256层螺旋CT评估主动脉夹层患者动脉弹性、左心功能及其相关性

Evaluation of Arterial Elasticity,Left Ventricular Function and Correlation by 256-slice Spiral CT in Patients with Aortic Dissection

目的利用256层i CT在心功能测定及动脉弹性指标测定的功能,对比分析主动脉夹层患者与非夹层对照者动脉弹性、左心功能及其相关性,为临床治疗主动脉夹层患者提供参考依据.方法选择以胸、背或腹部疼痛来昆明医科大学第二附属医院急诊,临床症状高度提示、平扫或增强确诊主动脉夹层的患者36例作为病例组,同时随机选取来昆明医科大学第二附属医院进行心电门控心脏冠脉检查并结果显示无主动脉夹层的患者40例作为对照组,所有研究对象行CTA一站式扫描并测量同层面动脉弹性及心功能.依据测量结果,评价病例组、对照组的动脉弹性指标并与所测心功能对比分析,进而评价主动脉夹层患者动脉弹性变化及其与左心功能的相关性.结果主动脉夹层患者动脉可扩张度及顺应性显著低于对照组人群(P<0.05),主动脉夹层患者平均直径变化率及僵硬度与对照组人群相比(P>0.05),差异无统计学意义,主动脉夹层患者僵硬度均值明显高于非主动脉夹层者.主动脉夹层患者动脉平均直径变化率、可扩张度与动脉的僵硬度呈高度负相关关系.Stanford A型、Tanford B型主动脉夹层患者各动脉弹性指标与心功能并无明显相关性,对照组人群各弹性指标与心功能也无明确相关性(r<0.3).结论 CTA一站式扫描可以作为主动脉夹层患者的动脉弹性、左心功能等多种参数测定的重要手段.早期动脉夹层患者可扩张度及顺应性明显降低、僵硬度升高、心功能无明显变化并与各弹性指标无明显相关性对临床具有重要提示意义.

Objective Using the function of 256-layer i CT in the determination of cardiac function and arterial elasticity index, to compare the arterial elasticity, left ventricular function and their correlation between patients with aortic dissection and non-dissected controls, and to provide a reference for the clinical treatment of patients with aortic dissection. Me thods This study selected 36 cases in our emergency department,with chest,back or abdominal pain, whose clinical symptoms were highly suggestive of aortic dissection, and plain or enhanced diagnosis confirmed aortic dissection as a case group. At the same time, we randomly selected 40 cases without aortic dissection as the control group. All subjects underwent CTA one-stop scanning and measurement of elastic and cardiac function at the same level. According to the measurement results, the arterial elasticity indexes and the measured cardiac function of the case group and the control group were evaluated and compared so that to evaluate the arterial elasticity and its correlation with left ventricular function in patients with aortic dissection.Re s ults patients＇ s arterial expansion and compliance in patients with aortic dissection were significantly lower than the control group（P〈 0.05）. The mean diameter change rate and stiffness of the patients with dissection were significantly lower than those in the control group（P〉0.05）. The difference was not statistically significant. The mean stiffness in patients with aortic dissection was significantly higher than non-aortic dissection patients. In patients with aortic dissection, the mean arterial diameter change rate, expandability and arterial stiffness showed a highly negative correlation. There was no significant correlation between arterial elasticity index and cardiac function in patients with Stanford type A and Stanford type B aortic dissection. There was no significant correlation between each elasticity index and cardiac function in the control group（r 0.3）. Conclus ion CTA one-stop scan can be used as an important measure of arterial elasticity, cardiac function and other parameters in patients with aortic dissection. Significantly lower aortic expansion and compliance, increased stiffness, insignificant changes in cardiac function, and insignificant correlation between cardiac function and each elasticity index in patients with early aortic dissection all have a clinical significance.