基于CT血流储备分数评估冠心病合并高脂血症患者预后的研究  

Prognostic value of CT fractional flow reserve assessment of patients with coronary artery disease combined with hyperlipidemia

作　　者：欧阳丽娜 王晶晶 张怀瑢 王瑞 吴倩 王霈[1] 牛媛媛 朱力[1] OUYANG Li-na;WANG Jing-jing;ZHANG Huai-rong;WANG Rui;WU Qian;WANG Pei;NIU Yuan-yuan;ZHU Li(Department of Radiology,the Affiliated Hospital of Ningxia Medical University,Yinchuan 750003,China;Department of Ultrasonography,Ningxia Guolong Hospital,Yinchuan 750003,China)

机构地区：[1]宁夏医科大学总医院放射科,宁夏银川750003 [2]宁夏国龙医院超声科,宁夏银川750003

出　　处：《中国临床医学影像杂志》2025年第4期245-249,255,共6页Journal of China Clinic Medical Imaging

基　　金：2022年度宁夏重点研发计划(2022BEG02025);宁医大总院[2023]394号2023年新入职硕士人才培养项目。

摘　　要：目的:分析影响冠心病合并高脂血症患者预后的不良斑块特征,并建立冠心病合并高脂血症患者未来发生主要不良心血管事件(MACE)风险的预测模型。方法:收集2016年1月—2020年12月于宁夏医科大学总医院诊断为冠心病、且合并高脂血症的患者102例,随访患者36月内MACE结局。对比MACE组和MACE阴性组间冠状动脉CTA(CCTA)管腔狭窄程度、斑块定性及定量特征及CT-FFR值,采用Logistic回归筛选出于MACE相关的独立危险因素,分别使用ROC曲线和Hosmer&Lemeshow检验评估模型的区分度和校准度。结果:共38例(37.25%)患者发生MACE。MACE组与MACE阴性组间管腔狭窄程度、斑块总负荷、非钙化斑块负荷、病变血管CT-FFR及ΔCT-FFR存在显著差异(P均<0.05)。Logistic回归结果显示:管腔狭窄程度、斑块总负荷、病变血管CT-FFR及ΔCT-FFR是冠心病合并高脂血症患者发生MACE的独立危险因素,联合上述指标的预测模型有较高的区分度(AUC 0.872,P<0.0001)和校准度(P=0.189)。结论:管腔狭窄程度、斑块总负荷、病变血管CT-FFR及ΔCT-FFR是冠心病合并高脂血症患者发生MACE的独立危险因素,对冠状动脉病变的解剖学特征及功能学特征的综合评估可提高对MACE的预测。Objective:To analyse the adverse plaque characteristics affecting the prognosis of patients with coronary artery disease combined with hyperlipidemia,and to establish a prediction model for the risk of future MACE in patients with coronary artery disease combined with hyperlipidemia.Methods:One hundred and two patients diagnosed with coronary artery disease and combined with hyperlipidemia in the General Hospital of Ningxia Medical University from January 2016 to December 2020 were collected,and the patients were followed up for MACE results within 36 months.The degree of luminal stenosis,qualitative and quantitative plaque characteristics,and CT-FFR values were compared between the MACE group and MACE-negative group,and Logistic regression was used to screen for independent risk factors associated with MACE,and ROC curves and the Hosmer&Lemeshow test were used to assess the discriminatory and calibrated nature of the models,respectively.Results:MACE occurred in a total of 38(37.25%)patients.Significant differences were found in the degree of luminal stenosis,total plaque burden,non-calcified plaque burden,CT-FFR of the diseased vessel,andΔCT-FFR between the MACE group and the MACE-negative group(all P<0.05).The results of the Logistic regression showed that:degree of luminal stenosis,total plaque burden,diseased vessel CT-FFR andΔCT-FFR were independent risk factors for MACE in patients with coronary artery disease combined with hyperlipidemia,and the prediction model combining the above indexes had a high discriminatory degree(AUC 0.872,P<0.0001)and calibration degree(P=0.189).Conclusion:The degree of luminal stenosis,total plaque burden,CT-FFR andΔCT-FFR of the diseased vessel are independent risk factors for the development of MACE in patients with coronary artery disease combined with hyperlipidemia,and a comprehensive assessment of anatomical and functional characteristics of coronary artery lesions may improve the prediction of MACE.

关 键 词：冠心病 高脂血症 体层摄影术 螺旋计算机 

分 类 号：R541.4[医药卫生—心血管疾病] R589.2[医药卫生—内科学] R814.42[医药卫生—临床医学]