基于冠状动脉CT血管成像的狭窄率联合斑块特征分析对CT诊断心肌缺血的研究价值  

Research of joint analysis of stenosis rate and plaque characteristics based on coronary CT angiography for CT diagnosis of myocardial ischemia

作　　者：秦鹏 张岩 赵锐 Qin Peng;Zhang Yan;Zhao Rui(CT Room,Henan Xuchang People′s Hospital,Henan 4610000,China)

机构地区：[1]河南省许昌市人民医院CT室,461000

出　　处：《实用医学影像杂志》2025年第1期13-17,共5页Journal of Practical Medical Imaging

摘　　要：目的 探讨联合分析基于冠状动脉CT血管成像(CCTA)的狭窄率与斑块特征对于CT诊断心肌缺血效能的研究价值。方法 选取某院2021年2月至2023年10月收治的接受冠状动脉造影检查的300例已知或疑诊冠心病患者,入院后1周内全部患者分别接受CCTA检查、冠状动脉造影检查以及血流储备分数(FFR)检查。测量病变斑块,收集斑块高危征象、病变长度、非钙化成分体积比、钙化成分体积比、斑块负荷等斑块特征。全部病变血管按照心肌FFR分成非缺血组(FFR>0.8)、缺血组(FFR≤0.8),对2组的斑块特征差异进行观察比较;Logistic回归分析缺血病变与斑块特征、狭窄率的相互关系;ROC曲线对斑块特征、狭窄率的特异度、灵敏度进行评估,并通过Delong检验比较各参数曲线下面积(AUC)。结果 缺血组中的餐巾环征、正性重构、CT高危斑块占比以及病变长度、斑块负荷均明显高于非缺血组,差异有统计学意义(P<0.05)。单因素分析结果发现,CT高危斑块、病变长度、斑块负荷、狭窄率均会影响心肌缺血的发生(P<0.05);多因素回归分析结果发现,心肌缺血的独立影响因素包括病变长度、狭窄率以及高危斑块(P<0.05)。在诊断心肌缺血时,与单独使用相比较,联合应用CCTA、病变长度、高危斑块能提高诊断特异度,差异有统计学意义(P<0.05)。结论 在诊断缺血病变时,联合应用CCTA狭窄率与病变长度、CT高危斑块等斑块特征,能明显提高冠状动脉CTA检查的诊断效能,具有临床推广价值。Objective To explore the value of joint analysis of stenosis rate and plaque characteristics based on coronary CT angiography(CCTA)in improving the efficiency of CT diagnosis of myocardial ischemia.Methods A total of 300 patients with known or suspected coronary heart disease who underwent coronary angiography in a hospital from February 2021 to October 2023 were selected.Within 1 week after admission,all patients underwent CCTA,coronary angiography,and fractional flow reserve(FFR)examination.The high-risk signs of plaque,lesion length,the volume ratio of non-calcified components,volume ratio of calcified components,plaque load and other plaque characteristics were collected.All the diseased vessels were divided into the non-ischemic group(FFR>0.8)and the ischemic group(FFR≤0.8)according to myocardial FFR.The plaque characteristics of the two groups were observed and compared.Logistic regression was used to analyze the relationship between ischemic lesions and plaque characteristics,stenosis rate.The specificity and sensitivity of plaque characteristics and stenosis rate were evaluated by the receiver operator characteristic curve(ROC),and the area under the curve(AUC)of each parameter was compared by Delong test.Results The napkin ring sign,positive remodeling,CT high-risk plaque proportion,lesion length and plaque load in the ischemic group were significantly higher than those in the non-ischemic group,and the differences were statistically significant(P<0.05).Univariate analysis showed that CT high-risk plaque,lesion length,plaque load,and stenosis rate all affected the occurrence of myocardial ischemia(P<0.05).Multivariate regression analysis showed that the independent influencing factors of myocardial ischemia included lesion length,stenosis rate and high-risk plaque(P<0.05).In the diagnosis of myocardial ischemia,compared with the single use,the combined application of CCTA,lesion length,high-risk plaque can significantly improve the diagnostic specificity,the difference was statistically significant(P<0

关 键 词：冠状动脉狭窄 CT血管成像 心肌缺血 斑块特征 诊断效能 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]