冠状动脉CT血管成像定量评价斑块特征对冠心病预后评估的价值

Value of coronary CT angiography in quantitative evaluation of plaque characteristics for the prognosis of coronary heart disease

目的探讨冠状动脉CT血管成像(CCTA)定量评价斑块特征对冠心病预后评估的价值。方法选择89例冠心病患者,均行CCTA检查测量斑块定量参数。根据患者1年内不良心血管事件,将发生不良心血管事件的23例患者纳为预后不良组,未发生不良心血管事件的66例患者纳为预后良好组,比较两组患者一般资料和斑块定量参数,采用logistic回归分析冠心病不良预后的影响因素,采用受试者工作特征(ROC)曲线分析斑块定量参数预测冠心病预后的价值。结果预后不良组患者男性比例、年龄、低密度脂蛋白胆固醇(LDL-C)水平明显高于预后良好组(χ^(2)=4.46,t分别=3.66、2.02,P均<0.05);预后不良组患者的总斑块负荷、非钙化斑块负荷、钙化斑块负荷、血管狭窄率、重建指数明显高于预后良好组(t分别=12.57、10.18、7.23、5.80、4.61,P均<0.05);logistic回归分析显示,年龄、总斑块负荷、非钙化斑块负荷、钙化斑块负荷、血管狭窄率、重建指数是影响冠心病患者预后的主要因素(OR分别=1.28、1.26、1.82、1.78、2.07、1.49,P均<0.05);ROC曲线分析显示,斑块负荷、非钙化斑块负荷、钙化斑块负荷、血管狭窄率、重建指数预测冠心病预后的AUC为0.77、0.75、0.79、0.81、0.82。结论CCTA定量评价斑块特征与不良心血管事件有关,在预测冠心病预后方面有一定价值。

Objective To investigate the value of coronary CT angiography(CCTA)in quantitative evaluation of plaque characteristics for the prognosis of coronary heart disease.Methods A total of 89 patients with coronary heart disease were selected and CCTA was performed to measure the quantitative parameters of plaque.According to the patient’s adverse cardiovascular events within 1 year,twenty-three patients with adverse cardiovascular events were included in the poor prognosis group,and sixty-six patients without adverse cardiovascular events were included in the good prognosis group.The general data and quantitative parameters of plaque were compared between the two groups.Logistic regression was used to analyze the factors influencing the poor prognosis of coronary heart disease,and receiver operator characteristic(ROC)curve was used to analyze the value of plaque quantitative parameters in predicting the prognosis of coronary heart disease.Results The proportion of males,age and low-density lipoprotein cholesterol levels in the poor prognosis group were significantly higher than those in the good prognosis group(χ^(2)=4.46,t=3.66,2.02,P<0.05).The total plaque load,non-calcification plaque load,calcification plaque load,vascular stenosis rate and remodeling index in the poor prognosis group were significantly higher than those in the good prognosis group(t=12.57,10.18,7.23,5.80,4.61,P<0.05).Logistic regression analysis showed that age,total plaque load,non-calcification plaque load,calcification plaque load,vascular stenosis rate and remodeling index were the main factors affecting the prognosis of coronary heart disease(OR=1.28、1.26、1.82、1.78、2.07、1.49,P<0.05).ROC curve analysis showed that the AUC of plaque load,non-calcified plaque load,calcified plaque load,vascular stenosis rate and remodeling index predicted the prognosis of coronary heart disease were 0.77,0.75,0.79,0.81,0.82.Conclusion CCTA quantitative evaluation of plaque characteristics is related to adverse cardiovascular events,and has certain value in predicting the prognosis of coronary heart disease.