冠状动脉CT血管造影鉴别老年冠状动脉慢性完全闭塞与次全闭塞患者的价值研究  

Value of CCTA in discrimination of subtotal and chronic total occlusion of coronary artery in elderly patients

作　　者：任俊立 任丽臣 姚广 张永高[1] Ren Junli;Ren Lichen;Yao Guang;Zhang Yonggao(Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 50052,Henan rovince,China)

机构地区：[1]郑州大学第一附属医院放射科,450052

出　　处：《中华老年心脑血管病杂志》2024年第1期9-12,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省医学科技攻关计划省部共建重点项目(SBGJ 202102113)。

摘　　要：目的探讨冠状动脉CT血管造影(CCTA)对老年冠状动脉慢性完全闭塞(CTO)和次全闭塞患者进行无创区分的价值。方法回顾性选择2019年1月至2021年12月于郑州大学第一附属医院接受CCTA和有创冠状动脉造影的老年CTO或次全闭塞患者134例,分为CTO组62例和次全闭塞组72例。测量患者闭塞长度、闭塞头端形态(钝形/锥形)、侧支血管作为解剖学相关参数。管腔内密度衰减梯度通过后处理软件获得。采用单因素及多因素logistic回归分析,运用限制性立方样条图(第10、第50、第90个百分位数)建模相关因素和CTO的关联,使用ROC曲线分析。结果糖尿病(OR=0.423,95%CI:0.186~0.963)、闭塞长度(OR=1.088,95%CI:1.031~1.148)、钝形头端(OR=2.453,95%CI:1.042~5.773)是鉴别老年CTO和次全闭塞患者的独立预测因素(P<0.05,P<0.01)。闭塞长度鉴别老年CTO与次全闭塞患者的曲线下面积为0.718(95%CI:0.634~0.792,P=0.001)。结论CCTA可用于老年CTO与次全闭塞患者的鉴别。Objective To investigate the value of coronary computed tomography angiography(CCTA)for the non-invasive discrimination of chronic total occlusion(CTO)and subtotal occlusion(SO).Methods A total of 134 elderly patients undergoing CCTA and invasive coronary angio-graphy in our hospital from January 2019 to December 2021 were enrolled,and assigned into CTO group(62 cases)and SO(72 cases)according to the results of the examinations.Occlusion length,shape of proximal stump(blunt/conical),and collateral vessels were measured as anatomical findings.Transluminal attenuation gradient was obtained by a post-processing software.Univariate and multivariate logistic regression analyses were performed to explore factors related to CTO.Restricted cubic splines with three knots at the 10th,50th,and 90th percentiles were used to flexibly model the association of the factors with CTO,and ROC curve was plotted to evaluate the performance.Results Diabetes(OR=0.423,95%CI:0.186-0.963),occlusion length(OR=1.088,95%CI:1.031-1.148)and blunt-shaped stump(OR=2.453,95%CI:1.042-5.773)were independent predictors for discriminating CTO and SO(P<0.05,P<0.01).ROC curve analysis showed that the AUC value of occlusion length in the discrimination was 0.718(95%CI:0.634-0.792,P=0.001).Conclusion CCTA can be used to discriminate CTO and SO in elderly patients.

关 键 词：冠状动脉闭塞 计算机体层摄影血管造影术 LOGISTIC模型 冠状动脉慢性完全闭塞 冠状动脉次全闭塞 

分 类 号：R541.4[医药卫生—心血管疾病]