MSCT评价广州地区无症状自然人群冠状动脉斑块成分及其危险因素分析  

Relationship between risk profiles and presence of different types of coronary atherosclerotic plaque as detected by MSCT in asymptomatic subjects in Guangzhou

作　　者：连舟洋[1] 梁长虹[1] 黄美萍[1] 吕滨[2] 

机构地区：[1]广东省医学科学院广东省人民医院放射科,广州510080 [2]中国协和医科大学中国医学科学院阜外心血管病医院放射科,北京100037

出　　处：《岭南心血管病杂志》2011年第5期374-379,共6页South China Journal of Cardiovascular Diseases

基　　金：国家十一五科技支撑计划(项目编号:2007BAI05B00)

摘　　要：目的应用64层螺旋计算机断层扫描(multi-slice computed tomography,MSCT)评价广州地区无症状自然人群冠状动脉斑块成分及其相关危险因素分析。方法选择广州社区无症状自然人群,采用随机整群抽样的方法抽取样本,根据项目纳入及排除标准共入选280例,男149例,女131例,年龄(51.54±6.19)岁。入选后均行MSCT冠状动脉检查。每例均对冠状动脉的17个节段进行分析。对冠状动脉粥样斑块的不同成分进行分组,并分析每组的独立危险因素。结果 105例(38%)受试者存在斑块,非钙化性斑块、混合性斑块及钙化斑块分别53、42、94处。随着年龄的增加,非钙化性斑块发生率降低(F=38.36,P<0.001),而混合性斑块和钙化性斑块则增加(F=6.95,P=0.001;F=9.35,P≤0.001)。无斑块组、非钙化斑块组、混合性斑块组、钙化斑块组4组分别为175、14、42及49例,4组中比较有差异的因素共7项,分别为年龄、性别、高三酰甘油、高高密度脂蛋白、高血糖、吸烟史及冠状动脉粥样硬化性心脏病(冠心病)家族史,无斑块组与非钙化性斑块组两组之间年龄差异没有统计学意义(P>0.05)。男性(OR=0.06,P=0.02)及三酰甘油(OR=10.09,P=0.01)是非钙化斑块的独立危险因素;年龄(OR=1.18,P=0)及三酰甘油(OR=3.33,P=0.01)是混合性斑块的独立危险因素,而高密度脂蛋白(OR=0.21,P=0)则是独立保护因素;年龄(OR=1.23,P=0)又是钙化斑块的独立危险因素,而高密度脂蛋白(OR=0.12,P=0)亦是其独立保护因素。总胆固醇(OR=8.03,P=0.01)为冠心病发病的危险因素;高密度脂蛋白(OR=0.74,P=0.01),为冠心病的保护性因素。结论非钙化斑块的发生可能不受年龄的影响,且男性人群比女性人群更易发生;降低三酰甘油和升高高密度脂蛋白胆固醇是冠状动脉粥样硬化预防的首要目标,高密度脂蛋白的作用令人关注。Objectives To assess the relationship between cardiovascular risk factors and extent of noncalcified coronary atherosclerotic plaque （NCAP）, mixed coronary atherosclerotic plaque （MCAP）, and calcified coronary atherosclerotie plaque （CAP） in asymptomatic subjects in Guangzhou. Methods Two hundred and eighty asymptomatic subjects [aged （52 ±6） years, 149 men and 131 women] who underwent 64-slice muhidetector row computed tomography （MSCT） as part of a general health evaluation were consecutively enrolled. All plaques were classified as NCAP, MCAP and CAP and all plaque components were assessed on 17 segment. Results Plaques were found in 105 of 280 （38%） subjects. NCAP,MCAP and CAP were detected respectively in 53,42 and 94 segments. The extent of NCAP decreased （F=38.36,P〈0.001）and the extent of MCAP and CAP increased with age （F=6.95,P=0.001 ; F= 9.35, P〈0.001 ）. The number of four groups for subjects with no plaque, exclusively NCAP, MCAP, and CAP was respectively 175, 14, 42 and 49. Among individual risk factors, male （OR =0.06,P=0.02） and triglyceride （OR = 10.09, P=0.01 ） may be an independent risk factors of the extent of NCAP, age （ OR = 1.18, P=0） and triglyceride （ OR = 3.33,P=0.01 ）may be an independent risk factors of the extent of MCAP,while high density lipoprotein （HDL） （OR= 0.21,P=0）may be an independent protective factor,age （OR =1.23,P=0）may be an independent risk factor of the extent of CAP, inversely HDL （ OR =0.12, P=0） may be independent protective factor. Total cholesterol （OR =8.03, P= 0.01）may be an independent risk factor of coronary artery disease,inversely HDL may be also an independent protective factor. Conclusions Occurrence of NCAP may not be impacted by age, and it may be more likely occurred on the male population. Reducing triglycerides and increasing HDL is a patch to prevent atherosclerotic plaques. The role of HDL should be concerned.

关 键 词：冠状动脉疾病 体层摄影扫描仪 X线计算机 粥样硬化斑块 

分 类 号：R541.4[医药卫生—心血管疾病]