冠状动脉CT造影对冠心病预防策略的影响  

Influence of coronary CT angiography findings on prevention strategies of coronary artery disease

作　　者：李震南[1] 吕滨[1] 王志强[1] 刘坤[1] 侯志辉[1] 高扬[1] 尹卫华[1] 任心爽 蒋世良[1] 戴汝平[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院放射科国家心血管病中心心血管疾病国家重点实验室,100037

出　　处：《中华医学杂志》2015年第33期2664-2667,共4页National Medical Journal of China

摘　　要：目的 探讨冠状动脉CT造影结果对患者的药物治疗和心血管病危险因素控制的影响.方法 连续入选2013年9月至2014年12月期间于阜外心血管病医院行冠状动脉CT造影的患者,分为＜50％狭窄组和≥50％狭窄组.收集患者的基线资料并对其进行随访.对基线资料进行组间对比分析,对随访资料做CT造影前后对比分析,并做Logistic回归,探讨CT造影结果与后续药物治疗的相关性.结果 研究共纳入160例患者,＜50％狭窄99例,≥50％狭窄61例.CT造影前后相比,患者的总胆固醇[（5.06±1.04）比（4.54 ± 1.09） mmol/L,P＜0.01]、低密度脂蛋白胆固醇[（3.16±0.95）比（2.60±0.88） mmol/L,P＜0.01]、甘油三酯[1.66 （1.14,2.28）比1.55（1.07,2.05） mmol/L,P=0.004]水平显著下降,其余指标变化差异无统计学意义.狭窄≥50％组与狭窄＜50％组相比,总胆固醇[（-0.70±0.94）比（-0.42±0.96）mmol/L,P=0.035]和低密度脂蛋白胆固醇[（-0.78±0.99）比（-0.43±0.79）mmol/L,P=0.016]下降更为显著.CT造影后,患者服用阿司匹林（13.8％比65.6％,P＜0.01）和他汀类药（20.0％比71.9％,P＜0.01）比例显著上升,降压药（53.1％比63.1％,P=0.07）变化差异无统计学意义.Logistic回归结果显示,CT造影结果是患者后续接受阿司匹林[校正OR值：3.58（1.61～7.99）,P=0.002]和他汀类药物[校正OR值：15.01（4.40 ～51.22）,P＜0.01]治疗的独立相关因素.结论 冠状动脉CT造影结果对后续的药物治疗和心血管病危险因素控制有直接影响,对冠心病的预防策略有重要指导价值.Objective To explore impact of coronary CT angiography findings on preventive medical treatment and control of coronary artery disease （CAD） risk factors.Methods Consecutive patients with atherosclerotic plaque detected by coronary CT angiography were enrolled in our study from September 2013 to December 2014,grouped as 〈 50% stenosis and ≥ 50% stenosis.Baseline and follow-up data were recorded.Comparative analysis was performed both between stenosis groups and pre-and post-CT angiography data.Multivariable Logistic regression were preformed to investigate association between coronary CT angiography findings and subsequent medical therapies.Results Totally 160 patients were enrolled in our study,99 were 〈 50% stenosis and 61 were ≥50% stenosis.Significant reduction of total cholesterol （5.06 ± 1.04 vs 4.54 ± 1.09 mmol/L,P 〈 0.01）,low-density lipoprotein cholesterol （3.16 ± 0.95 vs 2.60±0.88 mmol/L,P〈0.01）,and triglyceride （1.66 （1.14,2.28） vs 1.55（1.07,2.05） mmol/L,P =0.004） were observed Pre-versus post-CT angiography.Compared to patients with 〈 50% stenosis,patients with ≥ 50% stenosis demonstrated more significant reduction with regard to total cholesterol （-0.70 ± 0.94 vs-0.42 ± 0.96 mmol/L,P =0.035） and low-density lipoprotein cholesterol （-0.78 ± 0.99 vs-0.43 ± 0.79 mmol/L,P =0.016）.After CT angiography,aspirin （13.8% vs 65.6%,P 〈 0.01） and statin （20.0% vs 71.9%,P 〈0.01） use were significantly increased,blood pressure medication （53.1% vs 63.1%,P =0.07） use showed no statistical differences.Adjusted for baseline risk factors and pretest medications,CT angiography findings were independently associated with increased post-CT angiography use of aspirin （adjusted OR （95 % CI）：3.58 （1.61-7.99）,P =0.002） and statin （adjusted OR （95% CI）：15.01 （4.40-51.22）,P 〈 0.01）.Conclusion Coronary CT angiography findings demonstrated direct impact on subsequent medical therapies and control of CAD risk factors,and offered i

关 键 词：冠状血管造影术 体层摄影术 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]