CT冠状动脉造影不同斑块性质的冠心病患者临床特点分析

Clinical features of plaques with different characteristics detected by CT coronary angiography for patients with coronary heart diseases

目的评价冠状动脉计算机断层成像(CTCA)对冠状动脉斑块性质的评价能力,比较不同斑块性质患者的临床诊断结果和高敏C反应蛋白(HS-CRP)水平的差异。方法选择因怀疑冠状动脉病变就诊的患者,均在接受CTAT检查后进行冠状动脉造影(CAG),CAG检查结果冠状动脉狭窄率≥50%且CTCA检查存在斑块者纳入研究。根据CTCA检查显示斑块的CT值将患者分为软斑块组、钙化斑块组和混合斑块组,比较各组间的临床特征。同时,比较急性冠状动脉综合征(ACS)患者与慢性稳定型缺血性心脏病(SIHD)患者以及不同HS-CRP水平患者CTAT斑块分布的特点,评价软斑块联合HS-CRP识别ACS患者的价值。结果共有106例患者入选该研究,其中66例(62.3%)为软斑块组,13例(12.3%)为钙化斑块组,27例(25.4%)为混合斑块组,三组斑块的CT值分别为(35.2±11.8)、(252.3±40.9)和(88.3±19.6)HU。除钙化斑块组患者年龄高于软斑块组和混合组(P=0.036),三组间其他临床因素以及血肌酐、血肌钙蛋白和HS-CRP水平比较差异均无统计学意义(P>0.05)。ACS组与SIHD组、HS-CRP水平正常组与HS-CRP水平升高组患者的斑块分布情况均无统计学差异(P>0.05)。8例HS-CRP水平升高且合并软斑块的患者均诊断为ACS。结论CTCA可区别不同性质的冠状动脉斑块。不同临床诊断结果和不同HS-CRP水平患者的CTCA斑块分布并无差异,而HS-CRP水平升高且斑块为软斑块的患者均诊断为ACS。

Objective To evaluate the ability of coronary computed tomography angiography （CTCA） to distinguish the features of coronary atherosclerosis plaques and to compare the differences of clinical diagnostic results and the high sensitivity C-reactive protein （HS-CRP） level of patients with plaques of different features. Methods Patients with suspicious coronary artery diseases received the coronary angiography （GAG） after the CTAT examination. According to the results of GAG and CTCA, patients with stenosis rate of coronary artery ≥500/0 and plaques were enrolled. Patients were divided into the soft plaque group, mixed plaque group, and calcified plaque group according to their CT values. Clinical features of groups were compared. The distribution of CTAT plaque characteristics of acute coronary syndrome （ACS） patients, stable ischemic heart disease （SIHD） patients, and patients with different HS-CRP levels were compared. The value of identifying ACS patients by the soft plaque combined with HS-CRP was evaluated. Results A total of 106 patients were selected. The soft plaque group, calcified plaque group, and mixed plaque group had 66 patients （62.3%）, 13patients （12.3%）, and 27 patients （25.4%）, respectively. CT values of three groups were （35.2 ±11.8） HU, （252.3±40.9） HU, and （88.3 ± 19.6） HU, respectively. The differences of clinical features and levels of serum creatinine, tropouin, and HS-CRP of three groups were not statistically significant （P〉0.05） except that the age of the calcified plaque group was older than that of the soft plaque group and mixed plaque group （ P = 0. 036）. The differences of the distribution of plaque characteristics of the ACS group and SIHD group, and the normal HS-CRP level group and high HS-CRP level group were not statistically significant （P 〉0.05）. Eight patients with soft plaques and high HS-CRP level were all diagnosed with ACS. Conclusion CTCA can distinguish coronary atherosclerosis plaques with different features. There is no difference in the distribution of plaque characteristics of patients with different clinical diagnostic results and HS-CRP levels. Patients with soft plaques and high HS-CRP levels were all diagnosed with ACS.