冠状动脉0钙化积分人群非钙化性斑块的发生率及其危险因素分析

Frequency and risk factors associated with noncalcified coronary artery plaque in patients with zero coronary artery calcium score

目的利用计算机断层扫描(computerized tomography,CT)冠状动脉成像,研究冠状动脉0钙化积分人群非钙化性斑块的发生率及管腔狭窄程度,并分析其相关危险因素。方法对968例冠状动脉0钙化积分患者的影像学资料和临床资料进行回顾性分析,所有患者均行64层螺旋CT冠状动脉钙化积分扫描及CT冠状动脉成像检查;采用单因素分析和Logistic回归分析冠状动脉非钙化性斑块形成的相关危险因素。结果 968例患者中,203例(21.0%)检出非钙化性斑块,斑块导致轻度狭窄124例(61.1%)、中度狭窄53例(26.1%)、重度狭窄26例(12.8%)。Logistic回归分析显示原发性高血压(高血压)(OR=3.994,P=0.010)、男性(OR=2.663,P=0.000)、吸烟史(OR=1.376,P=0.001)、甘油三酯增高(OR=3.536,P=0.000)、高密度脂蛋白胆固醇降低(OR=0.653,P=0.008)为冠状动脉非钙化性斑块形成的危险因素。糖尿病史、血清甘油三酯和高密度脂蛋白胆固醇浓度与斑块导致的管腔狭窄程度有关。结论冠状动脉0钙化积分人群中有相当比例的人存在非钙化性斑块,高血压、高脂血症为非钙化性斑块形成的两大独立危险因素。

Objectives To assess the frequency,severity and risk factors of noncalcified coronary artery plaque （NCAP） determined by 64-slice computed tomography coronary angiography in patients with zero coronary calcium score.Methods Analysis of coronary artery calcium levels were performed using 64-slice computed tomography and coronary computed tomography angiography.The demographic data,clinical risk factors and imaging features of 968 consecutive patients were retrospectively analyzed.Univariate and multivariate analyses were carried out to identify the frequency and risk factors associated with the presence of noncalcified coronary artery plaques.Results Among the 968 patients,203 patients （21.0％） were found to have NCAP.Mild coronary artery stenosis was found in 124 patients （61.1％）,moderate stenosis in 53 patients （26.1％） and severe stenosis in 26 patients （12.8％）.Multivariate logistic regression analysis showed that hypertension （OR =3.994,P=0.010）,male （OR =2.663,P=0.000）,smoking （OR =1.376,P=0.001）,increased triglyceride （OR =3.536,P=0.000） and decreased high-density lipoprotein cholesterol （OR =0.653,P=0.008） were independent risk factors associated with the presence of NCAP in patients with zero coronary calcium score.Diabetes,levels of increased triglyceride and decreased high-density lipoprotein cholesterol were associated with the extent of NCAP.Conclusions NCAPs are found in a significant proportion of individuals with zero coronary artery calcium score.In addition,hypertension and hyperlipidemia are high risk factors associated with the development of noncalcified plaques.