45岁以下疑似冠心病患者冠状动脉计算机断层摄影术征象及相关危险因素分析

Coronary Computer Tomography Angiography Features and Associated Risk Factors of Coronary Artery Disease in Young Patients With Suspected Coronary Artery Disease

目的:量化≤45岁青年患者冠状动脉计算机断层摄影术成像(CCTA)的冠心病检出率,并初步探讨其影像学特征及相关危险因素。方法:选择我院接受CCTA检查的≤45岁青年患者2 099例,分析≤45岁青年人群中冠心病发病的危险因素,并且对≤20岁、21~30岁、31~40岁及41~45岁4组不同年龄段患者冠心病发病率及病变特征进行分析比较,观察图像并记录有无冠状动脉斑块及其性质和狭窄程度。结果:2 099例患者中,男性、吸烟、血脂异常、高血压、糖尿病及家族史在冠心病阳性患者中所占比率均高于冠心病阴性患者(P均<0.05~0.001)。CCTA检出冠心病患者229例,总检出率为10.9%(229/2 099);其中≤20岁检出率为3.1%(1/32),21~30岁检出率为6.2%(11/177),31~40岁检出率为9.7%(79/818),41~45岁检出率为12.9%(138/1 072),随着年龄的增加,发病率逐渐升高,差异有统计学意义(F=11.4,P<0.001)。单支病变患者发生率72.5%(166/229)显著高于多支病变患者发生率27.5%(63/229),差异有统计学意义(P<0.001);323支病变血管中,非钙化斑块183支(56.7%),其中低密度斑块39支(12.1%);混合斑块54支(16.7%);钙化斑块86支(26.6%),其中斑点状钙化斑块72支(22.3%)。重度狭窄及其以上158支(49.0%)。结论:青年≤45岁疑似冠心病患者CCTA图像上冠心病的检出率为10.9%,其影像学特征多表现为单支病变和非钙化斑块。对于临床怀疑冠心病的≤45岁青年患者,尤其具有吸烟、高血压、高血脂等危险因素且相关症状典型的30~45岁男性患者,可建议行CCTA检查。

Objectives： To observe the detection rate of coronary artery disease（CAD） by coronary computer tomography angiography（CCTA） in young patients with suspected CAD, and to explore the imaging features and related risk factors of CAD.Methods： Data from 2 099 patients aged≤45 years who underwent CCTA in our hospital due to suspected CAD were retrospectively obtained. The risk factors of CAD in this patient cohort were analyzed, detection rate and imaging features of CAD among≤20, 21-30, 31-40 and 41-45 years subgroups were compared. Presence or absence of coronary plaque, plaque nature and stenosis degree were recorded. Results： CAD was detected in 229（10.9%） out of 2 099 patients. Incidence of male gender, smoking, dyslipidemia, hypertension, diabetes mellitus, and family history of CAD was significantly higher in CAD group than in non-CAD group（P〈0.05-0.001）. Detection rate of CAD significantly increased in proportion with increase of age（F=11.4,P〈0.001） and was 3.1%, 6.2%, 9.7% and 12.9%, respectively in the ≤ 20,21-30,31-40 and 41-45 years groups. The proportion of single-vesseldisease（72.5%） was significant higher than the multiple lesion（27.5%） in CAD patients（P〈0.001）. There were 183（56.7%） non-calcified plaques including 39（12.1%） low-attenuation plaques and 54（16.7%） mixed plaques, 86（26.6%） calcified plaques including 72（22.3%） spotty calcified plaques in the 323 diseased vessels. Severe stenosis was found in 158（49.0%） vessels. Conclusions： The prevalence of CAD was 10.9% in this young patient cohort with suspected CAD and imaging features were characterized as single-vessel disease and non-calcified plaques. CCTA should be recommended to young patients with suspected CAD, especially in 30-45-year-old male patients with following risk factors： smoking, hypertension, hyperlipidemia, diabetes mellitus and family history of CAD.