64层螺旋CT冠状动脉成像与心血管疾病危险分层的相关性

目的 探讨64层螺旋CT(64MSCT)冠状动脉(冠脉)成像与心血管病危险分层的相关性.方法 收集疑诊冠心病患者470例,按64MSCT冠脉成像结果根据冠脉有无病变、病变范围、钙化积分、冠脉狭窄程度、斑块性质分组;其中80例患者同时行冠脉造影术,按冠脉造影结果根据冠脉有无病变、病变范围、冠脉狭窄程度分组.470患者按心血管病危险分层分为极高危、高危、中高危、中危、低危5组,观察各危险分层中冠脉病变情况,并分析相关性.结果 470例患者中同时行MS CT冠脉成像与冠脉造影者80例,判断冠脉病变范围(χ2=3.631,P=0.067)与狭窄程度(χ2=1.639,P=0.200)两种方法间差异无统计学意义.随着危险分层的增高,冠脉病变范围增加(极高危多支血管病变值分别为1.09、高危双支血管病变值分别为0.91、低危单支血管病变值分别为1.07,冠脉狭窄程度也增加、极高危重度狭窄值分别为0.96、高危中度狭窄值分别为1.03、低危.轻度狭窄值分别为0.78,各心血管危险分层之间冠脉病变钙化积分差异有统计学意义(F=256.20、123.76、62.50、98.24、52.36,P＜0.01).在极高危的患者中软斑块比例最高,随着危险分层降低钙化斑块比例增高或无斑块极高危软斑值分别为1.01、低危钙斑值分别为1.17.结论 64MSCT冠脉成像可作为心血管病危险分层的依据,患者冠脉病变复杂,狭窄程度、钙化积分程度严重,软斑块比例较高,危险分层越高;随着危险分层的降低,冠脉病变支数减少,钙化积分降低,狭窄程度减轻,斑块以钙化斑块比例增高或无斑块.

Relationship between risk stratification of cardiovascular diseases and outcome of 64-slice helical computed tomography coronary angiography

Objective To investigate the relationship between the risk stratification of cardiovascular diseases and the outcome of 64-slice helical computed tomography (MSCT) coronary angiography. Methods A total of 470 cases suspected to have coronary heart disease were enrolled.They all received 64-slice MSCT coronary angiography, and they were divided into groups according to the range of disease, degree of calcium scoring, degree of stenosis and characteristic of plaque. Among them, 80 patients underwent both MSCT and selective coronary angiography (CAG) at one time, and they were grouped according to the range of disease and degree of stenosis. All the 470 cases were classified as five levels according to the risk stratification of cardiovascular diseases. The lesions of coronary artery in different risk stratifications were observed, and the correlations were analyzed.Results In the 80 patients who underwent both MSCT and selective CAG, there were no significant differences in the range of coronary artery diseases(χ2=3.631, P=0.067) and coronary arterystenosis (χ2=1.639, P=0.200) between MSCT and CAG. Along with the increased level of the risk stratification, there were the more ranges of the coronary artery diseases (λvery high risk. multi-vessel disease=1.09,λhigh risk. double-vessel disease=0.91, λlow-risk. single-vessel disease=1.07)and the more degrees of coronary artery stenosis(λvery high risk. severe stenosis=0.96,λhigh risk. moderate stenosis=1.03,λlow-risk. mild stenosis=0.78). The degrees of calcium scoring in different risk stratifications of cardiovascular diseases showed significantly differences (F=256.20,123.76,62.50, 98. 24,52.36,P＜0.01). There was the highest percentage of soft plaque in very high risk patients.Higher percentages of fiber plaque, calcified plaque and mixed plaque were found in moderate risk and low risk patients(λvery high risk. soft plaque=1.01,λlow-risk. calcium plaques=1.17). Conclusions The 64-slice MSCT coronary angiography could provide a basis for assessing risk stratification of cardiovascular diseases. The complicated coronary artery disease, moderate-severe calcification, more severe stenosis, higher percentage of soft plaque are found in the very high risk patients. The lower level of the risk stratification is found in patients with the less range of the coronary artery disease and less severe degree of the coronary artery calcification and stenosis. The calcified plaque and mixed plaque are found in moderate risk and low risk patients.