基于CCTA对胸痛病人高危斑块成分及血流动力学特征的研究  

Plaque and hemodynamic characteristics of cardiac artery on coronary CT angiography in patients with highrisk plaque and chest pain

作　　者：李永霞[1] 马跃虎[2] 王同兴[2] 谢光辉[2] 徐辉[2] 唐春香 LI Yongxia;MA Yuehu;WANG Tongxing;XIE Guanghui;XU Hui;TANG Chunxiang(Department of Radiology,Nangjing City Pukou District Hospital of Traditional Chinese Medicine,Nanjing 211800,China;Department of Radiology,Nanjing First Hospital,Nanjing Medical University;Department of Diagnostic Radiology,General Hospital of Eastern Theater Command.)

机构地区：[1]江苏省南京市浦口区中医院医学影像科,南京211800 [2]南京医科大学附属南京医院(南京市第一医院)医学影像科 [3]东部战区总医院放射诊断科

出　　处：《国际医学放射学杂志》2021年第1期19-24,共6页International Journal of Medical Radiology

摘　　要：目的基于冠状动脉CT血管成像(CCTA)研究伴高危斑块的胸痛病人其斑块成分特征及血流动力学特征。方法回顾性纳入行CCTA且于2个月内行有创冠状动脉造影检查的43例冠心病病人,男30例,女13例,平均年龄(60.8±8.7)岁。依据病人是否存在高危斑块及胸痛将病人分为2组,组1同时存在胸痛和至少1个高危斑块特征(23例),组2仅有胸痛或高危斑块特征任意一项(20例)。测量斑块成分特征参数[斑块总体积、钙化斑块体积、纤维斑块体积、脂质斑块体积占比(脂质斑块%)、脂质斑块面积、最小管腔面积、偏心指数]和血流动力学特征参数[基于CCTA的血流储备分数(FFRCT),斑块近、远端FFRCT差值(△FFRCT)]。采用Mann-Whitney U检验或独立样本t检验比较2组间参数的差异。利用约登指数计算斑块成分特征及血流动力学特征判断高危斑块合并胸痛的临界值,采用受试者操作特征(ROC)曲线分析计算其临界值的敏感度、特异度以及曲线下面积(AUC)。结果组1的脂质斑块%、脂质斑块面积均高于组2(均P<0.05),FFRCT值低于组2(P<0.05),2组间其他斑块成分特征参数及△FFRCT差异均无统计学意义(均P>0.05)。分析脂质斑块%、脂质斑块面积及FFRCT特征参数的诊断能力,FFRCT的临界值为0.82时的敏感度最高(61%)、特异度最低(85%),AUC最高(0.80)。结论采用CCTA分析高危斑块中脂质斑块成分特征并进行FFRCT测量,可作为评估高危斑块合并胸痛病人的有效辅助手段,为临床治疗决策提供依据。Objective To study the characteristics of plaque components and hemodynamics of cardiac artery on coronary CT angiography(CCTA)in patients with high-risk plaque and chest pain.Methods Forty-three patients with coronary atherosclerosis disease who underwent CCTA and invasive coronary angiography within 2 months were retrospectively collected,including 30 males and 13 females,with an average age of 60.8±8.7 years.High-risk plaque combining chest pain was used as the grouping factor,and patients were divided into 2 groups:group 1 with chest pain and at least one high-risk plaque characteristic(23 cases),and group 2 with either chest pain or high-risk plaque characteristic(20 cases).The characteristic parameters of plaque components[total plaque volume,calcified plaque volume,fibrotic plaque volume,lipid plaque volume proportion(lipid-plaque%),lipid plaque area,minimum lumen area,eccentricity index]and characteristic parameters of hemodynamics[blood flow reserve fraction based on CCTA(FFRCT),difference between proximal and distal plaques(△FFRCT)]were measured.Mann-Whitney U test or independent sample t test was used to compare the difference in each parameter between the two groups.The characteristics of plaque components were calculated using Youden index.The critical value of high-risk plaque with chest pain was determined using hemodynamic characteristics.The sensitivity,specificity,and area under the curve(AUC)of the critical value were calculated by receiver operating characteristic(ROC)curve analysis.Results The lipid-plaque%and lipid plaque area in the group 1 were higher than those in the group 2(both P<0.05),and the FFRCT value in the group 1 was lower than that in the group 2(P<0.05).There were no significant differences in the other characteristic parameters of plaque components and△FFRCT between the two groups(all P>0.05).Among the diagnostic abilities of the lipid plaque%,lipid plaque area,and FFRCT,with a critical value of 0.82,the FFRCT achieved the highest sensitivity(61%),lowest specificity(85%)

关 键 词：CT血管成像 冠状动脉 高危斑块 血流储备分数 胸痛 

分 类 号：R541.4[医药卫生—心血管疾病] R445.3[医药卫生—内科学]