冠状动脉血管内超声与定量血流分数的相关性研究

Correlation Study between Intravascular Ultrasound and Quantitative Flow Ratio in Coronary Arteries

摘要: 目的：探讨血管内超声(IVUS)所测冠脉病变最小面积、病变长度、斑块负荷指标与冠脉血流分数(QFR)的相关性，为临床判断冠脉病变的程度与性质，提供关键的数据支持，进一步分析不同靶血管、斑块类型、合并症亚组下IVUS形态指标与QFR关联的异质性特征。方法：选取258例行IVUS及QFR检查的冠心病患者作为研究对象，收集患者一般临床资料、IVUS相关指标(最小面积、病变长度、斑块负荷)及QFR值，采用Spearman相关性分析，检验IVUS各项指标与QFR之间的关联性，依据靶血管、斑块性质、是否合并糖尿病开展亚组分层Spearman相关分析，对比各亚组相关系数与统计学差异。结果：病变长度与QFR之间呈显著的负相关(r = −0.138, P = 0.027)，亚组分层结果：① 靶血管分层：LAD组病变长度与QFR (r = −0.161, P = 0.042)；非LAD组(r = −0.097, P = 0.215)，仅LAD亚组二者相关性存在统计学意义；② 斑块性质分层：钙化斑块亚组(r = −0.174, P = 0.035)，非钙化斑块亚组(r = −0.102, P = 0.186)，钙化斑块人群病变长度与QFR关联更显著；③ 糖尿病分层：合并DM组(r = −0.189, P = 0.021)，非DM组(r = −0.105, P = 0.169)，糖尿病患者病变长度对QFR的负向影响更突出。结论：QFR的降低与靶血管病变长度的增加呈显著负相关，尤其关联在LAD病变、钙化斑块、合并糖尿病患者中负相关更为明显。

Abstract: Objective: To explore the correlations between the minimum area, lesion length, plaque burden indicators measured by intravascular ultrasound (IVUS) and the coronary flow fraction (QFR), providing key data support for clinical assessment of the severity and nature of coronary artery lesions, and further analyzing the heterogeneity characteristics of IVUS morphological indicators and QFR associations under different target vessels, plaque types, and subgroups with comorbidities. Methods: 258 patients with coronary heart disease who underwent IVUS and QFR examinations were selected as the research subjects. General clinical data, IVUS-related indicators (minimum area, lesion length, plaque burden), and QFR values were collected. Spearman correlation analysis was used to test the correlations between IVUS indicators and QFR. Subgroup stratified Spearman correlation analysis was conducted based on target vessels, plaque types, and whether diabetes was present. The correlation coefficients and statistical differences among subgroups were compared. Results: There was a significant negative correlation between lesion length and QFR (r = −0.138, P = 0.027). Subgroup stratified results: ① Target vessel stratification: LAD group (r = −0.161, P = 0.042); non-LAD group (r = −0.097, P = 0.215), and only the LAD subgroup had a statistically significant correlation between the two; ② Plaque type stratification: calcified plaque subgroup (r = −0.174, P = 0.035), non-calcified plaque subgroup (r = −0.102, P = 0.186), and the association between lesion length and QFR was more significant in the calcified plaque population; ③ Diabetes stratification: DM group (r = −0.189, P = 0.021), non-DM group (r = −0.105, P = 0.169), and the negative impact of lesion length on QFR was more prominent in diabetic patients. Conclusion: The reduction of QFR is significantly negatively correlated with the increase in the length of the target vessel lesion. This correlation is particularly evident in LAD lesions, calcified plaques, and patients with diabetes.