冠状动脉造影与冠状动脉内超声检查对钙化斑块检出的比较  

The comparison of detecting coronary arterial calcification between intracoronary ultrasound and coronary angiography

作　　者：韩丁[1] 朱文玲[2] 黄超联[2] 沈珠军[2] 姜秀春[2] 李燕华[2] 

机构地区：[1]中国医学科学院 中国协和医科大学 北京协和医院外宾医疗科,北京100730 [2]中国医学科学院 中国协和医科大学 北京协和医院外宾医疗科 心脏内科,北京100730

出　　处：《中国介入心脏病学杂志》2002年第1期5-10,共6页Chinese Journal of Interventional Cardiology

基　　金：国家教委博士点资金资助(95020’72)

摘　　要：目的 探讨冠状动脉造影（CAG）检查结合临床资料分析能否正确检出患者在拟行介入治疗的冠状动脉狭窄段有无钙化,并与冠状动脉内超声（ICUS）检查结果进行比较分析,进一步评价在冠状动脉介入治疗前应用ICUS确定钙化的范围和严重程度的价值作进一步的评价。方法 对150例拟行冠状动脉介入治疗的患者行CAG同时行ICUS检查,评价靶血管狭窄处的钙化情况。结果有113例（75.3％）靶血管狭窄处被ICUS检出钙化。而CAG检出52例有钙化。两种方法的检查结果有75例相符,75例不相符合。CAG对钙化检出的敏感性为38.9％,特异性为86.5％。在靶血管狭窄段CAG检出钙化的平均弧度（n=52）较ICUS检出的（n=113）要大。CAG判定表浅型钙化的敏感性和特异性分别为35.3％和95.2％。在98例靶血管狭窄处CAG判定为无钙化的患者中,68例患者ICUS检出有不同程度的钙化。而CAG在非靶血管狭窄段检出钙化是ICUS在98例患者中检出钙化惟一的预期值（P=0.003,OR=1.16,95％可信区间为1.1～1.3）。有73例CAG在冠状动脉丛任何处均未见钙化,而ICUS检出44例（60.3％）有钙化,其中>90弧度的表浅型钙化仅9例（12.3％）。结论CAG检出靶血管狭窄段有钙化存在提示可能为弧度较大的表浅型钙化。在CAG检不出靶血管狭窄处钙化的病例中,若患者的年龄较大,旦发?Objective We sought to determine whether careful examination of angiograms in conjunction with other clinical information could reliably detect, quantitate and localize target lesion of calcification before a coronary intervention. Methods Target lesion calcification was assessed in 150 patients by angiography and intravascular ultrasound before a planned percutaneous coronary intervention. Results Ultrasound detected calcium lesion in 113 patients, whereas angiography showed calcification in 52.The two techniques agreed in 75 patients and disagreed in 75. Sensitivity and specificity of determined calcium lesion by angiography were 38.9% and 86.5% , respectively. The mean arc of calcium by CAG ( n = 52) was greater than ICUS ( n = 113) . The sensitivity and specificity of angiography in identifying superficial calcium was 35.3 % and 95.2 % , respectively. Of 98 patients without angiographically visible calcium at the target lesion site, calcium lesion was detected by ultrasound in 68 patients. The only predictor of ultrasound calcium lesion in these 98 patients was angiographic calcification elsewhere in the coronary tree ( P = 0.003, odds ratio [ OR ] = 1.16, 95% confidence interval [ CI ] 1.1 to 1.3 ) . The probability of any calcium lesion was 60.3% , but the superficial > 90° calcium lesion was only 12.3% in the 73 patients without angiographic calcifications anywhere in the coronary tree. Conclusion When it is angiographically visible, the arc of calcium is likely to be large and superficial. Angiographically calcification at a remote site is a predictor of ultrasound target calcium lesion in patients without target calcium lesion angiographically detected. Patients without angiographic calcification in the coronary tree may not need routine ultrasound examination, as the likelihood of > 90° superficial calcium is low.

关 键 词：冠状动脉造影 冠状动脉内超声 冠状动脉钙化 

分 类 号：R543.5[医药卫生—心血管疾病]