基于CCTA分析血流储备分数和冠状动脉斑块特征诊断心肌缺血的效能评价  

Evaluation of the Diagnostic Efficacy of Myocardial Ischemia Based on CCTA Analysis of Flow Reserve Fraction and Coronary Plaque Characteristics

作　　者：滕菲[1] 刘纯岩[1] 姜海余 韩庆贺[1] TENG Fei;LIU Chunyan;JIANG Haiyu;HAN Qinghe(Department of Radiology,the Second Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]吉林大学第二医院放射线科,长春130000

出　　处：《临床误诊误治》2023年第9期47-52,57,共7页Clinical Misdiagnosis & Mistherapy

基　　金：2019年度吉林省卫生健康委科技能力提升计划(201902JL288)。

摘　　要：目的 探讨基于冠状动脉CT血管成像(CCTA)分析血流储备分数(FFR)、冠状动脉斑块特征对冠心病心肌缺血的诊断价值。方法 选取2021年1月—2023年1月收治的40例冠心病心肌缺血作为研究组,另选同期40例冠心病非心肌缺血作为对照组。2组均行CCTA检查,获取FFR、冠状动脉斑块特征参数。比较2组血清心肌缺血相关标志物[缺血修饰白蛋白(IMA)、心型脂肪酸结合蛋白(H-FABP)]、FFR、冠状动脉斑块特征参数。分析研究组FFR、冠状动脉斑块特征参数与血清心肌缺血相关标志物、心肌缺血程度相关性,评价FFR、冠状动脉斑块特征参数对心肌缺血的诊断效能。结果 研究组FFR低于对照组,斑块长度长于对照组,总斑块负荷以及血清IMA、H-FABP水平高于对照组(P<0.01)。FFR与血清IMA、H-FABP水平及心肌缺血程度呈负相关,斑块长度、总斑块负荷分别与之呈正相关(P<0.01)。受试者工作特征曲线分析显示,FFR、斑块长度、总斑块负荷联合诊断心肌缺血的曲线下面积大于血清IMA、H-FABP联合诊断,且诊断效能明显改善(P<0.05)。结论 基于CCTA分析FFR、冠状动脉斑块特征参数对冠心病心肌缺血具有一定诊断价值,且联合检测可明显提高诊断效能。Objective To explore the diagnostic value of flow reserve fraction(FFR)and coronary plaque characteristics in myocardial ischemia in patients with coronary heart disease(CHD)based on coronary CT angiography(CCTA).Methods Forty CHD patients with myocardial ischemia admitted from January 2021 to January 2023 were selected as the research group,and another 40 CHD patients without myocardial ischemia in the same period were selected as the control group.CCTA examination was performed in both groups to obtain FFR and coronary plaque characteristic parameters.Serum myocardial ischemia-related markers[ischemia modified albumin(IMA),heart type-fatty acid binding protein(H-FABP)],FFR and coronary plaque characteristic parameters were compared between the two groups.The correlation between FFR,coronary plaque characteristic parameters,serum myocardial ischemia-related markers and severity of myocardial ischemia was analyzed in the research group,and the diagnostic efficacy of FFR and coronary plaque characteristic parameters on myocardial ischemia was evaluated.Results The FFR of the research group was lower than that of the control group,the plaque length was longer than that of the control group,and the total plaque load and serum IMA and H-FABP levels were higher than those of the control group(P<0.01).FFR was negatively correlated with IMA and H-FABP levels and severity of myocardial ischemia,while plaque length and total plaque load were positively correlated with FFR(P<0.01).The analysis of receiver operating characteristic(ROC)curve showed that the area under the ROC curve of FFR,plaque length and total plaque load in combination for the diagnosis of myocardial ischemia was greater than that of the combination of serum IMA and H-FABP,and the diagnostic efficiency of the combination was significantly improved(P<0.05).Conclusion CCTA based analysis of FFR and coronary plaque characteristic parameters has certain diagnostic value for myocardial ischemia in CHD patients,and the combined detection can significantly impro

关 键 词：冠心病 心肌缺血 冠状动脉CT血管成像 血流储备分数 冠状动脉斑块特征 缺血修饰白蛋白 心型脂肪酸结合蛋白 诊断 

分 类 号：R541.4[医药卫生—心血管疾病]