128层螺旋CT冠状动脉成像在冠心病中的临床应用

Study on the 128-slice spiral CT coronary angiography and its applications on clinical diagnosis of coronary artery disease

目的探讨128层螺旋CT冠状动脉成像(128SCTCA)在冠心病中的临床应用价值。方法对349例疑似冠心病患者行128SCTCA筛查,对其中59例患者同时作选择性冠状动脉血管造影(CAG)检查,分析比较128SCTCA诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值和准确率。结果 341例患者成功完成了128SCTCA检查,并可清晰显示冠脉主干及其主要分支,193例患者的596支冠脉伴有不同性质的斑块和不同程度的狭窄,对其中59例冠心病患者以CAG为金标准,得出128SCTCA诊断冠脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为100%9、0.23%、92.57%、100%、95.59%。从59例患者的295支冠脉中检测出136个斑块,脂质软斑块、纤维斑块及钙化硬斑块分别占18%、11%、71%。结论 128SCTCA是一种无创的成像方法,冠心病的检出准确程度高,对冠状动脉狭窄的诊断准确率接近CAG,区分高危斑块优于CAG,作为冠心病的一种无创筛查手段具有很高的临床应用价值。

Objective To explore the clinical usage of 128-slice spiral CT coronary angiography（128SCTCA）in the coronary heart disease diagnosis.Methods 128SCTCA was performed in 349 patients who were suspected a coronary heart disease,and 59 of 349 patients underwent selective coronary angiography（CAG）.And then we analyzed the sensitivity,specificity,positive predicative value（PPV）,negative predicative value（NPV）and accuracy of the diagnosis results of 128SCTCA on coronary artery disease.Results 349 patients successfully completed 128SCTCA examination,and the coronary artery branches and the main sub-branches were clearly displayed.596 coronary artery branches of 193 patients were diagnosed to have coronary artery plaque with various characteristics and stenosis with various degree.According to the CAG standard,the sensitivity,specificity,positive prediction,negative prediction and accuracy of coronary artery stenosis of 59 cases diagnosed by 128SCTCA were 100 %,90.23 %,92.57 %,100 %,95.59 %,respectively.136 plaques were tested from the 295 coronary artery branches of the 59 patients.The lipid soft plaques,fiber plaques and hard calcified plaques accounted for 18%,11%,71%,respectively.Conclusion 128-slice spiral CT coronary angiography is a noninvasive imaging method to detect and diagnose coronary heart disease with a high extent of accuracy.The diagnostic accuracy rate is approximate to CAG in the diagnosis of coronary artery stenosis,or even better than CAG in distinguishing high-risk plaques.It is very useful in clinical application of coronary heart disease diagnosis.