CT血管成像对冠心病患者斑块状态、管腔狭窄的评估效果及临床应用价值

张兰兰; 黄海珅; 李俊超; 程帅

doi:10.16766/j.cnki.issn.1674-4152.003447

CT血管成像对冠心病患者斑块状态、管腔狭窄的评估效果及临床应用价值

doi: 10.16766/j.cnki.issn.1674-4152.003447

1.
郑州市第七人民医院CT室，河南郑州 450012
2.
郑州市第七人民医院介入导管室
3.
郑州市第七人民医院心血管内科

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20210754

详细信息

通讯作者:
张兰兰，E-mail：zll287655@163.com

中图分类号: R541.4 R816.2
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- 文章访问数: 69
- HTML全文浏览量: 23
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-22
- 网络出版日期: 2024-05-29

Evaluation effect and clinical application value of CT angiography on plaque status and luminal stenosis in patients with coronary heart disease

1.
CT Room, the Seventh People' s Hospital of Zhengzhou Zhengzhou, Henan 450012, China

摘要

摘要: 目的分析CT血管成像(CTA)对冠心病患者斑块状态、管腔狭窄的评估效果及临床应用价值，以期为临床寻找适宜的无创检查方法提供参考。方法回顾性分析郑州市第七人民医院2019年10月—2022年10月收治的166例冠心病患者的临床资料，以冠状动脉造影(CAG)为“金标准”，计算CTA与CAG检查结果的一致性。基于CTA比较不同狭窄程度患者的冠脉节段斑块类型，分析CTA冠脉斑块特征及狭窄程度对主要心脏不良事件(MACE)发生风险的影响。结果 CAG共检出冠脉狭窄病变172处，CTA检出灵敏度、特异度及符合率分别为96.51%(166/172)、71.54%(352/492)、78.01%(518/664)，与CAG结果的一致性良好(Kappa=0.818，P＜0.001)。经CTA检查共检出89处冠脉斑块，轻度狭窄冠脉节段的非钙化(35.71%，10/28)、混合斑块(32.14%, 9/28)占比分别较中/重度狭窄[57.37%(35/61)、39.34%(24/61)]冠脉节段低，轻度狭窄冠脉节段钙化斑块(32.14%, 9/28)占比较中/重度狭窄(3.27%, 2/61)冠脉节段高，差异均有统计学意义(P＜0.05)。非钙化斑块体积、斑块长度及管腔直径狭窄率是MACE发生的独立影响因素(P＜0.001)。结论 CTA可较为准确地评估冠心病患者斑块状态、管腔狭窄情况。
- 冠心病 /
- 斑块状态 /
- CT血管成像 /
- 管腔狭窄
Abstract: Objective To evaluate the evaluation effect and clinical application value of CT angiography (CTA) on plaque status and lumen stenosis in patients with coronary heart disease, in order to provide reference for clinical search for appropriate non-invasive examination methods. Methods The clinical data of 166 patients with coronary heart disease admitted to the Seventh People' s Hospital of Zhengzhou from October 2019 to October 2022 were retrospectively analyzed. Coronary angiography (CAG) was used as the "gold standard" to calculate the consistency of CTA and CAG results. The types of coronary segmental plaque in patients with different degrees of stenosis were compared based on CTA, and the effects of coronary plaque characteristics and stenosis degree on the risk of major adverse cardiac events (MACE) were analyzed. Results A total of 172 coronary stenosis lesions were detected by CAG, and the sensitivity, specificity and coincidence rate of CTA were 96.51% (166/172), 71.54% (352/492) and 78.01% (518/664), respectively, which were in good agreement with the results of CAG (Kappa=0.818, P < 0.001). A total of 89 coronary plaques were detected by CTA. The proportions of non-calcified plaques (35.71%, 10/28) and mixed plaques (32.14%, 9/28) in the mild stenosis segments were lower than those in the moderate/severe stenosis segments [57.37%(35/61), 39.34%(24/61)]. The proportion of calcified plaques in mild stenosis segments (32.14%, 9/28) was higher than that in moderate/severe stenosis segments (3.27%, 2/61), and the difference was statistically significant (P < 0.05). Non-calcified plaque volume, plaque length and lumen diameter stenosis rate were independent risk factors for MACE (P < 0.001). Conclusion CTA can accurately evaluate the plaque status and lumen stenosis in patients with coronary heart disease.
- Coronary heart disease /
- Plaque status /
- CT angiography /
- Luminal stenosis

