不稳定心绞痛罪犯斑块冠状动脉CT造影与光学相干成像的相关性研究

The correlational study of computer tomographic coronary angiography(CTCA) and optical coherence tomography(OCT) to identify culprit plaques in unstable angina

目的 观察不稳定心绞痛患者的罪犯斑块的冠状动脉CT造影（CTCA）和光学相干成像（OCT）特征的相关性。方法 入选2012年6月~2014年2月在解放军总医院心内科住院并行CTCA、OCT检查的不稳定心绞痛患者，常规获取病史和临床检验指标。分析CTCA显示罪犯病变最小CT值、CT重构指数和OCT显示罪犯斑块最薄纤维帽厚度、内膜撕裂和血栓的关系。依据最薄纤维帽厚度分将患者为≤65μm和＞65μm两组，比较两组患者最小CT值、CT重构指数、内膜撕裂及血栓发生率情况。结果 最薄纤维帽厚度与对应截面最小CT值之间正相关，相关系数r=0.627，P＜0.001；而CT重构指数与最薄纤维帽厚度负相关，相关系数r=-0.45，P=0.006。最薄纤维帽厚度≤65μm和＞65μm两组患者CTCA显示的最小CT值（50.7±25.5 vs. 78.7±29.8，P=0.006）、CT重构指数（1.34±0.22 vs. 1.12±0.15，P=0.0013）、内膜撕裂（78.6% vs. 19%，P=0.001）均有显著统计学差异；血栓发生率有差别（50.0% vs. 14.3%，P=0.053），但未达统计学差异。内膜最薄厚度与CTCA及临床指标逐步回归分析显示内膜厚度与斑块最小CT值、CTRI相关，偏相关系数分别为0.64、-0.28。结论 结合CTCA最小CT值、CTRI对预测内膜撕裂的有帮助。

Objective To study the correlation of computer tomographic coronary angiography (CTCA) andoptical coherence tomography (OCT) characteristics to identify culprit plaques in patients with unstable angina.Methods From Aug 2012 to Feb 2014, patients with unstable angina in department of cardiology of Chinese PLAgeneral hospital receiving CTCA and OCT were enrolled to the study. Medical history and clinical examinationindicators were collected as normal. Relationship among minimum computer tomographic (CT) value of the culpritlesion, CT reconstruction index (CTRI), the thinnest fibrous cap thickness, intima tear and thrombus were analyzed.Patients were separated into two groups based on the thinnest fibrous cap thickness (≤65μm or >65μm), andminimum CT value of the culprit lesion, CTRI, incidence of intima tear and thrombus were compared. Resluts1. Positive correlation between thinnest fibrous cap thickness and the minimal CT value of corresponding crosssectionwas shown, r=0.627, P<0.001; but negative correlation was found between thinnest fibrous cap thicknessand CTRI, r= -0.45, P=0.006. 2. Significant differences between the two groups of followed characteristics werefoun: Minimum CT value (50.7±25.5 vs. 78.7±29.8,P=0.006), CTRI (1.34 ± 0.22 vs. 1.12 ± 0.15,P=0.0013),intima tear (78.6% vs. 19%,P=0.001). The incidence of thrombosis (50% vs. 14.3%,P=0.053) showed nosignificant difference. 3. Stepwise regression analysis showed that minimum CT value and CTRI are related to thefibrous cap thickness, partial correlation coefficients were 0.64 and -0.28. Conclusions Combined with minimumCT value and CTRI in CTCA may be useful to predict intima tear.