螺旋CT冠状动脉校正性对比剂浓度差值联合生化指标评价冠状动脉狭窄的诊断效能

Diagnostic efficacy of differences in corrected coronary opacification measured with computed tomography combined with biochemical index in evaluating coronary artery stenosis

目的探讨冠状动脉校正性对比剂浓度(corrected coronary opacification,CCO)差值联合生化指标对冠状动脉粥样硬化性心脏病(冠心病)的诊断效能。方法将左前降支狭窄患者205例,按照狭窄率≥70%为界分为2组,≥70%患者119例,<70%患者86例,所有患者均检测三酰甘油(three acyl glycerol,TG)、总胆红素(total bilirubin,TBIL)、γ-谷氨酰转移酶(gamma glutamyl transferase,GGT)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、尿酸(uric acid,UA)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、载脂蛋白A(apolipoprotein A,APOA)、载脂蛋白B(apolipoprotein B,APOB)、脂蛋白a[apolipoprotein a,Lp(a)]、同型半胱氨酸(homocysteine,Hcy),所有患者均经过CT图像工作站的后处理,测量左前降支狭窄段前后的CCO值,并计算CCO差值。通过Logistic回归分析及ROC曲线筛选与冠心病密切相关的指标,与CCO差值进行联合检测。结果 2组各生化指标差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示UA、GGT、Hcy、APOB、Lp(a)为狭窄率≥70%的独立危险因素,通过ROC曲线筛选出CCO差值、GGT、APOB 3个指标的AUC>0.750。CCO差值联合GGT、APOB检测的灵敏度为92.4%,特异度为65.1%。结论通过CCO差值联合GGT、APOB检测提高了灵敏度降低了特异度,能显著提高冠心病狭窄率的诊断效能。

Objective To investigate the diagnostic efficiency of differences in corrected coronary opacification（CCO） measured with computed tomography combined with biochemical indexes for coronary heart disease.Methods The 205 patients whose left anterior descending artery stenosis rate were greater than 70%, were divided into two groups, 119 patients ≥70%, 86 patients〈70%. All patients were detected with the following parameters three glycerol（TG）, total bilirubin（TBIL）, gamma glutamyl transferase（GGT）, total cholesterol（TC）, high density lipoprotein cholesterol（HDL-C）, uric acid（UA）, glycosylated hemoglobin（HbA 1c）, low density lipoprotein cholesterol（LDL-C）, apolipoprotein A（APOA）, apolipoprotein B（APOB）, Lp（a）, homocysteine（Hcy）. All patients were treated by CT workstation image postprocessing, the differences in CCO before and after the left anterior descending branch stenosis was measured. The Logistic regression analysis and the ROC curve were used to screen the indexes closely related to coronary heart disease, and the differences in CCO.Results The difference of the biochemical indexes of the two groups was statistically significant（ P 〈 0.05）. Multivariate Logistic regression analysis showed that UA, GGT, Hcy, APOB, Lp （a） were independent risk factor. The stenosis rate was higher than 70%, the ROC curve is selected from the CCO, GGT, APOB. The difference of 3 indexes of AUC〉 0.750 . The sensitivity of difference in CCO combined with GGT and APOB was 0.924 , and the specificity was 0.651 .Conclusion Differences in CCO combined with GGT and APOB enhanced the sensitivity to reduce the specificity, and could significantly improve the diagnostic efficiency of the coronary stenosis rate.