螺旋CT冠状动脉校正性对比剂浓度联合心肌灌注显像在冠心病诊断价值

The value of spiral CT coronary corrected contrast opacity combined with myocardial perfusion imaging in the diagnosis of coronary heart disease

目的:探讨螺旋CT冠状动脉校正性对比剂浓度,联合心肌灌注显像对冠心病预后的判断价值。方法:选取2017年3月至2018年2月,在我院接受数字减影血管造影(DSA)检查的冠心病患者211例作为研究对象,按照冠状动脉左前降支狭窄程度≥70%为严重狭窄组(n=121)和冠状动脉左前降支狭窄程度<50%的轻度狭窄组(n=90)。所有患者均进行CCO差值、心肌灌注显像相位参数(静息BW和SD、负荷BW和SD)检测,观察分析对应数据。通过Logistic回归分析与冠心病密切关联的指标,与CCO差值进行联合检测。采用ROC曲线分析具有差异的指标来预测冠心病预后的效能。结果:严重狭窄组患者的CCO差值、BW(静息)、SD(静息)、BW(负荷)、SD(负荷)均高于轻度狭窄组,差异有统计学意义(P<0.05)。多因素Logistics回归分析显示CCO差值、BW(静息)、BW(负荷)是冠状动脉左前降支狭窄率≥70%的危险因素。单独进行CCO差值的检测诊断冠状动脉左前降支狭窄率的灵敏度80.17%,特异度78.89%;CCO差值联合心肌灌注显像BW(静息)及BW(负荷)检测的灵敏度为92.56%,高于单独检测值,特异度为65.56%,低于单独检测值。分析CCO差值、BW(静息)、BW(负荷)在预测冠心病预后的AUC面积为:CCO差值(0.675)、BW(静息)(0.868)、BW(负荷)(0.850),并以最大约登指数计算出CCO差值、BW(静息)、BW(负荷)最大AUC面积相应参数截止值,其中CCO差值截止值为0.190(敏感度=72.30%,特异性=69.80%);BW(静息)截止值为0.534(敏感度=82.20%,特异性=88.90%);BW(负荷)截止值为0.473(敏感度=83.40%,特异性=86.20%)。结论:螺旋CT冠状动脉校正性对比剂浓度联合心肌灌注显像检测能够提高灵敏度,降低特异度,从而显著提高对冠心病诊断的准确率,对预后防治具有重要意义。

Objective: To evaluate the prognostic value of spiral CT coronary artery corrective contrast medium concentration combined with myocardial perfusion imaging in patients with coronary heart disease. Methods: 211 patients with coronary heart disease who underwent digital subtraction angiography in our hospital from March 2017 to February 2018 were selected as the study subjects. Severe stenosis group(n=121) and mild stenosis group(n=90) according to the degree of stenosis of left anterior descending branch of coronary artery(≥70%) and the degree of stenosis of left anterior descending branch of coronary artery(< 50%). All patients underwent CCO difference, phase parameters of myocardial perfusion imaging(resting BW and SD), load BW and SD. Observe and analyze the corresponding data. Logistic regression analysis was used to analyze the indicators closely related to coronary heart disease, and the difference between CCO and CCO was detected jointly. ROC curve analysis was used to predict the prognosis of coronary heart disease. Results: The difference of CCO, BW rest, SD rest, BW load and SD load in severe stenosis group were higher than those in mild stenosis group, the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed that CCO difference, BW rest and BW load were independent risk factors for left anterior descending coronary artery stenosis(≥70%). The sensitivity and specificity of CCO difference combined with myocardial perfusion imaging were 80.17% and 78.89%, respectively. The sensitivity and specificity of CCO difference combined with myocardial perfusion imaging were 92.56% and 65.56% respectively, which were higher than those of single detection and lower than those of single detection. The AUC area of CCO difference, BW rest and BW load in predicting the prognosis of CHD was analyzed as follows: CCO difference(0.675), BW rest(0.868), BW load(0.850). The parameters cut-off values of CCO difference, BW rest and BW load maximum AUC area were calculated by maximum Yoden index, among which the cut-off values of CCO difference were 0.190(sensitivity=72.30%, specificity=69.80%) and BW rest cut-off values were 0.53. 4(sensitivity=82.20%, specificity=88.90%);BW load cut-off value was 0.473(sensitivity=83.40%, specificity=86.20%). Conclusions: Spiral CT coronary artery corrective contrast agent concentration combined with myocardial perfusion imaging can improve sensitivity, reduce specificity, thus significantly improve the accuracy of diagnosis of coronary heart disease, which is worthy of clinical application. It is of great significance to the prevention and treatment of prognosis.