易损斑块---血管内光学相干成像技术（ivoct）研究进展.doc

易损斑块---血管内光学相干成像技术（IVOCT）研究进展 作者：张丽伟 单位：解放军总医院第一附属医院心内科 研究已经明确动脉粥样硬化斑块破裂引发血栓形成是临床急性冠脉综合征（Acute Coronary Symptom，ACS）的根本原因。易损斑块的早期识别与及时处理是避免临床心血管事件的关键。目前已经有很多影像学方法应用于冠脉内易损斑块的检测，但无论是易损斑块的形态学，还是其破裂导致血栓形成的机制，仍是临床医生关注的重点。血管内光学相干成像技术（Intravascular Optical Coherence Tomography, IVOCT）是一种基于心脏导管的检查方法，它利用近红外光，可获取高达10μm分辨率的影像，从而以前所未有的细胞水平实现体内血管壁微结构成像。目前，随着新一代频域OCT（Frequency-domain OCT，FD-OCT）的发展，使这一技术在易损斑块研究中发挥积极作用。由于新型OCT在国内应用并不广泛，现将OCT目前在易损斑块相关研究中的进展做一综述。相信，随着大家对这项技术的了解及熟悉，IVOCT将给心血管介入治疗带来全新的认识。 The Vulnerable Coronary Plaque: Update on Intravascular Optical Coherence Tomography The current studies have shown that plaque rupture of a vulnerable plaque is the main cause of Acute Coronary Syndrome (ACS). The important point is to find and treat a vulnerable plaque to prevent the acute event. Many imaging modalities have been introduced to identify thin-capped fibroatheroma (TFCA). But the morphology and the mechanism of rupture of vulnerable plaques are still the clinical problems. Intravascular Optical Coherent Tomography (IVOCT) is an examine method based on cardiac catheter. It uses near-infrared light, for up to 10 microns high-resolution images, thus to obtain images and tissue characterization on a microscopic scale. With the development of a new generation of Frequency-Domain OCT (FD-OCT), this technology has played a positive role in the study of TCFA. Our main objective is to review the studies of TCFA with OCT. Development of IVOCT might provide new insights into the diagnosis and treatment of coronary heart disease. Key words: Vulnerable plaque, Acute Coronary Syndrome, Thin-capped fibroatheroma，Intravascular Optical Coherence Tomography, Frequency-Domain OCT, Coronary heart disease. 1. 背景 1.1 不稳定斑块的概念 冠状动脉造影时代，我们普遍认为，冠状动脉狭窄程度决定了血管发生阻塞的可能。但随着对冠状动脉血管的认识，越来越多的研究发现，临床心脏事件主要原因在于不稳定斑块破裂，并继发血栓形成(1)。Muller等最早提出了“易损斑块（vulnerable plaque）”的概念(2)。随后，Libby将这一概念进一步明确，提出了炎症浸润的纤维帽等组织学概念（3）。1997年，Burke等对心源性死亡患者的病理学研究证实：导致猝死事件的根本原因是斑块破裂并继发血栓形成，并明确将“易损斑块”定义为“薄纤维帽的动脉斑块（Thin-capped fib