256层螺旋CT联合NLR及D-二聚体检测诊断冠脉斑块稳定性的临床价值

Clinical Value of 256-Slice Spiral CT Combined with NLR and D-Dimer in Diagnosing Coronary Plaque Stability

目的通过对冠心病患者行256层螺旋CT检查,中性粒细胞/淋巴细胞比值(NLR)及D-二聚体水平检测,探讨其对冠脉斑块稳定性的诊断价值。方法选取72例可疑冠心病患者作为观察组,根据病史将其分为急性冠脉综合征(ACS)组40例及稳定型心绞痛(SAP)组32例,同期选取35例行冠脉CTA检查未见明显异常的体检患者作为对照组。根据CTA检查结果将观察组分为易损斑块组、混合斑块组、稳定斑块组;根据RI指数是否大于1将观察组分为RI>1及RI<1两组。结果(1)与SAP相比,ACS组的易损斑块显著增高;钙化斑块显著降低(P<0.05);(2)NLR及D-二聚体水平均为ACS组>SAP组>对照组,差异均有统计学意义(P<0.05);(3)NLR及D-二聚体水平均为易损斑块组>混合斑块组>稳定斑块组>对照组,差异均有统计学意义(P<0.05);(4)RI>1组的NLR及D-二聚体水平显著高于RI<1组(P<0.05)。结论(1)256层螺旋CT可以较为准确地判定冠脉斑块的性质。(2)NLR比值及D-二聚体浓度对冠脉斑块的稳定程度具有一定的预测价值。

Objective To investigate the value of 256-MSCT combined with neutrophil/lymphocyte ratio(NLR)and D-dimer for estimating the stability of coronary artery plaques of patients with coronary heart disease.Methods Selected 72 cases of patients with suspected coronary heart disease were selected as the observation group.According to the medical history,they were divided into acute coronary syndrome(ACS)group (40 cases)and stable angina pectoris(SAP)group(32 cases),and 35 physical examination patients with no obvious abnormality in coronary CTA examination were selected as the control group during the same period.According to the results of CTA,the observation group was divided into vulnerable plaque group,mixed plaque group and stable plaque group.According to whether the RI index is greater than 1,the observation group was divided into two groups:RI>1 and RI<1.Results(1)Compared with SAP,the vulnerable plaques in the ACS group were significantly increased;calcified plaque was significantly reduced(P<0.05).(2)The levels of NLR and D-dimer in SAP and ACS group were higher than those in control group,and the level of NLR and D-dimer in the ACS group was higher than that in the SAP group(P<0.05).(3)Both the levels of NLR and D-dimer were vulnerable plaque group>mixed plaque group>stable plaque group>control group,and the differences were statistically significant(P<0.05).(4)The level of NLR and D-dimer in RI>1 group was significantly higher than that in RI<1 group(P<0.05).Conclusion(1)256-slice spiral CT can accurately determine the nature of coronary plaques.(2)The NLR ratio and D-dimer concentration have certain predictive value for the stability of coronary plaque.