双源CT冠状动脉斑块与冠心病临床类型的相关性

The Correlation of Coronary Artery Plaques in DSCT and Clinical Types of Coronary Heart Disease

目的评价双源CT(DSCT)冠状动脉斑块性质、形态及冠状动脉狭窄程度与冠心病临床类型的关系。方法 35例临床诊断为冠心病患者,据临床标准分成急性冠状动脉综合征(ACS)和稳定型心绞痛(SAP)两组,均接受DSCT冠状动脉成像与血管内超声(IVUS)检查。以IVUS检查为标准,测量斑块的性质、冠状动脉狭窄程度并评估斑块偏心性及血管重构。结果 35例(105支血管)59支病变血管共200段,对146个DSCT和IVUS对应病变节段分别行DSCT与IVUS测量,两项检查在血管重构指数、斑块偏心指数测量结果方面具有很好的一致性(P>0.05)。ACS组及SAP组之间的脂质斑块、钙化斑块节段数目有统计学差异(P<0.05),ACS组及SAP组之间的斑块偏心性、血管重构指数存在统计学差异(P<0.05)。结论与SAP对照,ACS在DSCT多显示为脂质斑块,斑块呈偏心性分布,病变血管多为正性重构。

Aim To evaluate the correlation of the plaque composition,morphology and degree of coronary artery stenosis with the clinical types of coronary heart disease. Methods 35 cases received dual-source CT （DSCT） coronary angiography and intravenous ultrasound （IVUS） examination in one month were collected from March,2008 to October,2010. The patients were divided into acute coronary syndrome （ACS） and stable angina pectoris （SAP） groups,according to clinical standards. Among 35 cases,there were 25 with ACS,10 with SAP. With the IVUS as the reference standard,DSCT was performed to measure the plaque composition and the degree of coronary artery stenosis,and to evaluate remodeling index （RI） and eccentric index （EI） of plaques. Results There were 105 vascular branches in 35 cases,including 59 branches in total of 200 segments with lesion vessels. Evaluable 146 segments with lesion vessels had a good consistency in RI and EI （P〉0.05）. There was a significant difference between ACS and SAP groups in the number of lipid and calcified plaques （P〈0.05）. The lipid plagues accounted for great proportion in ACS group and calcified plaques in SAP group. There was significant difference between RI and EI of plaque for the two groups （P〈0.05）.In 130 stenosed segments,there was no statistic difference in the degree of artery stenosis between ACS and SAP groups（P〉0.05）. Conclusion Compared with SAP,most of the segments with ACS are detected to have lipid plaque,eccentric distribution and positive remodeling by DSCT.