稳定型与不稳定型心绞痛患者电子束CT 冠状动脉钙化检测的比较

【目的】比较稳定型心绞痛（SAP）与不稳定型心绞痛（UAP）患者冠状动脉(冠脉)钙化（CAC）的不同模式。【方法】67例SAP与94例UAP患者，行选择性冠脉造影和电子束CT（EBCT）检查，分析两组CAC积分（CS）的差异及其与冠脉狭窄程度之间的关系。【结果】①SAP组CAC检测阳性率（100%）显著高于UAP组（87.23%）（P<0.05）。②SAP组CAC积分显著高于UAP组，其自然对数转换值［ln（CS+1）］的均数按心脏整体计算为（5.24±1.72）对（3.13±1.96）（P<0.001），按冠脉分支计算为（3.28±2.08）对（1.68±1.62）（P<0.001）。③在每一相同的年龄段内比较，SAP组的CAC程度均明显高于UAP组。④ln(CS+1)与冠脉狭窄程度在两组均呈正相关，但SAP组相关程度相对较好；SAP组重度狭窄的冠脉多发生重度或中度钙化，而UAP组重度狭窄的冠脉则多数无钙化或仅有轻度钙化。【结论】稳定型与不稳定型心绞痛患者冠脉钙化存在不同的模式，前者冠脉钙化大多较为严重，钙化积分与冠脉狭窄程度的相关性较好，而后者钙化程度多数较轻，钙化积分与冠脉狭窄程度的相关性很差。

Comparison of Coronary Artery Calcification Detected by Electron Beam Computed Tomography Between Patients with Stable Angina Pectoris and Unstable Angina Pectoris

【Objective】 To compare the different patterns of coronary arterycalcification (CAC) in stable angina pectoris (SAP) and in unstable angina pectoris (UAP). 【Methods】 Sixty-seven patients with stable angina pectoris and 94 patients with unstable angina pectoris underwent electron beam computed tomography (EBCT) and selective coronary angiography. The difference of CAC score (CS) in patients with SAP versus UAP and the correlation between CS and severity of angiographically detected coronary narrowing were separately analyzed in the two groups. 【Results】 ①The positive percentage of CAC in patients with SAP was 100%, significantly higher than the 87.23% in UAP patients (P<0.05). ②The natural logarithm transformation of CAC score ln (CS+1)] were (5.24±1.72) in SAP vs (3.13±1.96) in UAP by whole-heart (P<0.001), and (3.28±2.08) vs (1.68±1.62) by individual coronary artery (P<0.001). ③The tendency that severity of CAC is increasing with aging was more apparent in SAP group than in UAP group. If compared at the same age, the patients with SAP usually had more extensive calcium deposits than those with UAP. ④In both groups, ln (CS+1) had positive correlation to the extent of arterial stenosis, but the degree of correlation was better in SAP group than in UAP group. Severe coronary stenosis (defined as maximal percent diameter reduction ≥75%) in SAP group occurred most often in extensively or intermediately calcified coronary arteries, whereas in UAP group it occurred more often in mildly calcified or noncalcified arteries. 【Conclusions】 EBCT results demonstrate that there are different patterns of coronary artery calcification between patients with stable angina pectoris and unstable angina pectoris. Extensive calcification and significantly positive correlation between calcium score and lumen narrowing characterize the coronary arteries of patients with stable angina pectoris, whereas in those with unstable angina pectoris the arteries are less frequently and severely calcified, and the calcium score is poorly correlated to lumen stenosis.