256层螺旋CT测量冠状动脉校正性对比剂浓度与冠心病患者冠状动脉狭窄、斑块负荷及患者临床预后之间的相关分析

The correlation between corrected coronary opacification measurement with 256-slice spiral CT and coronary artery stenosis,plaque load and clinical ronosis in atients with coronarheart disease

目的研究CT冠状动脉造影(CT coronary angiography,CTCA)校正性对比剂浓度(correctedcoronary opacification,CCO)在冠心病患者血管狭窄、冠状动脉斑块负荷及患者临床预后中的价值。方法选择205例左前降支狭窄的冠心病患者,患者临床均已行TIMI评分,通过256层螺旋CT行冠状动脉CT成像检查,经CT图形工作站分别测量患者冠状动脉狭窄段前后管腔内的CCO值及其狭窄段前后的CCO差值,患者均检测三酰甘油、总胆固醇、总胆红素、尿酸、糖化血红蛋白、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、脂蛋白a、γ-谷氨酰转移酶、同型半胱氨酸、载脂蛋白A,患者行冠状动脉造影(coronary arteriongraphy,CAG)及血管内超声(intravenous ultrasound,IVUS)检查,采用多元线性回归分析法分析CCO差值与CAG冠状动脉狭窄率、IVUS狭窄率、IVUS测量的斑块负荷及TIMI评分的相关性。结果 CCO差值与CAG测量的冠状动脉狭窄率、IVUS狭窄率、IVUS测量的斑块负荷及TIMI评分的相关系数分别为0.646,0.464,0.656及0.722,多元线性回归分析法测量CAG冠状动脉狭窄率、IVUS狭窄率、IVUS测量的斑块负荷及TIMI评分与CCO差值的决定系数为0.537。结论CCO差值与冠心病患者冠状动脉血管狭窄、冠状动脉斑块负荷及冠状动脉管腔内血流动力学的变化有很好的相关性,它可能成为一种新的快速、无创及方便的冠心病的评价指标。

Objective To study the value of coronary artery corrected contrast medium concentration(CCO)in evaluating coronary stenosis,coronary plaque load and clinical prognosis in patients with coronary heart disease by spiral CT.Methods Two hundred and five patients with coronary artery disease with stenosis of left anterior descending artery were enrolled in this study.All of them had TIMI score and underwent coronary CT imaging with 256-slice spiral CT.The CCO values in the anterior and posterior lumen of coronary artery stenosis and the CCO differences before and after the stenosis were measured by CT imaging workstation.Three acyl glycerol,total bilirubin,gamma glutamyl transferase,total cholesterol,high density lipoprotein cholesterol,uric acid,glycosylated hemoglobin,low density lipoprotein cholesterol,apolipoprotein A,apolipoprotein B,apolipoprotein a,coronary arteriongraphy,homocysteine were detected in all patients.Patients underwent coronary angiography and intravascular ultrasound.Multivariate regression analysis was used to analyze the correlation between CCO difference,coronary arteriongraphy(CAG)coronary stenosis rate,intravenous ultrasound(IVUS)stenosis rate,plaque burden measured by IVUS and TIMI score.Results The correlation coefficients between CCO difference,CAG-measured coronary stenosis rate,IVUS stenosis rate,IVUS-measured plaque load and TIMI score were 0.646,0.464,0.656 and 0.722 respectively.The determination coefficients of CAG-measured coronary stenosis rate,IVUS-stenosis rate,IVUS-measured plaque load and TIMI score and CCO difference were 0.537 by multivariate linear regression analysis.Conclusion CCO difference has a good correlation with coronary artery stenosis,plaque load and coronary artery intraluminal hemodynamics in patients with coronary heart disease.It may become a new rapid,noninvasive and convenient evaluation index of coronary heart disease.