CCTA斑块特征在冠状动脉管腔狭窄程度进展预测及预后的价值研究  

Predictive Value of CCTA Plaque Characteristics for the Progression and Prognosis of Coronary Artery Stenosis

作　　者：李正腾 王敏[1] 潘冬梅 王宪凯 LI Zhengteng;WANG Min;PAN Dongmei;WANG Xiankai(Department of Radiology,Jining No.1 People’s Hospital,Jining 272000,China)

机构地区：[1]济宁市第一人民医院放射科,山东济宁272000

出　　处：《CT理论与应用研究(中英文)》2025年第1期23-30,共8页Computerized Tomography Theory and Applications

基　　金：济宁市重点研发计划双源CT双能量减影技术在评估严重钙化冠状动脉狭窄程度的应用研究(2023YXNS074);AI辅助下的冠状动脉CTA预测斑块进展和急性冠脉综合征的价值探讨(2024YXNS173)。

摘　　要：目的:探讨冠状动脉CTA(CCTA)斑块定性、定量特征在预测冠状动脉管腔狭窄程度进展及预后的价值。方法:回顾性分析济宁市第一人民医院2018年5月至2023年8月行2次CCTA检查的患者66例,分为管腔狭窄非进展组和进展组,将患者CCTA图像传入人工智能软件进行斑块分析,共检出斑块87个。分析参数包括一般临床资料、斑块性质、狭窄范围、斑块长度、钙化成分CT值及体积、非钙化成分CT值及体积、低密度成分CT值及体积、斑块总体积、总钙化积分、钙化斑块等效质量、重构指数、低密度斑块、正性重构、“餐巾环征”、点状钙化。分别比较斑块进展组和非进展组以及存在易损斑块和非易损斑块患者的预后情况。结果:与狭窄非进展组相比,进展组糖尿病、易损斑块比例高于非进展组;进展组钙化积分、斑块钙化成分体积、钙化成分占比和钙化斑块等效质量低于非进展组且点状钙化发生率高于非进展组。多因素Logistic回归显示糖尿病(OR值=3.67,95%CI:1.21~11.11)、易损斑块(OR值=3.97,95%CI:1.32~11.94)、点状钙化(OR值=5.73,95%CI:2.03~16.17)为狭窄进展的独立危险因素,钙化成分体积(OR值=0.986,95%CI:0.976~0.997)为狭窄进展的独立保护因素。生存分析曲线显示,非进展组无MACE生存率高于进展组;非易损斑块组无MACE生存率高于易损斑块组。结论:糖尿病、易损斑块、点状钙化为狭窄进展的独立危险因素,钙化成分体积为狭窄进展的独立保护因素,冠状动脉CTA斑块定性、定量特征在预测冠状动脉管腔狭窄进展及预后中有较好的临床价值。Objective:To investigate the value of qualitative and quantitative plaque characteristics on coronary computed tomography angiography(CCTA)in predicting coronary stenosis progression and prognosis.Methods:This retrospective study analyzed the data of66 patients who underwent two CCTA examinations in Jining First People’s Hospital from May 2018 to August 2023.Patients were categorized into non-progressive and progressive groups.CCTA images were processed with an artificial intelligence software for plaque analysis,identifying 87 plaques.Analysis parameters included general clinical data;plaque characteristics;stenosis range;plaque length;CT values and volumes of calcified,non-calcified,and low-density components;total plaque volume;total calcification score;equivalent mass of calcified plaque;remodeling index;low-density plaque;positive remodeling;“napkin-ring sign;”and punctate calcification.Prognoses were compared between the progression and non-progression groups and between the vulnerable and non-vulnerable plaque groups.Results:The progression group had a higher proportion of patients with diabetes and vulnerable plaques compared to the non-progression group.The calcification score,calcified component volume,proportion of calcified components,and equivalent mass of calcified plaque in the progression group were lower than those in the non-progression group,whereas punctate calcification incidence was higher than that in the non-progression group.Multivariate logistic regression analysis indicated that diabetes(odds ratio OR=3.67,95%confidence interval CI:1.21~11.11),vulnerable plaque(OR=3.97,95%CI:1.32~11.94),and punctate calcification(OR=5.73,95%CI:2.03~16.17)were independent risk factors for stenosis progression,whereas calcification volume(OR=0.986,95%CI:0.976~0.997)was an independent protective factor.Survival analysis curve revealed that major adverse cardiovascular event-free survival rate was significantly lower in the progression group than in the non-progression group and similarly lower in the

关 键 词：冠状动脉CT血管造影 冠心病 斑块进展 

分 类 号：R814[医药卫生—影像医学与核医学]