多层螺旋CT在非ST段抬高性急性冠脉综合征患者冠脉病变诊断中的应用价值

目的应用256层螺旋CT冠状动脉成像(CTA)对不同年龄段的非ST段抬高性急性冠脉综合征(NSTEACS)患者的罪犯病变及斑块性质进行分析,探讨其在NSTEACS诊断中的应用价值。方法选取诊断为NSTEACS并在1周内行CTA和冠状动脉造影(CAG)者98例,常规收集病史资料及临床检查指标,按年龄分为≤50岁、50~70岁和≥70岁三组。所有入选患者首先应用256层螺旋CT进行CTA检查,接着在同一次住院期间通过CAG检查进一步确定其冠状动脉病变的情况。结果通过CTA检查98例NSTEACS患者中查出145个罪犯病变,以非钙化斑块及以钙化斑块为主的混合性斑块为最多见,占90.1%;256层CTA对NSTEACS患者罪犯病变诊断的敏感度为98.2%,特异度高达99.1%。其中≤50岁组CTA对冠状动脉病变诊断的敏感度、特异度、阳性预测值、阴性预测值和准确诊断指数分别为:93.1%、98.5%、86.9%、96.2%、91.6%;50~70岁组的相关数据分别为:95.6%、98.2%、85.8%、95.9%、94.2%;≥70岁组的相关数据分别为:94.5%、97.7%、87.9%、95.6%、92.2%。结论 256层CTA对NSTEACS患者罪犯病变的诊断有较高的敏感度、特异度,且与年龄无关。

The diagnostic value of multi-slice spiral CT in patients with non-st elevation acute coronary syndrome among different age groups

Objective To analyze the plaque characteristic in culprit lesions of patients with non-ST elevation acute coronary syndrome（ NSTEACS） in different age groups by 256-slice spiral CT coronary angiography（ CTA）,and explore its application value in NSTEACS. Methods 98 patients with non-ST elevation acute coronary syndrome（ NSTEACS） who underwent CTA and CAG within a week were included during hospitalization from June2012 to October 2013 The medical history and clinical examination data were collected. According to the age,the patients were divided into three groups： ≤50 years,50-70 years and ≥70 years. The 256-slice spiral CT were applied to examine CTA for all included patients and then CAG examination were conducted to confirm the situation of coronary lesions subsequently during the hospitalization. Results There were 145 culprit lesions among 98 patients by CTA examination,and the most common was mixed plaques（ non-calcified and calcified plaques）,which accounted for 90.1%. The sensitivity and specificity of the diagnostic procedure by 256-slice CTA in patients with NSTEACS was 98. 2%and 99. 1% respectively. In the ≤50 age group,the sensitivity,specificity,PPV,NPV and accurate diagnosis index is93. 1%,98. 5%,86. 9%,96. 2%,91. 6% respectively; the data of 50-70 age group was 95. 6%,98. 2%,85. 8%,95. 9%,94. 2%; the data of ≥70 age group was 94. 5%,97. 7%,87. 9%,95. 6%,92. 2%. Conclusion The sensitivity and specificity of the diagnostic procedure is high in patients with NSTEACS by 256-slice CTA,among different age groups.