operation characteristics of carotid artery plaque ultrasound tissue and the content of triglyceride in the carotid artery were detected,and the 7 d after PCI operation microvascular function was determined by angiography.All patients were followed up for at least 1 years after PCI,and the cardiovascular events rate was statistically analyzed.The relationship between the characteristics of ultrasound tissue of carotid artery plaque,the content of triglyceride and the microvascular function were analyzed,and the relationship between the three above factors with the cardiovascular events rate of 1 years after the operation were analyzed.Results:Compared with those of before PCI operation,the 7 d after PCI operation carotid artery intima media thickness(IMT),the percentage of hypoechoic area,the ratio of plaque thickness to the outer membrane ratio,and the content of triglyceride in myocardium were lower(P<0.05).Compared with those of the patients with 7 d after PCI myocardial blush ≥grade 2,the 7 d after PCI operation IMT,the percentage of the plaque area in the hypoechoic area,the ratio of plaque thickness to the outer membrane,and the content of triglyceride in the myocardium of the patients with 7 d after PCI myocardial blush<grade 2 were all increased(P<0.05).The results of spearman correlation analysis showed that the 7 d after PCI operation IMT,hypoechoic area,plaque thickness and outer membrane ratio,myocardial triglyceride content in ACS patients treated with emergency PCI were negatively correlated with the myocardial blush classification(r=-0.788,-0.845,-0.812,P<0.05).After 1 years of follow-up,the cardiovascular events rate was 16.25%(13/80).Compared with those of the patients without cardiovascular events,the periopetative IMT,the percentage of the plaque area in the hypoechoic area,the thickness of plaque and the ratio of the outer membrane and the content of triglyceride in the myocardium of the patients with cardiovascular events were all increased,while in the same time myocardium blush grade of the patients with cardiovascular events decreased(P<0.05).The results of Spearman correlation analysis showed that,the periopetative IMT,the percentage of the plaque area in the hypoechoic area,the thickness of plaque and the ratio of the outer membrane and the content of triglyceride in the myocardium,myocardial blush classification were closely related to the 1 year cardiovascular events in ACS patients treated with emergency PCI(P<0.05).Conclusion:Emergency PCI treatment in ACS can improve the characteristics of ultrasound tissue and microvascular function of carotid artery plaque and reduce the content of triglyceride,so as to reduce the risk of cardiovascular events.更多还原