HTML全文

图 1 冠心病CTA图像

注：A为前降支钙化及非钙化斑块并管腔轻-中度狭窄，约50%；B为中段部分管腔走行于心肌内，回旋支钙化及非钙化斑块并管腔轻度狭窄，约25%；C为右冠状动脉钙化及非钙化斑块并管腔轻度狭窄，约30%；D为后降支非钙化斑块并管腔轻度狭窄，约30%，对角支、钝缘支、圆锥支、锐缘支管腔充盈良好，未见明显异常。

Figure 1. CTA image of coronary heart disease

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表 1 CTA与CAG对冠脉狭窄病变的检出情况

Table 1. The detection of coronary artery stenosis lesions by CTA and CAG

CTA	CAG		合计
CTA	病变血管节段	正常血管节段	合计
病变血管节段	166	40	206
正常血管节段	6	352	358
合计	172	492	664

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表 2 CTA与CAG诊断冠脉管腔狭窄程度的结果比较[例(%)]

Table 2. Comparison of the results of CTA and CAG in the diagnosis of coronary vessel lumen stenosis[cases(%)]

检查方法	例数	轻度狭窄	中度狭窄	重度狭窄
CAG	172	75(43.60)	69(40.12)	28(16.28)
CTA	206	99(48.06)	63(30.58)	44(21.36)
注：2组冠脉管腔狭窄程度比较，Z=-1.825, P=0.068。

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表 3 CTA检出钙化斑块在不同管腔狭窄中的分布情况[例(%)]

Table 3. Distribution of calcified plaque in different lumen stenoses detected by CTA[cases(%)]

管腔狭窄程度	例数	非钙化斑块	混合斑块	钙化斑块
轻度狭窄	28	10(35.71)	9(32.14)	9(32.14)
中/重度狭窄	61	35(57.37)	24(39.34)	2(3.27)
注：2组钙化斑块分布情况比较，χ²=14.986，P＜0.001。

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表 4 有、无MACE者CTA管腔狭窄及冠脉斑块特征比较(x±s)

Table 4. Comparison of CTA lumen stenosis and coronary plaque characteristics between patients with and without MACE(x±s)

组别	例数	非钙化斑块体积 (mm³)	钙化斑块体积 (mm³)	斑块负荷 (%)	混合斑块体积 (mm³)	管腔直径狭窄率 (%)
MACE组	29	164.65±25.14	8.76±1.11	0.72±0.12	128.56±9.45	67.56±5.56
无MACE组	137	106.85±19.54	9.03±1.16	0.59±0.06	126.55±8.31	56.33±3.56
t值		13.724	1.147	5.685	1.155	10.434
P值		＜0.001	0.253	＜0.001	0.250	＜0.001

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表 5 变量赋值情况

Table 5. Variable assignment

变量	赋值方法
非钙化斑块体积	≤136 mm³=0，＞136 mm³=1
斑块负荷	≤0.67%=0，＞0.67%=1
管腔直径狭窄率	≤60.5%=0，＞60.5%=1

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表 6 CTA管腔狭窄及冠脉斑块特征影响MACE发生的多因素分析

Table 6. Multivariate analysis of lumen stenosis and coronary plaque characteristics on CTA influencing the occurrence of MACE

变量	B	SE	Waldχ²	P值	OR(95% CI)
非钙化斑块体积	0.414	0.152	9.124	＜0.001	1.513(1.123~2.038)
斑块负荷	0.577	0.214	11.574	＜0.001	1.781(1.171~2.709)
管腔直径狭窄率	0.401	0.187	8.524	＜0.001	1.493(1.035~2.154)

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