电子计算机断层扫描血管成像在冠心病心绞痛诊断及斑块稳定性评估和不良心血管事件预测中的应用  

Application of computed tomography angiography in diagnosis of angina pectoris of coronary heart disease and assessment of plaque stability and prediction of major adverse cardiovascular events

作　　者：郭广卿 王厚革 GUO Guang-qing;WANG Hou-ge(Imaging Department,Puyang Hospital of Traditional Chinese Medicine,Puyang,Henan 457001,China)

机构地区：[1]濮阳市中医医院影像科,河南濮阳457001

出　　处：《医药论坛杂志》2024年第10期1117-1120,F0003,共5页Journal of Medical Forum

摘　　要：目的分析CT血管成像(computed tomography angiography,CTA)在冠心病心绞痛诊断及斑块稳定性评估和不良心血管事件(major adverse cardiovascular eventsm,MACE)预测中的应用价值。方法选取2020年1月至2022年12月濮阳市中医医院收治的168例拟诊冠心病心绞痛患者临床资料,根据患者临床表现分为稳定心绞痛(SAP)组61例和不稳定心绞痛(UAP)组107例,同时根据随访1年内有无MACE分为MACE组(n=39)和非MACE组(n=129)。患者均进行冠状动脉造影及CTA检查,评估CTA在冠心病心绞痛诊断及斑块稳定性评估、不良心血管事件预测中的应用价值。结果CTA诊断冠心病心绞痛的敏感度、特异度、准确度分别为0.968、0.837和0.935,阳性预测值为0.945,阴性预测值为0.900,Kappa值为0.824,CTA检查结果与冠状动脉造影检查结果具有较好的一致性;SAP组软斑块检出率显著低于UAP组(P<0.05),钙化斑块检出率显著高于UAP组(P<0.05),两组混合斑块检出率比较差异无统计学意义(P>0.05);MACE组斑块总体积、总体斑块负荷、冠状动脉直径狭窄率及斑块长度显著高于非MACE组(P<0.05),最小管腔面积显著低于非MACE组(P<0.05);多因素logistic回归分析结果显示,总体斑块负荷(OR=1.137,95%CI:1.065~1.214)、冠状动脉直径狭窄率(OR=1.174,95%CI:1.058~1.302)及斑块长度(OR=1.488,95%CI:1.216~1.821)是影响MACE发生的相关因素(P<0.05);ROC曲线分析结果显示,总体斑块负荷、冠状动脉直径狭窄率、斑块长度及三者联合预测MACE发生的AUC分别为0.832、0.770、0.821及0.956,其中三者联合预测的AUC最大。结论CTA可作为冠心病心绞痛诊断的有效手段,其能够用于评估斑块稳定性,且CTA斑块定量参数总体斑块负荷、冠状动脉直径狭窄率、斑块长度对患者MACE的发生具有一定的预测价值。Objective To analyze the application value of CT angiography(CTA)in the diagnosis of angina pectoris of coronary heart disease,assessment of plaque stability and prediction of major adverse cardiovascular events(MACE).Methods The clinical data of 168 patients who were suspected of angina pectoris of coronary heart disease in the hospital from January 2020 to December 2022 were retrospectively selected.According to the clinical manifestations,the patients were divided into stable angina pectoris(SAP)group(61 cases)and unstable angina pectoris(UAP)group(107 cases).The patients were classified into MACE group(n=39)and non-MACE group(n=129)according to whether there were MACE within 1 year of follow-up.All patients underwent coronary angiography and CTA examination,and the application value of CTA in the diagnosis of angina pectoris of coronary heart disease,assessment of plaque stability and prediction of adverse cardiovascular events was evaluated.Results The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of CTA in diagnosing angina pectoris of coronary heart disease were 0.968,0.837,0.935,0.945,0.900 and 0.824 respectively,and CTA had a good consistency with coronary angiography.The detection rate of soft plaque in SAP group was significantly lower than that in UAP group(P<0.05)while the detection rate of calcified plaque was significantly higher than that in UAP group(P<0.05),but there was no statistical significance in the detection rate of mixed plaque between the two groups(P>0.05).The total plaque volume,total plaque load,coronary artery diameter stenosis rate and plaque length in MACE group were significantly higher than those in non-MACE group(P<0.05),and the minimum lumen area was significantly lower than that in non-MACE group(P<0.05).Multivariate logistic regression analysis showed that total plaque load(OR=1.137,95%CI:1.065-1.214),coronary artery diameter stenosis rate(OR=1.174,95%CI:1.058-1.302)and plaque length(OR=1.48895%CI:1.216-1.821)were relate

关 键 词：CT血管成像 冠心病 心绞痛 斑块稳定性 不良心血管事件 

分 类 号：R814[医药卫生—影像医学与核医学]