冠状动脉硬化斑块与血液动力学及心脏事件关联性分析

Correlation analysis among coronary arteriosclerosis mottling,blood dynamics and cardiac event

目的探讨不同类型冠状动脉斑块与血液动力学及心脏事件之间的关联性。方法回顾临床相关资料,分析冠状动脉螺旋CT成像的软斑块、钙化斑块对血液动力学影响及在诱发心脏事件的差异。结果冠状动脉粥样硬化斑块致血管狭窄程度为20%～40%时,在流经斑块前后速度剖面满足抛物线分布;狭窄程度为50%时,速度剖面紊乱,几乎不呈抛物线分布,分布已不满足层流规律,有回流出现;狭窄程度在50%～75%时,斑块附近管轴上的速度反而比周围的速度小,速度剖面呈中心凹状,在斑块后部呈现明显的回流。软斑块、钙化斑块与心脏事件相关性比较,钙化斑块发生心脏事件93.3%,P<0.05,具有统计学意义。结论软斑块是可逆转的,对血液动力学无明显影响,但不稳定、易破碎是发生急性冠状动脉综合征关键,是心脏事件发生独立危险因素;钙化斑块是不可逆转的,对血液动力学有明显影响,但斑块稳定、不易破碎是稳定性心绞痛主要诱因,是冠状动脉疾病病程晚期表现。

Objective To discuss the correlations among different types of coronary artery mottling,blood dynamics and the cardiac event.Methods The correlated clinical data were retrospectively analyzed.The spiral CT image of soft coronary artery mottling and the effects of calcified mottling on the blood dynamics were analyzed.Meanwhile,the differences of calcified mottling in inducing the cardiac event were discussed.Results When the vascular stenosis caused by coronary atherosclerotic mottling was between 20%～40%,the velocity section before and after the mottling was in parabolic distribution;When the vascular stenosis was 50%,the velocity section was in disorder,the distribution did not meet the law and there was back-flow;When the vascular stenosis was between 50%～75%,the speed of the mottling near the tube axis was smaller than that around and the velocity section was in concave-shaped showing a clear return back in central part of the mottling.The correlations of soft mottling,calcified mottling and the cardiac events were compared,the incidence of cardiac events induced by calcified mottling was 93.3%,with statistical significances,P〈0.05.Conclusion The soft mottling is reversible and has no obvious effect on the blood dynamics,but it is unstable and fragile,therefore it is the key to the acute crown arteries syndrome and it is the independent hazard factor of cardiac event.The calcified mottling is irreversible and has obvious influence on the blood dynamics,but it is stable,not easily crumbled,therefore it is the major causes of angina and it is the manifestation of coronary artery disease at later satges.