【摘要】 目的探讨餐巾环征(NRS)和未来急性冠脉综合征(ACS)之间的关系。方法回顾性地分析2008-01-01—2013-05-31在我院行冠脉CT血管造影(CCTA)的患者499例。记录冠脉节段斑块特点包括非钙化斑块、钙化斑块和混合斑块,非阻塞性斑块和阻塞性斑块,低密度斑块,正性重塑斑块和餐巾环征斑块(PNRS)。随访以电话随访为主,辅以门诊随访、住院随访等,终点事件为ACS,随访截止时间为2013-06-30。生存率估算应用Kaplan-Meier法,两条生存曲线之间的比较采用log-rank检验。Cox比例风险模型评估PNRS与ACS之间的关系。结果7 119个节段、749个斑块纳入分析。26个(3.5%)斑块为PNRS,分别有11个(42.3%)、16个(61.5%)PNRS为正性重塑斑块和低密度斑块,20个(76.9%)PNRS为正性重塑斑块或低密度斑块,7个(26.9%)PNRS既是正性重塑斑块又是低密度斑块。随访结束时16例发生ACS,其罪犯节段的阻塞性斑块、正性重塑斑块、低密度斑块、PNRS均高于非罪犯节段,差异有统计学意义(P<0.05)。Cox比例风险模型证实,低密度斑块、正性重塑斑块和PNRS是预测罪犯节段即ACS事件的独立因素。NRS阳性组与阴性组无ACS生存曲线间差异有统计学意义(P<0.05)。结论 CCTA NRS与未来ACS事件密切相关,独立于正性重塑斑块和低密度斑块,NRS的检测有助于识别未来ACS事件的高危患者。更多还原

【Abstract】 Objective To determine the relationship between napkin- ring sign( NRS) on coronary computed tomography angiography( CCTA) and acute coronary syndrome( ACS) through a retrospective analysis. Methods Medical records of 499 patients who underwent coronary CCTA examination in our hospital between January 1,2008 and May 31,2013 were reviewed. Data on various plaque- associated variables( e. g.,non- calcified plaque,calcified plaque,mixed plaque,nonobstructive plaque and obstructive plaque,low- attenuation plaque,positive remodeling plaque,and plaque with NRS),and data on patient survival rate estimated with the Kaplan- Meier method were analyzed. The relationship between ACS and PNRS were analyzed using the Cox proportional hazards model. Results A total of 7 119 segments and 749 plaques were included in the analysis. PNRS was present in 26( 3. 5%) of the 749 plaques. Of these 26 plaques,11( 42. 3%) were positive remodeling plaques and 16( 61. 5%) were low- attenuation plaques,20( 76. 9%) were positive remodeling or low- attenuation plaques,and 7( 26. 9%) were overlapping positive remodeling and low- attenuation plaques. At the end of follow- up,ACS events were observed in 16 cases. Culprit lesions associated with ACS events had an increased prevalence of obstructive plaques,positive remodeling,low- attenuation or NRS than lesions not associated with ACS events. Cox proportional hazard analysis suggested that positive remodeling,low- attenuation,and NRS were good predictors of culprit lesions or ACS events. ACS- free survival curves were significantly different between NRS- positive and NRS- negative groups. Conclusion NRS on CCTA is closely related with the characteristics of ACS events,independently of positive remodeling plaque and low- attenuation plaque. NRS detection may help identify patients in high- risk of ACS events.更多还原