基于CT血流储备分数联合冠状动脉血管成像在不稳定型心绞痛患者主要不良心血管事件中的预测价值  

Prognostic value of coronary angiography based on CT flow reserve fraction in patients with unstable angina pectoris

作　　者：李林[1] 张凌翔 汪远哲 Li Lin;Zhang Lingxiang;Wang Yuanzhe(Department of Radiography,Wuhan Huangpi District People′s Hospital/Huangpi District People′s Hospital Affiliated to Jianghan University,Wuhan 430300,China)

机构地区：[1]武汉市黄陂区人民医院/江汉大学附属黄陂区人民医院放射影像科,武汉430300

出　　处：《中国医师进修杂志》2024年第12期1121-1126,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的分析CT冠状动脉血流储备分数(CT-FFR)联合冠状动脉血管成像在不稳定型心绞痛(UAP)患者主要不良心血管事件(MACE)中的预测价值。方法回顾性选取2021年4月至2023年4月在武汉市黄陂区人民医院/江汉大学附属黄陂区人民医院治疗的106例UAP患者,其中8例失访,共98例最终完成随访,统计1年内MACE发生情况,根据是否发生MACE分为MACE组(21例)和非MACE组(77例)。比较两组一般资料、狭窄率、CT-FFR值、冠状动脉斑块特征,分析各参数指标与B型脑钠肽(BNP)、加拿大心血管病学会(CCS)心绞痛分级、病变血管支数的相关性,采用受试者工作特征(ROC)曲线分析各参数对UAP患者发生MACE的预测价值,采用Logistic回归分析UAP患者发生MACE的危险因素。结果两组BNP、CCS心绞痛分级、病变血管支数比较差异有统计学意义(P<0.05)。MACE组斑块总体积、狭窄率、钙化斑块体积、斑块负荷均高于非MACE组,CT-FFR值低于非MACE组[(142.56±18.94)mm^(3)比(132.78±15.43)mm^(3)、(68.22±10.78)%比(58.42±9.14)%、(9.35±1.85)mm^(3)比(8.05±2.02)mm^(3)、0.75±0.15比0.62±0.11、0.68±0.10比0.84±0.08],差异有统计学意义(P<0.05),上述各参数指标与CCS心绞痛分级、病变血管支数存在相关性(P<0.05)。ROC曲线分析结果表明,狭窄率、CT-FFR值、斑块总体积、钙化斑块体积、斑块负荷联合预测UAP患者发生MACE的曲线下面积为0.925,灵敏度为90.48%,特异度为83.12%。Logistic回归分析结果表明,狭窄率、CT-FFR值、斑块总体积、斑块负荷、钙化斑块体积是UAP患者发生MACE的危险因素(P<0.05)。结论UAP患者CT-FFR、狭窄率、冠状动脉斑块特征存在不同程度差异,且以上参数联合检测对预测UAP患者发生MACE具有一定临床价值。ObjectiveTo analyze the predictive value of CT coronary flow reserve fraction(CT-FFR)combined with coronary angiography in major adverse cardiovascular events(MACE)in patients with unstable angina pectoris(UAP).MethodsA total of 106 UAP patients treated in Wuhan Huangpi District People′s Hospital/Huangpi District People′s Hospital Affiliated to Jianghan University from April 2021 to April 2023 were retrospectively selected,among which 8 cases were lost to follow-up,and a total of 98 cases finally completed follow-up,and the occurrence of MACE within 1 year was counted,and they were classified into the MACE group(21 cases)and the non-MACE group(77 cases)according to whether or not MACE occurred.The general data,stenosis rate,CT-FFR and coronary plaque characteristics of the two groups were analyzed,and the correlation between each parameter index and B-type brain natriuretic peptide(BNP),Canadian angina pectoris(CCS)grade and the number of diseased vessels were analyzed.The predictive value was analyzed by receiver operating characteristic(ROC)curve,and the relationship between each parameter and the occurrence of MACE was analyzed by Logistic.ResultsThere were statistical differences in BNP,CCS and the number of diseased vessels between the two groups(P<0.05).The total plaque volume,stenosis rate,calcified plaque volume and plaque load in the MACE group were higher than those in the non-MACE group,the CT-FFR value was lower than that in the non-MACE group:(142.56±18.94)mm 3 vs.(132.78±15.43)mm 3,(68.22±10.78)%vs.(58.42±9.14)%,(9.35±1.85)mm 3 vs.(8.05±2.02)mm 3,0.75±0.15 vs.0.62±0.11,0.68±0.10 vs.0.84±0.08,there were statistical differences(P<0.05);the parameters above mentioned were closely correlated with CCS grade and the number of diseased vessels(P<0.05).The results of ROC curve analysis showed that the area under the curve of MACE in UAP patients predicted by the combination of all parameters was 0.925,the sensitivity and specificity were 90.48%and 83.12%.The results of Logistic analysis showed

关 键 词：体层摄影术 X线计算机 心绞痛 不稳定型 血流储备分数 心肌 心血管造影术 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]