摘要
目的探讨320排CT诊断冠状动脉易损斑块的临床价值及分析易损斑块的危险因素。方法收集行320排CT血管造影(CTA)和冠状动脉造影的112例冠状动脉粥样硬化性心脏病(冠心病)患者,检测血清内皮素-1、基质金属蛋白酶-9(MMP-9)、IL-6、TNF-α和超敏-C反应蛋白(hs-CRP)。用320排CT检测冠状动脉斑块,根据CT值将对斑块分为易损斑块及非易损斑块:易损斑块CT值<50 Hu,非易损斑块≥50 Hu。分析易损斑块的危险因素。结果 320排CT检测冠状动脉斑块的灵敏度为90.6%,特异度为91.4%,阳性预测值为86.7%,阴性预测值为94.8%。易损斑块组和非易损斑块组的糖尿病、不稳定型心绞痛、稳定型心绞痛、单/双/多支病变例数、MMP-9、IL-6、hs-CRP比较差异均有统计学意义(P均<0.01),性别、高血压病、吸烟、年龄、总胆固醇(TC)、LDL-C、HDL、TC/HDL、内皮素-1和TNF-α比较差异均无统计学意义(P均>0.05)。Logistic回归分析显示MMP-9升高(P=0.0215,OR=2.33,95%CI 1.13~4.79)、hs-CRP升高(P=0.0008,OR=4.32,95%CI 1.84~10.15)和不稳定型心绞痛(P=0.0339,OR=4.33,95%CI1.12~16.77)是易损斑块的独立危险因素。结论 320排CT可无创性诊断冠状动脉易损斑块,MMP-9、hs-CRP和不稳定型心绞痛是易损斑块的独立危险因素。
Objective To evaluate the clinical value of 320-slice computed tomography angiography （320-CTA） in the diagnosis of the vulnerable coronary artery plaque and analyze the risk factors. Methods A total of l12 patients diagnosed with coronary heart disease received 320-CTA and coronary angiography. The levels of serum endothelin-1（ET-1）, matrix metalloproteinase-9 （MMP-9）, interleukin-6（IL-6）, tumor necrosis factor-α（TNF-α） and high sensitivity C-reactive protein （hs-CRP） were quantitatively measured.The coronary artery plague was analyzed by 320-CTA. According to the CT values, the plagues were divided into vulnerable （CT value 〈 50 Hu） and non-vulnerable plagues （CT value≥50 Hu）. The risk factors of vulnerable coronary artery plaque were analyzed. Results The sensitivity, specificity, positive predictive value and negative predictive value of 320-CTA in detecting coronary artery plaques were 90.6%, 91.4%, 86.7% and 94.8%, respectively.The levels of MMP-9, IL-6, hs-CRP, the quantity of coronary lesions, unstable angina pectoris, stable angina pectoris and diabetes mellitus significantly differed between the vulnerable and non-vulnerable plaque groups （all P 〈 0.001）. Logistic regression analysis revealed that MMP-9（P=0.0215, OR=2.33, 95%CI 1.13-4.79）, hs-CRP （P=0.0008, OR=4.32, 95%CI 1.84-10.15） and unstable angina pectoris （P=0.0339, OR=4.33, 95%CI 1.12-16.77） were the independent risk factors of vulnerable plaques. Conclusion 320-CTA is a noninvasive approach for the diagnosis of vulnerable coronary artery plaque. MMP-9, hs-CRP and unstable angina pectoris are the independent risk factors of vulnerable plaque.
出处
《新医学》
2017年第4期235-238,共4页
Journal of New Medicine
基金
国家自然科学青年科学基金(81101096)
广东省医学科研基金(B2011102)
广东省科技计划(2015A020212017)
广东省自然科学基金(2016A030313323)
