心脏CT联合颈动脉超声无创性评估疑似冠状动脉疾病患者动脉粥样硬化病变的研究  

Cardiac CT combined with carotid ultrasound for noninvasive evaluation of atherosclerosis in patients with suspected coronary artery disease

作　　者：薛军 吴迪 王旭 郑金刚[3] 范煜东 XUE Jun;WU Di;WANG Xu;ZHENG Jin-gang;FAN Yu-dong(Department of Cardiology,National Emergency Medicine Research Center,Beijing 100028,China;Imaging Department,National Emergency Medicine Research Center,Beijing 100028,China;Department of Cardiology,China-Japan Friendship Hospital,Beijing 100100,China)

机构地区：[1]国家应急医学研究中心,应急总医院心内科,北京市100028 [2]国家应急医学研究中心,应急总医院影像科,北京市100028 [3]中日友好医院心血管内科

出　　处：《中国心血管病研究》2024年第12期1063-1067,共5页Chinese Journal of Cardiovascular Research

基　　金：首都卫生发展科研专项项目(首发20221-4062)。

摘　　要：目的研究心脏CT联合颈动脉超声(US)无创性评估疑似冠状动脉疾病患者动脉粥样硬化病变的诊断价值。方法回顾性分析应急总医院2022年4月至2024年4月收治的107例不典型胸痛患者,其中64例男性,年龄(59±12)岁。107例不典型胸痛患者同时行心脏CT(CCT)和颈动脉US检查,联合评估动脉粥样硬化斑块的严重程度(梗阻性或非梗阻性)、位置、形状和成分。结果107例患者中,冠状动脉正常占36%(n=38),颈动脉正常占53%(n=57),33%的患者(n=35)在两个动脉区域出现斑块,然而只有2例患者在两个区域出现梗阻性狭窄。平均颈动脉内膜中层厚度(CIMT)为(1.0±0.3)mm。27例患者CIMT<0.9 mm;CMIT≥0.9时,冠心病斑块的差异无统计学意义(P>0.05)。冠状动脉斑块位于开口部位占7%(n=5),位于非开口部位占29%(n=20),位于两个部位均占64%(n=44)。颈动脉斑块位于颈内或颈外动脉起始部者占56%(n=28),位于分叉部者占20%(n=10),位于分叉部者占24%(n=12)(P<0.05)。冠状动脉区96%(n=66)和颈动脉92%(n=46)斑块形态偏心(P>0.05)。冠状动脉斑块钙化占25%(n=17),无钙化占19%(n=13),混合型占56%(n=39);颈动脉斑块钙化占8%(n=4),无钙化占8%(n=4),混合型占84%(n=42)(P<0.05)。非梗阻性冠状动脉占36%(n=39),梗阻性冠状动脉占28%(n=30);非梗阻性占44%(n=47),梗阻性占3%(n=3)(P<0.05)。结论CT联合颈动脉US评价在冠状动脉和颈动脉疾病病变严重程度,沿血管位置和斑块组成等方面中影像表现不同。Objective To explore the non-invasive diagnosis of atherosclerosis in patients with suspected coronary artery disease with cardiac CT combined with carotid artery ultrasound(US).Methods A total of 107 patients(64 males,age 59±12 years)with atypical chest pain in our hospital between April 2022 and April 2024 were selected.The patients underwent cardiac CT(CCT)and carotid US to evaluate the severity(obstructive or non-obstructive),location,shape,and composition of atherosclerotic plaques.Results Normal coronary artery accounted for 36%(n=38)and normal carotid artery accounted for 53%(n=57).There were plaques in both arterial regions in 35 patients(33%),but only 2 patients had obstructive stenosis in the both regions.The average carotid intima-media thickness(CIMT)was(1.0±0.3)mm and 27 patients had CIMT<0.9 mm.When CIMT was≥0.9,there was no statistically significant difference in coronary artery plaque between patients with and without coronary heart disease(P>0.05).The coronary artery plaque was located at the entrance of the artery in 7%(n=5)of the patients,at non-entrance sites in 29%(n=20),and in both sites in 64%(n=44).The carotid artery plaque was located at the starting point of the internal or external carotid artery in 56%(n=28)of the patients,at the bifurcation in 20%(n=10),and at the bifurcation in 24%(n=12)(P<0.05).In the coronary artery region,96%(n=66)and in the carotid artery,92%(n=46)of the plaques had eccentric morphology(P>0.05).25%(n=17)of the coronary artery plaques were calcified,19%(n=13)were non-calcified,and 56%(n=39)were mixed;8%(n=4)of the carotid artery plaques were calcified,8%(n=4)were non-calcified,and 84%(n=42)were mixed(P<0.05).Non-obstructive coronary artery disease was present in 36%(n=39)of the patients,while obstructive coronary artery disease was present in 28%(n=30);non-obstructive disease was present in 44%(n=47),while obstructive disease was present in 3%(n=3)(P<0.05).Conclusion Atherosclerotic disease presents different imaging manifestations by Cardiac CT combined with

关 键 词：心脏CT 颈动脉超声 冠状动脉疾病 动脉粥样硬化 

分 类 号：R541.4[医药卫生—心血管疾病]