640层动态容积CTA两种分类方法对冠状动脉斑块稳定性评价的对比研究

A Comparative Study of the Stability Evaluation of Coronary Plaque with Two Classification Methods by 640-Slice Dynamic Volume CT

目的对比640层动态容积CT血管造影（CTA）冠状动脉斑块密度分类法与高危斑块分类法对急性冠状动脉综合征（ACS）诊断的准确性。方法搜集120例有常规冠状动脉CTA检查资料的冠心病患者为研究对象,按照密度分类法分为钙化组（20例）、混合组（51例）及非钙化组（49例）三组;按照高危斑块分类法依据有无高危斑块特征（点状钙化、正性重构、低密度斑块、＂餐巾环征＂）分为阳性组（65例）及阴性组（55例）。以非钙化斑块及高危斑块为不稳定斑块。对比分析两种分类方法诊断的准确性,并采用统计学方法检验两种分类方法间及每种分类方法中组间差异。结果发生ACS的冠心病患者非钙化斑块及高危斑块的发生率较其他分组高（P〈0.05）。受试者工作特征（ROC）曲线显示,高危斑块分类法[曲线下面积（AUC）：0.729]较斑块密度分类法（AUC：0.676）对ACS的诊断价值大,而联合两种方法后诊断准确率较单种方法更高（AUC：0.766）。结论高危斑块分类法中的高危斑块比密度分类法中的非钙化斑块对ACS的诊断价值更大,联合两种分类方法能够进一步提高诊断准确率。

Objective To investigate the diagnostic accuracy of two coronary plaque classification methods with application of 640-slice dynamic volume CT for detecting acute coronary syndrome（ ACS）. Methods 120 patients with coronary heart disease conducted with routine coronary CT angiography were included into our study. According to the result of coronary plaques by CT,using two plaques classification methods to make groups,such as density classification method（ calcified n = 20/mixed n = 51/non-calcified n = 49） and high-risk plaque characteristics classification method（ positive n = 65/negative n = 55）,non-calcified plaques and high-risk plaques are indentified as unstable plaques. Compare the diagnostic accuracy of the two methods,and statistical methods were used to test the difference between the two methods and the difference between groups in each classification method. Results The incidence of non-calcified plaques and high-risk plaques in ACS patients was higher than that of other groups（ P 0. 05）. ROC curve analysis showed that high-risk plaque classification method（ AUC： 0. 729） has higher diagnostic efficiency compared with density classification method（ AUC： 0. 676）,moreover,diagnostic efficiency is further improvement after combining the two methods（ AUC： 0. 766）. Conclusion The diagnostic value of the high-risk plaques in the high-risk plaque classification method is greater than that of non-calcified plaques in the density classification method,and combining the two methods will make higher diagnostic accuracy for detecting ACS.