计算机断层扫描冠状动脉造影对前降支心肌桥患者冠状动脉迂曲及管腔狭窄的评估价值  

Evaluation value of coronary computed tomography angiography for coronary tortuosity and lumen stenosis in patients with myocardial bridge of anterior descending branch

作　　者：王铁钢 李小明 朱丹阳 王宝岭 Wang Tiegang;Li Xiaoming;Zhu Danyang;Wang Baoling(Department of Radiology,West Campus,Tangshan Hospital of Traditional Chinese Medicine,Tangshan 063000,Hebei,China;Department of Intervention,Tangshan Hospital of Traditional Chinese Medicine,Tangshan 063000,Hebei,China)

机构地区：[1]唐山市中医医院西院区放射科,河北唐山063000 [2]唐山市中医医院介入科,河北唐山063000

出　　处：《血管与腔内血管外科杂志》2021年第11期1380-1383,1394,共5页Journal of Vascular and Endovascular Surgery

摘　　要：目的 探讨计算机断层扫描冠状动脉造影(CCTA)检查对前降支心肌桥(MB)患者冠状动脉迂曲情况及管腔狭窄程度的评估价值.方法 收集2019年1月至2021年1月唐山市中医医院收治的187例冠心病患者的临床资料.所有患者均接受CCTA和冠状动脉造影(CAG)检查,分析两种检查方式的临床诊断结果,并比较前降支MB患者的冠状动脉迂曲情况及管腔狭窄程度.通过Logistic回归模型分析前降支MB患者发生冠状动脉粥样斑块的影响因素;以CAG检查结果为金标准,分析CCTA与CAG对前降支MB患者冠状动脉迂曲情况及管腔狭窄程度诊断结果的一致性.结果 187例冠心病患者中,前降支MB患者84例.冠状动脉迂曲患者的冠状动脉管腔狭窄程度高于冠状动脉无迂曲患者(P<0.05).随着迂曲程度的增加,冠状动脉管腔狭窄的发生率越高(P=0.029).Logistic回归分析结果显示,冠状动脉迂曲、管腔狭窄是前降支MB患者发生冠状动脉粥样斑块的独立危险因素(P<0.05).84例前降支MB患者共检查出冠状动脉节段426段,其中7个节段的造影图像不能达到CCTA诊断要求.对前降支MB患者的419个冠状动脉节段进行分析,结果显示,CCTA检查评估迂曲情况及管腔狭窄的灵敏度为84.29%(59/70),特异度为95.99%(335/349),阳性预测值为80.82%(59/73),阴性预测值为96.82%(335/346),与CAG检查具有较高的一致性(Kappa值=0.789,P<0.01).结论 CCTA检查对前降支MB患者冠状动脉迂曲及管腔狭窄程度具有一定的诊断价值,能够为临床诊断提供依据.Objective To explore the evaluation value of coronary computed tomography angiography(CCTA)for coronary tortuosity and lumen stenosis in patients with myocardial bridge(MB)of anterior descending branch.Method The clinical data of 187 patients with coronary heart disease admitted to Tangshan Hospital of Traditional Chinese Medicine were collected from January 2019 to January 2021.All underwent CCTA and then coronary angiography(CAG).The clinical diagnosis results of the two methods were analyzed.The degree of coronary tortuosity and lumen stenosis in patients with MB of anterior descending branch were compared.The influencing factors of coronary atherosclerotic plaques in patients with MB of anterior descending branch were analyzed by Logistic regression analysis.Taking CAG results as the golden standard,consistency between CCTA and CAG in the diagnosis of coronary tortuosity and lumen stenosis was analyzed.Result In the 184 patients with coronary heart disease,there were 84 cases with MB of anterior descending branch.The degree of coronary stenosis in patients with tortuous coronary artery was higher than that in patients without tortuous coronary artery(P<0.05).With the aggravation of tortuosity,incidence rate of the degree of coronary stenosis was increased(P=0.029).The results of Logistic regression analysis showed that coronary tortuosity and lumen stenosis were risk factors of coronary atherosclerotic plaques in patients with MB of anterior descending branch(P<0.05).A total of 426 segments of coronary artery were detected in 84 patients with anterior descending artery MB.Among them,the angiographic images of 7 segments could not meet the diagnostic requirements of CCTA.419 coronary segments of patients with anterior descending artery MB were analyzed.CAG was used as the gold standard for diagnosis.The results showed that the sensitivity of CCTA in evaluating tortuosity and lumen stenosis was 84.29%(59/70),the specificity was 95.99%(335/349),the positive predictive value was 80.82%(59/73),and the negative pre

关 键 词：冠状动脉 计算机断层扫描冠状动脉造影 心肌桥 迂曲 狭窄 

分 类 号：R543[医药卫生—心血管疾病]