Page 54 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第42卷第5期
·650 · Journal of Nanjing Medical University（Natural Sciences） 2022年5月

·临床研究·

光学相干成像结合定量血流分数在急性冠脉综合征介入诊疗

中的指导价值

孟浩宇，薛 源，孔祥清，王连生 *
南京医科大学第一附属医院心血管内科，江苏 南京 210029

［摘 要］ 目的：评估光学相干断层成像（optical coherence tomography，OCT）结合无创功能学检查定量血流分数（quantitative
flow ratio，QFR）在急性冠脉综合征（acute coronary syndrome，ACS）介入诊疗中的指导价值。方法：入选拟行择期经皮冠状动脉
介入术（percutaneous coronary intervention，PCI），并于术中接受OCT检查的ACS患者。若OCT下靶病变的最小管腔面积（mini⁃
2
mum luminal area，MLA）＞2.6 mm 且未见斑块破裂或夹层，则予以最佳药物治疗（optimal medical therapy，OMT），设为 OCT⁃
OMT组；余ACS患者在OCT指导下行PCI治疗，设为OCT⁃PCI 组。比较两组间OCT测得的相关数据，回顾性使用QFR技术对
造影图像质量良好病变的功能学指标进行分析和验证。收集两组患者术后1年内的不良临床事件，完成数据统计分析。结
果：入选120例拟行择期PCI并于术中接受OCT检查的ACS患者，共计146处靶病变。OCT⁃OMT组47例（39.2%），OCT⁃PCI组
73例（60.8%）。OCT检查结果示：OCT⁃OMT病变的平均MLA水平显著高于OCT⁃PCI病变（3.74 mm vs. 2.41 mm ，P < 0.000 1），
2
2
同时其平均狭窄程度显著偏低（62.6% vs. 73.6%，P < 0.000 1）。QFR分析结果示：OCT⁃OMT病变的平均QFR值显著高于OCT⁃
PCI病变（0.89 vs. 0.75，P < 0.000 1），OCT⁃OMT病变“QFR≤0.80”的占比显著低于OCT⁃PCI病变（7.14% vs. 84.7%，P < 0.000 1）。术
后1年的随访结果显示：主要不良心血管事件（死亡、心肌梗死、靶血管重建、因心绞痛再入院）及大出血事件的发生率较低（分
别为 7.5%和 0.8%），且在两组间差异无统计学意义；而 OCT⁃OMT 组小出血事件的发生率显著低于 OCT⁃PCI 组（RR=0.12，P=
0.04）。结论：OCT以“MLA＞2.6 mm 且未见斑块破裂或夹层”为决策标准指导部分ACS患者行药物治疗安全有效。QFR可为
2
OCT补充功能学证据，两者在评估和指导ACS介入诊疗上有着良好的一致性。
［关键词］ 光学相干断层成像；定量血流分数；急性冠脉综合征；经皮冠状动脉介入术；最佳药物治疗
［中图分类号］ R541.4 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）05⁃650⁃07
doi：10.7655/NYDXBNS20220508

Combination of optical coherence tomography and quantitative flow ratio in guiding the
intervention for acute coronary syndrome

MENG Haoyu，XUE Yuan，KONG Xiangqing，WANG Liansheng *
Department of Cardiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：This study was to assess the value of optical coherence tomography（OCT）in guiding the intervention for acute
coronary syndrome（ACS）verified by the non⁃invasive quantitative flow ratio（QFR），functionally. Methods：Patients who were intended
to undergo percutaneous coronary intervention（PCI）and evaluated by OCT during operation were enrolled. Patients target lesions with
2
a minimum luminal area（MLA）>2.6 mm by OCT and in whom OCT showed no features of plaque rupture or dissection received
optimal medical therapy（OMT）and these patients were assigned to OCT⁃OMT group. The other patients received PCI treatment and
were assigned to OCT⁃PCI group. Data measured by OCT between groups were compared. Functional indexes derived from lesions with
high quality images were retrospectively analyzed and validated by QFR. Adverse clinical events between two groups at 1 year follow⁃
up were collected and data statistical analyses were carried out subsequently. Results：A total of 120 ACS patients who were intended
to undergo PCI and evaluated by OCT during operation with 146 lesions were enrolled. Forty⁃seven patients（39.2%）were assigned to

［基金项目］ 国家自然科学基金（82070367）；江苏省自然科学基金青年项目（BK20210966）；江苏省人民医院临床科研项目
（303103513BA20）
∗
通信作者（Corresponding author），E⁃mail：drlswang@njmu.edu.cn