【作者】 周小林；

【导师】 胡信群；

【作者基本信息】 中南大学 ， 内科学， 2012， 硕士

【摘要】 目的：冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)是当前国内外最常见和危害最大的心脏病,绝大多数患者死于冠状动脉不稳定斑块的破裂及继发血栓形成与心肌梗死。用新的检测技术,尽早检出易破裂和血栓形成的斑块,对于防治ACS有重要意义。本研究尝试通过应用64层多源螺旋CT与冠脉造影对照,联合炎症反应因子C-反应蛋白的检测从临床角度探讨其对冠脉斑块性质判别的临床价值。方法：选择2011年6月至2012年3月期间因有典型的临床症状收入我院住院冠心病患者21例,其中男性15例,女性6例,年龄39-80(58.1±10.9)岁。结合胸痛病史、心电图改变及相关实验室检查,按照Braunwald心绞痛分型标准把患者分为稳定性心绞痛和不稳定性心绞痛两组,均行64层双源螺旋CT冠状动脉成像及冠脉造影检查,分别对同一冠状动脉狭窄病变程度及其内的斑块病变进行评价,以冠脉造影为标准,评价MDCT诊断冠心病、判断狭窄程度的敏感性、特异性、阳性预测值、阴性预测值等指标,并初步分析不同临床诊断类型与冠状动脉病变的关系。结果1.不稳定性心绞痛组患者高敏C-反应蛋白3.72±0.76mg/L,稳定性心绞痛患者组高敏C-反应蛋白2.6±0.72mg/L,两组比较P<0.05,有统计学差异。2.在所有21例患者可评价的189(21×9)段冠状动脉节段,冠脉造影检查冠脉病变节段数52处,64层双源螺旋CT检出冠脉病变47处,两者比较无统计学差异(P>0.05)。与冠脉造影比较,MDCT检测敏感性93.6%,特异性94.3%,阳性预测值84.6%,阴性预测值97%。MDCT与CAG对不同程度的狭窄病变检测之间比较,P>0.05,无统计学差异。3.在两组患者之间MDCT检出狭窄病变分布情况比较,P>0.05,无统计学差异。两组患者MDCT检出狭窄程度之间比较,SA组以重度狭窄为主,UA组以中度狭窄为主。不同程度组间两两比较,轻度与中度狭窄、重度狭窄组比较P>0.05,无统计学差异。中度与重度组之间P=0.04,有统计学差异。在SA组以硬斑块为主,UA组以软斑块为主。组间两两比较,软斑块组与纤维斑块组及硬斑块组比较,P>0.05,无统计学差异。软斑块组与硬斑块组比较,P<0.05,有统计学差异。结论1.在急性冠脉综合征患者中可以根据高敏C-反应蛋白的升高的程度,反应斑块的稳定性。2. MDCT冠脉成像对冠状动脉的狭窄及斑块的评估有较高的准确性,能对冠脉斑块的形态和成分作出无创评价,反应斑块的稳定性。3. MDCT冠状动脉成像结合高敏C-反应蛋白检测,可作为一种无创、安全可靠的检测技术,在冠心病高危人群的筛查中有重要作用。更多还原

【Abstract】 Objective:Coronary artery disease (CHD) is the most common and harmful heart disease at home and abroad. About70%of the CHD patients died of coronary plaque rapture, thrombosis and myocardial infarction caused by the instability coronary artery atherosclerosis plaques. Detecting the easy rupture and thrombosis patches as early as possible through new testing technology holds significant value for the prevention and control of ACS. The present study will discuss the clinical value of64spiral CT in the discrimination of coronary artery plaque through the contrast between the results of64spiral CT in CHD patients and that of selective coronary angiography and the analysis of the changes of C-reaction protein in those patients.Methods:21CHD patients [15male,6female, age range from39-80(58.1±10.9)] with typical clinical symptoms who were admitted in the department of cardiology at the Second Xiangya Hospital of Central South University from June2011-March2012were enrolled in the study. According to Braunwald angina pectoris classification standard and chest pain history, ECG changes and related laboratory results, patients were divided into stable angina group and unstable angina group. Both of dual-source coronary artery spiral CT imaging and coronary angiography will be used to evaluate the stenosis degree and the plaque lesions of the same coronary artery. Many indexes of MDCT in diagnosing CHD and judging the stenosis degree of coronary artery such as sensitivity, specificity, the positie predictie alue, negatie predictie value will be evaluated by the evaluation criterion based on the results of coronary angiography. We will also preliminary analyse the relationship between different clinical diagnosis forms and coronary artery pathological changes.Results:1. The serum level of hs-CRP of patients with unstable angina pectoris (3.72±0.76mg/L) was higher than that of patients with stable angina pectoris (2.6±0.72mg/L), the difference had statistical significance (P<0.05).2. Among all the assessable189(21x9) periods of coronary artery segments of21patients, coronary angiography detected52coronary lesions section, while the number of64layer spiral CT was47, the difference had not statistical significance (P>0.05). Compared with coronary angiography, the detection sensitivity of MDCT was93.6%, specificity was94.3%, the positie predictie alue was84.6%and the negatie predictie alue was97%. The comparison between MDCT and CAG for different degrees of narrow lesions detection had no statistical significance (P>0.05).3. Between the two groups, the comparison of MDCT results in narrow lesions distribution of coronary artery had no statistical significance (minimum P value is0.217>0.05). Among the MDCT detection results of the two groups, severe stricture is the major detection of SA group, while moderate narrow was primary in UA group. The comparison between two groups in different stenosis degree of coronary artery had no statistical significance (P>0.05). However, the comparison between moderate and severe stenosis degree had a statistical significance (P=0.04).4. Hard plaque is primary lesions in SA group, while soft patch is the main lesion of UA group. All the three groups (soft patch group, fiber plaques group and hard plaques group) are compared in pairs, and the difference between each two of them had no statistical significance (P>0.05). The comparison between soft patch group and hard plaques group had statistical significance (P<0.05).Conclusions:1. It is useful for us to evaluate the stability of the plaques of the patients with acute coronary syndrome according to the elevated extent of hs-CRP. 2. MDCT coronary artery imaging can judge the coronary artery stenosis and the quantitative of coronary artery plaques with high accuracy, noninvasively evaluate the shape and composition of coronary artery plaque.3. MDCT coronary artery imaging have higher accuracy in judging coronary artery stenosis and quantitative of plaques. MDCT combined with hs-CRP, can be used as a noninvasive, safe and reliable detection technology and play an important role in detecting coronary heart disease patients in high-risk group.更多还原