64排螺旋CT血管成像评价冠状动脉狭窄与斑块类型的相关性

Correlation between coronary artery stenosis and plaque type by CT angiography with 64-detector row CT

目的利用64排螺旋CT血管成像(CTA)探讨冠状动脉狭窄程度与斑块类型的相关性。方法采用美国心脏协会(AHA)推荐的15分段法分析冠状动脉树,评价每一个血管节段管腔狭窄程度及斑块类型。将管腔狭窄分为6级,0级:管腔正常;1级:管腔狭窄1%~29%;2级:管腔狭窄30%~49%;3级:管腔狭窄50%~69%;4级:管腔狭窄70%~99%;5级:管腔狭窄100%。根据CT值将冠状动脉斑块分为非钙化斑块、钙化斑块和混合斑块三种类型。结果入组患者125例,共对1740个血管节段进行分析。冠状动脉狭窄程度与对应的斑块类型存在明显相关性(r=0.834,P=0.000)。狭窄级别越高,混合斑块所占比例逐渐升高。冠状动脉管腔狭窄0~2级之间,不同斑块类型的分布存在差异,具有统计学意义(P<0.05),而在狭窄级别3~5之间,不同斑块类型分布差异不具统计学意义(P>0.05)。2级管腔狭窄,钙化斑块偏多,3~5级狭窄钙化斑块较少。结论冠状动脉狭窄程度与对应的斑块类型具有相关性。不同狭窄级别之间,斑块类型的分布存在差异。钙化在粥样硬化进程中的作用较为复杂,有待进一步研究。

Objective To evaluate the relationship between coronary stenosis and plaque type with CT angiography of 64-detector row CT. Methods Consecutive cases of coronary CT angiography were reviewed retrospectively. Coronary segmental evaluation was performed according to AHA classi cation and subdivision of coronary arteries into 15 segments. Coronary artery luminal stenosis was partitioned into five grades： grade 0（ normal coronary artery）,grade 1（ 1% ~ 29% stenosis）,grade 2（ 30% ~49% stenosis）,grade 3（ 50% ~ 69% stenosis）,grade 4（ 70% ~ 99% stenosis）,and grade 5（ 100% stenosis）. Coronary plaques were classified into three types based on CT attenuation value（ HU） ： non-calcified,calcified,and mixed plaques. Results One hundred and twenty-three subjects were enrolled in our study and 1740 coronry segments were analysed. Coronary stenosis showed obvious correlation with plaque type（ r = 0. 834,P = 0. 000）. The percentage of the mixed plaques showed an increasing trend with coronary stenosis increasing. There was significant differernce in distribution of three plaque type among coronary stenosis grades 0 ~ 2. However,there was no significant correlation among stenosis grade 3 ~ 5. Calcified plaques showed more frequently in stenosis grade 2,and less frequently in grade 3 ~ 5. Conclusion There was obvious correlation between coronary stenosis and plaque type. There was significant differences in distribution of plaque types among different coronary stenosis grades. The role of calcification in the process of coronary atherosclerosis is complicated.