连续冠状动脉CT血管造影评估动脉粥样硬化斑块逆转治疗的研究进展

Research progress on evaluating atherosclerotic plaque regression therapies using serial coronary CT angiography

心血管病死亡是当前我国最主要的死亡原因之一,在临床上多以动脉粥样硬化斑块快速进展相关的急性冠状动脉综合征为主要表现。既往多针对伴发多种危险因素的患者采用指南推荐的冠心病二级预防措施以降低心血管事件发生率。现代医疗背景下,影像学技术的进展使得识别高危斑块特征成为可能,为改善靶向斑块的治疗措施评估提供了依据。近些年研究发现,他汀类药物、前蛋白转化酶枯草杆菌蛋白酶9抑制剂等降脂类药物可通过改善血脂代谢、逆转斑块,为冠心病患者强化降脂治疗提供了有力证据。此外,秋水仙碱、西洛他唑、不饱和脂肪酸等可介导炎症状态、改善内皮功能进而改善斑块性质,成为靶向斑块逆转的潜在治疗药物。冠状动脉CT血管造影(CCTA)检查创伤小、普及性高,相较于冠状动脉造影及其他腔内影像学技术,更适用于斑块性质连续评估。随着CCTA技术革新,其空间分辨率、时间分辨率更加精确,结合心脏体积覆盖与重建算法实现了更高质量的成像与丰富的解剖细节。本文对CCTA评估斑块性质的定性与定量指标进行介绍,并对近些年使用CCTA评估药物治疗改善斑块性质的临床研究进行综述,以期对于临床治疗提供参考与指导。

Cardiovascular disease mortality is one of the leading causes of death in China.Clinically,it mainly manifests as acute coronary syndromes related to the rapid progression of atherosclerotic plaques.Previous guidelines have recommended coronary heart disease secondary prevention measures for patients with multiple risk factors to reduce cardiovascular events.In the current medical context,advances in imaging technologies have enabled the identification of high-risk plaque features,providing a basis for evaluating therapies targeting plaque improvement.In recent years,research has found that lipid-lowering drugs such as statins and PCSK9 inhibitors can stabilize and regress plaques by improving lipid metabolism,providing robust evidence for intensified lipid-lowering therapy in patients with coronary artery disease.Additionally,colchicine,cilostazol,omega-3 fatty acids,and other agents have the potential to improve inflammation status and endothelial function,thereby possibly reversing plaque characteristics.Coronary CT angiography(CCTA)is a minimally invasive imaging modality with high accessibility.CCTA is better suited for continuous plaque assessment than coronary angiography and other invasive techniques.With innovations in CCTA,spatial and temporal resolution have become more precise.Combined with volumetric coverage and reconstruction algorithms,higher-quality imaging and richer anatomical details can be achieved.This review introduces qualitative and quantitative metrics for plaque characterization by CCTA and summarizes recent clinical studies using CCTA to evaluate pharmacological therapies for improving plaque composition,aiming to provide references and guidance for clinical practice.