计算机断层扫描腺苷负荷心肌灌注成像定量参数心肌血流量与心血管危险因素的关系

Relationship between quantitative parameter-myocardial blood flow of computed tomography adenosine stress myocardial perfusion imaging and cardiovascular risk factors

目的通过计算机断层扫描(computed tomography,CT)腺苷负荷心肌灌注成像获取定量参数心肌血流量(myocardial blood flow,MBF),对MBF与心血管危险因素之间的关系进行分析。方法选取2018年6月至2019年4月怀疑冠状动脉粥样硬化性心脏病(冠心病)的南京医科大学第一附属医院门诊及住院患者56例,分别在本院放射科采用第3代双源冠状动脉CT血管成像(coronary CT angiography,CCTA)联合CT心肌灌注(CT myocardial perfusion,CTP)获取MBF值;在本院检验科抽取空腹血4 m L,获取生化和血常规等检验结果。结果56例患者根据CCTA联合CTP结果判定为冠心病的有26例,非冠心病的30例。其中冠心病组灌注异常18例,灌注正常8例;非冠心病组灌注异常9例,灌注正常21例。冠心病组MBF值高于非冠心病组,差异有统计学意义[120(100~122.5)mL·100 mL^-1·min^-1vs.90(65~120)mL·100 mL^-1·min^-1,P<0.05]。按照MBF中位数分3组,3组之间的MBF、年龄、载脂蛋白A,葡萄糖、尿素氮、血小板计数和Gensini积分等比较,差异有统计学意义(P<0.05)。Spearman相关分析显示,MBF与尿素氮、Gensini积分呈负相关,与血小板计数呈正相关。多元线性回归分析显示,Gensini积分、低密度脂蛋白胆固醇、尿素氮、血小板与因变量MBF的回归模型存在统计学意义。结论MBF可能受到尿素氮、低密度脂蛋白胆固醇、血小板、Gensini积分等多因素的综合影响。

objectives To obtained the quantitative parameter-myocardial blood flow(MBF)through computed tomography(CT)adenosine stress myocardial perfusion imaging,and to analyze the relationship between MBF and cardiovascular risk factors.MethodsTotally 56 patients with suspected coronary heart disease who were admitted to the outpatient department and inpatient department of The First Affiliated Hospital of Nanjing Medical University from June 2018to April 2019 were selected.Coronary CT angiography(CCTA)combined with CT myocardial perfusion(CTP)were performed in the radiology department of our hospital for one-step scanning to obtain MBF value.Fasting blood(4 mL)was extracted from the patients in the laboratory department of our hospital for obtaining biochemical and blood routine test results.ResultsAccording to the results of the CCTA combined with CTP,among the 56 patients,26 cases were diagnosed as coronary heart disease(CHD)and 30 cases without CHD.There were 18 patients with abnormal perfusion,8 patients with normal perfusion in CHD group and 9 patients with abnormal perfusion,21 patients with normal perfusion in non-CHD group.MBF of CHD group was significantly higher than that in non CHD group[120(100-122.5)mL·100 mL^-1·min^-1vs.90(65-120)mL·100 mL^-1·min^-1,P<0.05].According to MBF value,the patients were divided into three groups.Variables of MBF value,age,lipoprotein A,glucose,urea nitrogen,platelet count and Gensini scores were statistically different among the three group.Spearman correlation analysis showed that MBF value negatively correlated with urea nitrogen and Gensini integral,and positively correlated with platelet count.Multivariate linear regression analysis showed that the regression model of Gensini integral,low-density lipoprotein cholesterol(LDL-C),urea nitrogen,platelets and the dependent variable MBF had statistical significance.ConclusionsMBF value may be affected by urea nitrogen,LDL-C,platelet,Gensini score and other factors.