经640层容积CT评估左冠状动脉解剖结构与左前降支狭窄关系的研究

Relationship between anatomical structure of left coronary and left anterior descending stenosis with 640-slice volume CT

目的 运用640层容积CT测量结果探讨左冠状动脉解剖结构与左前降支狭窄程度的关系。方法选取锦州医科大学附属第一医院2018年1月—2019年3月行冠状动脉CT血管造影(CTA)及冠状动脉造影(CAG)的左冠状动脉多发斑块患者116例,测量左主干(LM)长度,左前降支与左回旋支(LAD-LCX)夹角,左主干与左前降支(LM-LAD)夹角。根据左前降支(LAD)是否显著狭窄分为LAD显著狭窄组(LAD狭窄≥50%)和LAD非显著狭窄组(LAD狭窄<50%)。并纳入年龄、性别、高血压、高血糖、高血脂、有吸烟史各临床指标,分析LM长度、各夹角及临床指标与LAD狭窄的关系。对差异有统计学意义的因素运用Logistic回归模型,得出独立预测LAD显著狭窄的左冠状动脉解剖因素。绘制受试者工作特征(ROC)曲线获得独立预测LAD显著狭窄的左冠状动脉解剖因素的临界值。结果 单因素分析显示,LAD显著狭窄组的LM长度、LAD-LCX夹角、LM-LAD夹角大于LAD非显著狭窄组(P<0.05)。Logistic回归分析显示,LAD显著狭窄的独立预测因素为LM长度[OR=1.167(95% CI:1.008,1.350)]、LAD-LCX夹角(OR=1.066(95% CI:1.018,1.115)]。LM长度预测LAD显著狭窄的临界值为10.3mm、敏感性为71.20%(95% CI:0.587,0.817)、特异性为66.00%(95% CI:0.512,0.788)、曲线下面积(AUC)为0.716(95% CI:0.620,0.810);LAD-LCX夹角预测LAD显著狭窄的临界值为80°、敏感性为66.10%(95% CI:0.433,0.683)、特异性为88.00%(95% CI:0.757,0.955)、AUC为0.762(95% CI:0.680,0.850)。结论 较长的LM长度、较大的LAD-LCX夹角能用来鉴别冠状动脉粥样硬化性心脏病的风险等级。

Objective To explore the relationship between anatomy of the left coronary artery and LAD stenosis by 640-slice volume CT.Methods A total of 116 subjects with multiple left coronary plaque formation who underwent 640-slice volume CT coronary artery CTA and coronary angiography were conducted.The anatomical structure of the left coronary artery (left trunk length,LAD-LCX angle,LM-LAD angle) was measured.It was divided into two groups according to whether there was significant stenosis (coronary angiography),LAD significantly stenosis group (LAD stenosis ≥ 50%) and not significantly stenosis group (LAD stenosis < 50%).The relationship among LM length,LAD-LCX angle,LM-LAD angle,age,sex,blood pressure,blood sugar,blood lipid,smoking history,and LAD stenosis was analyzed.Logistic regression analysis was used for the above statistically significant factors to obtain the anatomical factors independently predicting significant LAD stenosis.The ROC curve was used to obtain the critical value of anatomical factors.Results The lengths of the left trunk and angles in the significant LAD stenosis group were significantly larger than those in the non-significantly LAD stenosis group (P < 0.05).Logistic regression analysis shows that LM length[OR=1.167 (95% CI:1.008,1.350)]and LAD-LCX angle[OR=1.066,(95% CI:1.018,1.115)]has significant narrow values to predict LAD.The critical value of LM length,sensitivity,specificity,and area under the ROC curve were 10.3 mm,71.20% (95% CI:0.587,0.817),66.00% (95% CI:0.512,0.788),and 0.716 (0.62,0.81),respectively.The critical value of LAD-LCX Angle,sensitivity,specificity,and area under the curve were 80°,66.10% (95% CI:0.433,0.683),88.00% (95% CI:0.757,0.955),and 0.762 (0.68,0.85),respectively.Conclusion Long LM length and large LAD-LCX angle can be used to identify the risk level of coronary heart disease (CAD).