冠状动脉钙化积分评估冠心病的临床价值研究

目的 探讨冠状动脉钙化积分（CCS）评估冠心病的临床价值.方法 采用16排螺旋CT测定96例入选冠心病患者CCS;同时使用导管法冠脉造影评估其冠状动脉,依据造影显示冠状动脉狭窄是否大于90%进行分组.分析患者性别、年龄、高血压病史、糖尿病史、吸烟史、血脂紊乱以及阳性家族史等各危险因素与CCS的相关性.结果 1.行导管法冠脉造影的96例患者中,冠脉狭窄 90%的冠心病患者CCS与狭窄介于50%～90%的冠心病患者CCS相比较有显著性差异（P〈0.05）;在该96例患者中,通过描绘ROC曲线,获得CCS诊断冠脉狭窄≥90%的标准,即ROC曲线截断点为187.5（灵敏度为85.7%,特异度为64.3%）.2.利用所获得的截断点以及二分类Logistic回归统计方法得出：冠脉狭窄程度与CCS、血脂紊乱、合并高血压和糖尿病史、吸烟史以及性别等呈正相关,OR分别为10.833、5.000、3.400、1.735、1.333（P〈0.05）;而高CCS与血脂素乱、合并高血压和糖尿病、糖尿病、高血压病、家族史、吸烟史、性别等呈显著正相关,OR分别为14.880、13.008、8.750、5.250、3.315、2.200、1.998（P〈0.05）,特别是血脂紊乱以及合并高血压和糖尿病的患者,与高CCS相关性明显强于其它传统危险因素.结论 高CCS与冠脉重度狭窄存在较强的相关性,故钙化积分的测定不仅对冠心痛的早期诊断有重要意义,对于冠脉狭窄程度的预判亦有重要的临床价值.

Research on Clinical Value of Coronary Calcium Score Evlaue Coronary Artery Disease

Objective To study the clinical value of coronary calcium score in evaluation of coronary artery disease. Methods The analysis involved 96 consecutive patients, who were admitted to hospital with symptoms of coronary artery disease, and CCS estimation using 16-slice CT were performed. Meanwhile, all the patients were evaluated coronary artery by coronary angiography. And the 96 patients were divided into two groups for the degree ofstenosis. In all patients the presence of the following arteriosclerosis risk factors was collected： sex, age, hypertension, diabetes mellitus, cigarette smoking, hyperlipidaemia, positive family history, which were analysed the correlation with coronary calcium score. Results 1. The differences between mean CCS values in patients with coronary stenosis from 50% to 90% and patients with coronary stenosis greater than 90% varied significantly （p 〈0.05）. It meaned the patients who with severe coronary stenosis might have higher CCS. The cut-off point for total CCS for the presence of coronary artery stenosis greater than 90% in the study group was set at ≥ 187.5 （sensitivity 85.7% and specificity 64.3%）. 2. To make use of the cut-offpoint and Logistic regression analysis, the greatest influ- ence on the risk of significant stenosis was CCS, the next were hyperlipidaemia, complicated with hypertension and diabetes mellitus, cigarette smoking, positive family history and sex （0R=10.833, 5.000, 3.400, 1.735, 1.333, p 〈0.05）. And the high CCS were positive correlation with hyperlipidaemia,complicated with hypertension and diabetes mellitus, diabetes mellitus, hypertension,positive family history, cigarette smoking, and sex （OR=14.880, 13.008, 8.750, 5.250, 3.315, 2.200, 1.998, p 〈0.05）. Conclusions The high degree of coronary artery stenosis is correlative with CCS. The CCS is not only for the early diagnosis of coronary artery disease, but also to predict the degree of coronary artery stenosis.