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目的:应用血管内超声(IVUS)分析分支闭塞的预测因素。方法:行冠状动脉介入治疗(PCI)的分叉病变52处,定量分析分叉近端(分支入口平面)和分叉远端(分叉嵴平面)斑块面积、斑块负荷、偏心指数、斑块分布弧度。采用逐步回归法分析PCI术后分支斑块负荷的相关因素。对术前分支斑块负荷>50%(n=15)和<50%(n=37)这2种情况进行术后结果比较。结果:定量分析分叉近端和远端斑块负荷差异无统计学意义[(52.80±13.21)%∶(52.81±12.20)%,P>0.05],分叉近端斑块偏心指数明显低于分叉远端[(1.86±0.64)∶(9.52±2.78,P<0.01],分叉近端斑块弧度明显大于分叉远端[(357.15±12.02)°∶(233.33±45.91)°,P<0.01]。分叉远端斑块与分支的角度为(143.2±33.60)°。逐步回归分析显示,术后分支斑块负荷与术前分支斑块负荷、分叉近端斑块负荷正相关,与分叉角度、分支/主支直径负相关。术后分支斑块负荷在术前分支斑块负荷>50%者明显大于<50%者[(89.20±5.66)%∶(42.60±18.12)%,P<0.01]。结论:血管分叉改变了斑块的分布模式,分叉近端斑块向心性分布,而分叉远端斑块偏心性分布。分叉远端斑块主要分布在分叉嵴的对侧壁。术前分支斑块负荷大、分叉近端斑块负荷大,分叉角度小、分支/主支直径小,分叉病变PCI术后分支闭塞的可能性大。分支开口斑块负荷>50%较<50%术后闭塞的危险性更大。
Objective: To analyze the predictors of branch occlusion by intravascular ultrasound (IVUS). Methods: Fifty-two bifurcations of coronary artery disease (PCI) were performed. The plaque area, the plaque load, the eccentricity index and the plaque area were analyzed quantitatively in the proximal (branching entry plane) and the distal (bifurcation crest) Plaque distribution radian. Stepwise regression was used to analyze the related factors of plaque burden after PCI. Postoperative outcomes were compared between preoperative patch plaque load> 50% (n = 15) and <50% (n = 37). Results: Quantitative analysis showed no significant difference in proximal and distal bifurcation plaque burden (52.80 ± 13.21% vs (52.81 ± 12.20)%, P> 0.05). The eccentricity index of the proximal bifurcation plaque was significantly lower than The radii of the bifurcated proximal plaque were significantly greater than those of the distal bifurcation ([(357.15 ± 12.02) °: (233.33 ± 45.91) °, P <1.86 ± 0.64), (9.52 ± 2.78, P <0.01) <0.01] .The angle between the distal bifurcation and the branch was (143.2 ± 33.60) °. The stepwise regression analysis showed that the postoperative branch plaque burden was positively correlated with the preoperative branch plaque load and the bifurcated proximal plaque load , Negatively correlated with the bifurcation angle and branch / main branch diameter.The postoperative branch plaque burden was significantly higher than <50% [(89.20 ± 5.66)%: (42.60 ± 18.12% %, P <0.01] .Conclusion: The vascular bifurcations changed the pattern of plaque distribution, centripetal distribution of proximal bifurcation, and eccentric distribution of distal bifurcation.The distal bifurcation was mainly distributed in the Bifurcation of the opposite side of the wall.The preoperative branch plaque load, proximal bifurcation plaque load, bifurcation angle is small, branch / main branch diameter is small, bifurcation lesions of the possibility of occlusion after PCI. Branch opening plaque negative > 50% after occlusion than <50% greater risk.