冠状动脉CT血管造影预测冠脉斑块患者发生左心室重构临床价值研究  

Coronary CTA in prediction of left ventricular remodel in patients with coronary plaque

作　　者：尹小花 徐荣 郭鑫 黄茂盛 李宏松[3] 梁凯轶 周慧 YIN Xiaohua;XU Rong;GUO Xin;HUANG Maosheng;LI Hongsong;LIANG Kaiyi;ZHOU Hui(Department of Radiology,Jiading Central Hospital,Shanghai Universtiy of Medicine and Health Sciences and Key Laboratory of Smart Imaging of Shanghai Municipal Health Commission,Shanghai 201800,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院放射影像科上海市卫生健康委员会智慧影像重点实验室,上海201800 [2]上海健康医学院附属嘉定区中心医院超声影像科,上海201800 [3]上海健康医学院附属嘉定区中心医院心内科,上海201800

出　　处：《陕西医学杂志》2021年第2期192-196,200,共6页Shaanxi Medical Journal

基　　金：上海市卫生健康委员会科研面上项目(201940315);上海市卫生与计划生育委员会科研项目(201440598);上海市嘉定区农业和社会事业科研项目(JDKW-2016-W05);上海市嘉定区自然科学研究课题面上项目(JDKW-2020-0022)。

摘　　要：目的:探讨冠状动脉CT血管造影(CTA)用于预测冠心病患者发生左心室重构风险中的价值。方法:选取行冠状动脉CTA检查发现有斑块患者125例,收集临床危险因素指标,分析CTA图像,定量评定冠状动脉管腔狭窄程度并分级,分析高危斑块特征分为低CT衰减斑块和正性重构斑块,随访左心室重构发生情况、评估冠状动脉CTA对左心室重构的预测效能。结果:125例病例中共有19例失访,最终随访的病例数为106例。随访结束时,23例发生左心室重构。临床心血管病危险因素中,高血压具有较高的预测效能,ROC曲线下面积为0.665。冠状动脉CTA图像分析显示,冠状动脉CTA狭窄分级、低CT衰减斑块和正性重构斑块对左心室重构均有较高的预测效能,ROC曲线下面积分别为0.757、0.706、0.667。临床危险因素联合冠状动脉CTA指标可以提高预测效能,高血压联合冠状动脉CTA狭窄分级和低CT衰减斑块、高血压联合冠状动脉CTA狭窄分级和正性重构斑块的AUC分别为0.841、0.848。COX回归分析结果显示,冠脉狭窄分级(HR=7.54,P=0.001)、低CT衰减(HR=6.78,P<0.001)、正性重构(HR=4.05,P=0.004)是导致左心室重构的危险因素。结论:冠状动脉CTA可定量评估冠状动脉管腔狭窄程度并提供高危斑块信息,能有效预测左心室重构的发生,为心血管病防治的规范化提供依据。Objective:To explore the value of coronary CTA in prediction of left ventricular remodel in patients with coronary plaque.Methods:125 coronary atherosclerotic plaque patients underwent coronary CTA.Clinical risk factors including high blood pressure,dyslipidemia,diabetes,smoking,high body mass index(BMI)were collected,the degree of coronary stenosis was assessed quantitatively,and high risk plaque characteristics were analyzed and classified as low attenuation plaques and positive remodeling plaques.The occurrence of left ventricular remodeling was followed up.The predictive efficacy of coronary CTA for left ventricular remodeling was evaluated.Results:Follow-up was completed in 106 patients,and 23 patients had experienced left ventricular remodeling.Among the clinical cardiovascular risk factors,hypertension had a high predictive effect,and the area under the ROC curve was 0.665.Coronary CTA image analysis showed that coronary CTA stenosis grade,low attenuation plaques and positive remodeling plaques had high predictive power for left ventricular remodeling.The areas under the ROC curve were 0.757,0.706,and 0.667,respectively.Clinical risk factors combined with coronary artery CTA indicators can improve the prediction performance.The AUC of hypertension combined with coronary artery CTA stenosis grade and low attenuation plaques,hypertension combined with coronary artery CTA stenosis grade and positive remodeling plaques were 0.841 and 0.848,respectively.COX regression analysis results showed that coronary stenosis grade(HR=7.54,P=0.001),low attenuation plaques(HR=6.78,P<0.001),positive remodeling plaques(HR=4.05,P=0.004)were left ventricular remodeling risk factors.Conclusion:Coronary CTA assesses the risk of left ventricular remodeling from both coronary stenosis and high risk plaque characteristics.It can effectively predict the occurrence of left ventricular remodeling,and provide a basis for the standardization of cardiovascular disease prevention.

关 键 词：体层摄影术 X线计算机 血管造影 危险因素 高危斑块 左心室重构 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]