摘要
目的评价多层螺旋计算机断层扫描(computed tomography,CT)血管造影(multislice computed tomography angiography,MSCTA)检测冠状动脉易损斑块的可靠性,建立急性冠脉综合征积分(score system of acute coronary syndromes,SACS),用于评估冠状动脉粥样硬化性心脏病(冠心病)患者危险分层。方法研究20例非急性冠脉综合征及41例急性冠脉综合征且冠状动脉MSCTA发现斑块的患者,比较两组斑块CT值、重构指数(RI)等指标,进而构建急性冠脉综合征发病风险预测模型。结果两组病变血管99支,可分析斑块117个,非急性冠脉综合征组36个,以钙化斑块为主(88.9%,32/36);急性冠脉综合征组81个,以脂质斑块为主(37.0%,30/81)。两组正性重构比例比较,差异有统计学意义(61.1%vs.32.1%,P<0.01);负性重构比例比较,差异有统计学意义(25.0%vs.19.8%,P<0.01)。由RI建立SACS,所得模型为:SACS=0.003PA+2.255RI-4.22,预测准确率为76.9%(P<0.01),受试者工作曲线下面积为0.815(P<0.01)。结论急性冠脉综合征患者冠状动脉斑块多为脂质斑块,以正性重构为主,SACS对急性冠脉综合征发病具有较高的预测价值,有助于临床指导冠心病危险分层及早期干预。
Objectives To evaluate the reliability of multislice computed tomography angiography （MSCTA） in detecting vulnerable coronary artery plaques,and to establish the score system of acute coronary syndromes （SACS） for predicting the risk of patients with acute coronary syndrome （ACS）.Methods Twenty non-ACS and 41 ACS patients with coronary plaques found by MSCTA were included in this study.The plaque attenuation （PA） and remodelling index （RI） were analyzed,and the ACS prediction model was established.Results There were 99 lesion vessels and 117 analysable plaques in all patients.Plaques in non-ACS group were mainly calcified （88.9%,32/36）,while those in ACS group were mainly lipid-rich （37.0%,30/81）.Rates of positive remodelling （61.1% vs.32.1%,P〈0.01） and negative remodelling （25.0% vs.19.8%,P〈0.01） between the two groups were obviously different.The predicting model of SACS was：SACS=0.003PA＋2.255RI-4.22,the accuracy rate was 76.9% （P〈0.01）,the area under the curve （AUC） was 0.815 （P〈0.01）.Conclusions Coronary plaques of patients with ACS are mainly lipid-rich and positive remodelling; SACS has a high predicting value for ACS,and can be used for clinical guidance for risk stratification and early intervention of coronary heart disease.
出处
《岭南心血管病杂志》
2013年第5期601-605,共5页
South China Journal of Cardiovascular Diseases
关键词
冠状动脉疾病
急性冠脉综合征积分
多层螺旋计算机断层扫描血管造影
重构指数
coronary artery disease
score system of acute coronary syndromes
multislice spiral computed tomography angiography
remodelling index
