双源CT评估吸烟与冠脉斑块相关性的价值研究

Study on the Value of Dual Source CT Assessment of Smoking and Coronary Plaque Correlation

目的:利用双源CT(DSCT)血管成像技术探讨吸烟与冠状动脉粥样硬化斑块之间的相关性。方法:收集本院2012年4月到2013年4月接受DSCT冠状动脉造影检查的患者病例,以调查问卷为分组依据,先分为吸烟组和非吸烟组,再以是否有家族遗传史或合并糖尿病、高血压、高血脂等高危因素为剔除标准。选择余下的单纯吸烟组200例和单纯不吸烟组200例为本实验的研究对象。观察并比较两组患者斑块的发生率、分布特点、狭窄程度与斑块类型。结果:病变累及血管支数及范围比较:吸烟组冠脉3支血管病变发生率为23.0%,非吸烟组为7.0%;吸烟组弥漫性病变发生率为46.0%,非吸烟组为14.5%,两组比较差异均有统计学意义(P<0.05)。狭窄程度比较:吸烟组重度狭窄、完全闭塞的比例分别为27.5%、6.7%、非吸烟组分别为17.1%、3.7%,吸烟组较非吸烟组增高。斑块性质比较:吸烟组混合斑块的发生率为44.7%,非吸烟组为21.9%;而非钙化斑块的发生率,吸烟组为38.7%,非吸烟组为67.9%,两组比较差异均有统计学意义(P<0.05)。经调整年龄、性别和体重指数的统计学处理后,证明吸烟是混合斑块的独立危险因素。而通过不同吸烟指数分组的两两比较,混合斑块的发生率随吸烟指数的递增而增加。结论:DSCT冠状动脉造影能够准确评价冠状动脉粥样硬化斑块在吸烟和非吸烟患者之间的差异,吸烟者混合斑块发生率更高,更处于易发心血管事件的高危状态。

Objective： To investigate the correlation between smoking and coronary atherosclerotic plaque in DSCT angiography. Methods： The patients underwent DSCT coronary angiography, based on questionnaire packet basis, were divided into smoking group and non-smoking group first, then to eliminate high risk family history or diabetes, hypertension, hyperlipidemia and other factors, the rest of 200 cases of smoking group and 200 cases of non-smoking group were used for the experiment. Two groups were observed and compared the incidence rate of plaque, distribution characteristics and types. Results： The incidence rate of 3 coronary artery vascular lesions is 23.0% in smoking group and 7.0% in non smoking group; Incidence rate of diffuse lesions is 46.0% in smoking group, 14.5% in non smoking group, The difference between the two groups were statistically significant（P〈0.05）. Comparison of the degree of vascular stenosis： Severe stenosis was 27.5% and occlusion was 6.7% in smoking group; those were 17.1% and 3.7% respectively in non smoking. Plaque types： occurrence rate of mixed plaque is 44.7% in smoking group and 21.9% in non smoking group. The incidence of non calcified plaque was 38.7% in smoking group, 67.9% in non-smoking group, the difference between the two groups were statistically significant（P〈0.05）. The Logistic fitting multivariate regression models adjusted for age, sex and body mass index, smoking is an independent risk factor for mixed plaque. Mixed plaque was increased with the smoking index increasing through statistical analysis. Conclusion： DSCTCA can evaluate difference of coronary atherosclerotic plaque accurately between smokers and no-smokers. Incidence rate of mixed plaque in smokers is higher than no-smokers and having more risk prone to cardiovascular events.