慢性肾疾病患者冠状动脉斑块特征的320排冠状动脉CT造影评价

Assessment with 320-rows coronary computed tomography angiography plaques characteristics in patients with chronic kidney disease

目的：本研究的目的是评估慢性肾疾病（CKD）患者320排冠状动脉CT造影（CCTA）动脉硬化斑块的特征。方法比较了由于胸痛和冠心病的筛查而接受320排CCTA检查的73例CKD患者[平均年龄（57.0±9.9）岁，64.8%的男性]和73例肾功能正常（NRF）者[平均年龄（55.0±12.3）岁，62.2%的男性]的冠状动脉粥样硬化斑块[存在斑块、斑块负荷、钙化斑块（CP）、单支病变、多支病变、非钙化斑块（NCP）、混合斑块（MP）和梗阻性狭窄]。结果单因素分析显示与NRF者比较，CKD患者单支病变发生率低（24.7%vs.45.2%，P＝0.041），而多支病变发病率明显增高（61.6%vs.6.9%，P＜0.001），存在斑块发病率高（86.3%vs.52%，P＝0.025）；CKD患者的斑块负荷明显增高（2.81±3.61 vs.0.76±0.87， P＜0.001）；其CP和MP发病率高（分别为53.4%vs.15.1%，P＜0.001，39.7%vs.13.7%，P＝0.036），而NCP发病率相似（24.7%vs.26.0%，P＝0.868）；另外，CKD患者有着高的冠状动脉梗阻性狭窄（50.7%vs.15.1%，P＝0.014）多因素Cox比例风险回归模型分析显示CKD患者有着明显高的斑块负荷[5.77（95%CI 2.95～14.38），P＜0.001]和明显高的多支病变和CP发病率[危害比分别为7.47（95%CI 3.11～16.17）， P＜0.001和5.82（95%CI 2.98～15.61），P＜0.001]。结论 CKD患者的斑块数负荷、多支病变和CP百分率明显高于NRF者，预示着有更高的发生冠状动脉不良事件的风险。

Objective To assess plaques characteristic as detected by 320-rows coronary computed tomography angiography in patients with chronic kidney disease（CKD）. Methods We compared coronary atherosclerotic plaques[presance plaque, plaque burden, single vessel lesion, multivessels lesions, calcified plaque （CP）, non-calcified plaque （NCP）, mixed plaque（MP） and obstructive stenosis] between 73 CKD patiants（mean age： 34±9.9, 43.8% males） and 73 normal renal function（NRF） patients （mean age：41±8.3, 67.1% males） who underwent 320-rows coronary computed tomography angiography（CCTA） for the evaluation of doubtful coronary artery disease. Results The single factor analysis showed that patients with CKD had a lower prevalence of single vessel lesion（24.7% vs. 45.2%, P=0.041） and a significantly higher prevalence of multivessels lesions（61.6% vs. 6.9%, P〈0.001） and a higher prevalence of presence plaque（86.3% vs. 52%, P=0.025） as compared to patients with NRF. Patients with CKD had a significantly higher plaque burden（2.81±3.61 vs. 0.76 ± 0.87, P〈0.001） as compared to patients with NRF.Patients with CKD had a higher prevalence of CP and MP （53.4% vs. 15.1%, P〈0.001, 39.7% vs. 13.7%, P=0.036, respectively） and a similar prevalence of NCP（24.7% vs. 26.0%, P=0.868） as compared to patients with NRF. In addition, patients with CKD had a higher prevalence of obstructive stenosis （50.7% vs. 15.1%, P=0.014） as compared to patients with NRF. The Cox proportional hazards models analysis showed that patients with CKD had a significantlyhigherplaque burden[5.77 95% CI （2.95-14.38）, P〈0.001] and a significantly higher prevalence of multivessels lesions[7.47（95% CI 3.11-16.17）, P〈0.001]and CP[5.82, 95% CI （2.98-15.61）, P〈0.001] as compared to patients with NRF only. Conclusion Patients with CKD had a significantly higher plaque burden and a significantly higher prevalence ofmultivessels lesions and CP as compared to patients with NRF. It is possible that they have a higher risk of future adverse coronary events.