HIV感染患者冠状动脉斑块特征定量参数、高危斑块形态特征与CT-FFR的相关性研究  

Study on the Correlation Between Coronary Plaque Quantification Characteristics and High⁃risk Plaque Morphological Characteristics and CT⁃FFR in HIV+Population

作　　者：侯佳蒙 马雪妍 张永高[1] 赵清霞[2] HOU Jiameng;MA Xueyan;ZHANG Yonggao(Department of Radiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院放射科,450052 [2]郑州市第六人民医院感染科,北京100016

出　　处：《临床放射学杂志》2024年第4期561-566,共6页Journal of Clinical Radiology

基　　金：河南省科学技术厅河南省重点研发专项项目(编号:231111313100)。

摘　　要：目的 基于冠状动脉CT血管造影(CCTA)研究人类免疫缺陷病毒感染[HIV(+)]患者中冠状动脉斑块特征参数及高危斑块形态学特征与血流储备分数(FFR)测量值之间的相关性。方法 回顾性分析行CCTA检查的121例HIV(+)共167支血管的临床及影像资料。所有患者均接受CCTA检查。测量计算冠状动脉血管基于CCTA的无创性血流储备分数(CT-FFR)值,将CT-FFR≤0.80定义为冠状动脉缺血性改变,并依据CT-FFR值将其分为CT-FFR>0.80组(n=103)和CT-FFR≤0.80组(n=64)。使用半自动软件测量其斑块特征参数:斑块总体积、脂质斑块体积、钙化斑块体积、纤维斑块体积、非钙化斑块体积、最小管腔面积、斑块长度、狭窄程度、重塑指数及偏心指数;分析高危斑块形态学特征:低衰减斑块、正性重构、点状钙斑、“餐巾环征”。分析比较两组间冠状动脉斑块特征参数及高危斑块形态特征的差异,采用单因素及多因素Logistic回归分析CT-FFR≤0.80的相关危险因素。结果 与CT-FFR>0.80组相比,CT-FFR≤0.80组中斑块长度更长[13.2 mm(8.5 mm, 24.6 mm)vs.7.3 mm(5.2 mm, 10.5 mm),P<0.001],斑块总体积更大[122.8 mm^(3)(63.3 mm^(3),272.9 mm^(3))vs. 64.9 mm^(3)(41.9 mm^(3),103.9 mm^(3)),P<0.001],非钙化斑块体积更大[80.0 mm^(3)(36.7 mm^(3),154.6 mm^(3))vs. 37.5 mm^(3)(21.5 mm^(3),63.5 mm^(3)),P<0.001],脂质斑块体积更大[6.2 mm^(3)(1.6 mm^(3),15.8 mm^(3))vs. 2.2 mm^(3)(0.9 mm^(3),5.3 mm^(3)),P<0.001],纤维斑块体积更大[60.5 mm^(3)(34.6 mm^(3),133.6 mm^(3))vs. 32.9 mm^(3)(20.5 mm^(3),59.5 mm^(3)),P<0.001],最小管腔面积更小[4.7 mm^(3)(3.0 mm^(3),6.7 mm^(3))vs. 5.9 mm^(3)(3.9 mm^(3),9.1 mm^(3)),P=0.008],“餐巾环征”比例更大(χ~2=8.132,P<0.050)。其中,冠状动脉斑块长度(OR=1.097,95%CI:1.018~1.182,P=0.015)、脂质斑块体积(OR=1.015,95%CI:0.996~1.019,P=0.048)、最小管腔面积(OR=0.895,95%CI:0.790~1.013,P=0.008)、“餐巾环征”(OR=26.237,95%CI:5.008~119.166,P<0.001)与CT-FFR≤0.Objective To explore the correlation between coronary plaque quantification characteristics and high⁃risk plaque morphological characteristics and coronary computed tomography angiography(CTA)⁃derived fractional flow reserve(CT⁃FFR)measurements in HIV⁃infected patients.Methods The clinical and imaging data of 167vessels in 121 patients with HIV infection who underwent coronary CTA examination were analyzed retrospectively.All patients were examined by CCTA.The CT⁃FFRvalue of coronary artery was measured and calculated,and the coronary ischemic change was defined as CT⁃FFR≤0.80.according to the CT⁃FFRvalue,the patients were divided into two groups:CT⁃FFR>0.8 group(n=103)and CT⁃FFR≤0.80 group(n=64).The plaques characteristic parameters are measured by semi⁃automatic software:plaque length,total plaque volume,calcification volume,non⁃calculated plaque volume,lipid plaque volume,fiber plaque volume,minimum lumen area;high⁃risk plaque morphology characteristics:low⁃density plaque,positive remodeling,spotty calcification,napkin⁃ring sign.The coronary computed tomography angiography(CTA)⁃derived fractional flow reserve(CT⁃FFR)was measured.CT⁃FFR≤0.80 was defined as coronary artery ischemia.The differences of coronary plaque charac⁃teristic parameters and high⁃risk plaque morphological characteristics between the two groups were analyzed and compared.The related risk factors of CT⁃FFR≤0.80 were analyzed by univariate and multivariate logistic regression.Results Com⁃pared with the CT⁃FFR>0.80 group,the CT⁃FFR≤0.80 group had longer plaque length[13.2(8.5,24.6)vs.7.3(5.2,10.5)mm,P<0.001],larger total plaque volume[122.8(63.32,72.9)vs.64.9(41.9,103.9)mm^(3),P<0.001],and larger non⁃calcified plaque volume[80.0(36.7,154.6)vs.37.5(21.5,63.5)mm^(3),P<0.001],the vol⁃ume of lipid plaque was larger[6.2(1.6,15.8)vs.2.2(0.9,5.3)mm^(3),P<0.001],the volume of fibrous plaque was lar⁃ger[60.5(34.6,133.6)vs.32.9(20.5)mm^(3),P<0.001],and the minimum lumen area was smaller[4.7(3.

关 键 词：人类免疫缺陷病毒 冠状动脉CT血管造影 血流储备分数 斑块特征参数 高危斑块形态学特征 

分 类 号：R512.91[医药卫生—内科学] R541.4[医药卫生—临床医学]