宝石能谱CT评价冠脉支架再狭窄的临床研究

Clinical study of Gemstone Computed Tomography Angiography to evaluate coronary artery in-stent restenosis（ISR）

目的 评价应用宝石能谱CT检测冠状动脉支架再狭窄的可行性.方法 选取2014年6月至2015年12月入院,冠状动脉支架植入术后半年至1年并分别经宝石能谱CT和冠状动脉造影复查支架情况的患者100例,其中男性62例、女性38例,平均年龄（61.69±6.45）岁,共评价支架116枚.所有受试者植入支架内径不小于3.0 mm,无严重钙化病变.宝石能谱CT结果与冠状动脉造影结果对比,以冠状动脉造影的结果为金标准,评价宝石能谱CT检测冠状动脉支架再狭窄的可行性及特点.结果 对称性检验：P=0.7793认为检验结果在主对角线上是对称的,即宝石能谱CT和冠脉造影诊断结果具有线性趋势.一致性检验：Kappa值为0.5095,95％可信区间为0.3107～0.7083,认为宝石能谱CT和冠脉造影诊断再狭窄程度有一致性.两方法的相关性：CMH统计量x2=24.5189,P＜0.01,两法诊断结果具有较好的相关性.结论 支架内径不小于3.0 mm.无严重钙化病变的支架,应用宝石能谱CT冠脉血管成像可判定支架内再狭窄,与冠状动脉造影有较好的一致性.支架两端的再狭窄多于支架内部.

Objective To evaluate the feasibility of detecting coronary artery in-stent restenosis （ISR） using Gemstone Computed Tomography Angiography （GCTA）. Methods 100 patients were enrolled, 62 cases of men, 38 cases of women, who was in our hospital from June 2014 to December 2015. The average age was （61.69＋6.45）years old. All the patients received intracoronary artery stent implantation therapy 6 months to 1 year ago. 116 stents were checked by GCTA and coronary angiography. Stent diameter was not smaller than 3.0 mm, serious calcified lesions were excluded. To evaluate the feasibility of detecting coronary artery in-stent restenosis （ISR） and characteristics of ISR with GCTA, we compared the results of GCTA with the standard of coronary an- giography. Results Symmetry test： P=0.7793 it was recognized that the test results in the main diagonal was sym- metric, that was, the diagnosis and the results by GCTA and coronary angiography have the linear trend. Consis- tency test： Kappa value was 0.5095, of which 95% confidence interval was 0.3107-0.7083. It can be considered that GCTA and coronary angiography in the diagnosis of coronary restenosis have great degree of consistency. The relevance of the two methods： CMH statisticsx2=24.5189, P〈0.01, diagnostic results of the two methods was bet- ter relevant. Conclusion GCTA can be used for routine inspection of in-stent restenosis especially the diameter of the stent is not smaller than 3 mm and have no serious calcification. The two ends of the stent were easier to devel- op restenosis than within the stent.