冠状动脉粥样硬化管腔重构与斑块形态的320排CT研究

Coronary atherosclerotic vascular remodeling and plaque morphological 320-raw coronary computed tomography angiography

目的探讨320排冠状动脉CT造影（CCTA）血管重构和动脉斑块形态学的关系。方法纳入经320排CCTA检查的382例冠心病患者。男279例（73.0%）,女103例（27.0%）,年龄36~86岁,平均（58±11）岁。CCTA分析包括阳性重构、钙化斑块（CP）、非钙化斑块（NCP）、混合斑块（MP）、梗阻性斑块、偏心性斑块。通过手工测量血管横截面积定义重构指数（RI）,RI=病变处血管横截面积/（病变处近端正常血管面积＋远端血管面积）/2。RI〉1.10为PR,RI〈0.95为NR。RI=0.95~1.10为无重构。结果 382例1255个节段被发现存在动脉斑块,其中PR 121例（31.7%）148个节段（11.8%）;NR 82例（21.4%）91个节段（7.3%）和无重构179例（46.9%）1016个节段（81.0%）。CP 159个节段（12.7%）、NCP 549个节段（43.7%）和MP 547个节段（43.6%）;梗阻性病变194个节段（15.6%）,非梗阻性病变1061个节段（84.4%）;偏心性斑块1054个节段（84.0%）,同心性斑块201个节段（16.0%）。单因素分析显示PR组MP、非梗阻性病变和偏心性斑块百分率高于NR和无重构组（75.0%、57.1%和40.8%,93.9%、82.4%和83.4%,99.3%、16.5%和87.8%,P值为0.034、0.041、0.044,均〈0.05）。在多因素Cox比例风险回归模型分析中,只有偏心性斑块是发生PR的独立因素。结论 CCTA表现为MP、非梗阻性斑块和偏心性斑块,PR发生率高,而偏心性斑块是发生PR的独立因素。

Objective To investigate relation of coronary atherosclerotic vascular remodeling and plaque morphological 320-raw coronary computed tomography angiography（CCTA） in patients with coronary artery diseases. Methods This study consisted of 382 consecutive patients with coronary artery diseases who underwent 320-raw CCTA examination, male 279 cases（73.0%）, female 103 cases（27.0%）, age 36-86（58±11）years. The CCTA analysis included the presence of positive remodeling （PR）, calcified plaque（CP）, non-calcified plaque（NCP）, mixed plaque（MP）, obstructive plaque, and eccentric plaque. The manual inspection was used to define the remodeling index（RI） in the axial cross section area. RI=the axial cross section area at the plaque site/the axial cross section area proximal to the plaque site in a normal-appearing vessel segment＋the axial cross section area distal to the plaque site in a normal-appearing vessel segment/2.The PR was defined by a RI〉 1.10, The NR was defined by a RI〈0.95, and non-remodeling was defined by a RI=0.95-1.10. Results Of the 382 patients, the 1255 plaques were observed, including PR in 121 cases （31.7%）, 148 segments（11.8%）, NR in 82 cases（21.4%）, 91 segments（7.3%） and non-remodeling in 179 cases （46.9%）, 1016 segments（81.0%）, CP in 159 segments（12.7%）, NCP in 549 segments （43.7%） and MP in 547 segments（43.6%）, obstructive plaque in 194 segments（15.6%）, non-obstructive plaque in 1061 segments（84.4%）; eccentric plaque in 1054 segments（84.0%）, concentric plaque in 201 segments（16.0%）. Segment-based single factor analysis showed that MP, non-obstructive plaque and eccentric plaque had a higher prevalence with PR compared with NR and non-remodeling（75.0% vs. 57.1% vs. 40.8%; 93.9% vs. 82：4% vs. 83.4%; 99.3% vs. 16.5% vs. 87.8%; P=0.034, 0.041, 0.044, respectively）. Segment-based Cox proportional ha2ards models analysis showed that only eccenlricifiveplaquewere independent predictive factors for PR（HR=2.15, 95% CI： 0.81-6.70, P〈0.05）. Conclusion The present study demonstrated that the MP, non-obstructive plaque and eccentric plaque had a higher prevalence with PR compared with NR and non-remodeling, then only eccentric plaque were independent predictive factors for PR.