多层螺旋CT 冠状动脉成像结合IL-6、TNF-α检测对无症状人群非钙化斑块稳定性价值研究

The application value of multi-slice spiral CT coronary angiography combined with IL-6 and TNF-α detection in diagnosis of the stability of noncalcified plaque in asymptomatic patients

目的探讨多层螺旋CT冠状动脉成像结合血清检测IL-6,TNF-α对无症状人群非钙化斑块稳定性研究的可行性和安全性。方法选择2015年2月至2018年2月行冠脉造影成像的269例无症状患者进行回顾性分析,269例患者选择血清炎性因子IL-6和TNF-α检测合并多层螺旋CT检测以及冠状动脉造影检查。比较IL-6和TNF-α合并多层螺旋CT检测与冠状动脉造影检查结果之间的敏感性、准确性、特异性以及阳性和阴性预测值。结果 269例患者同时行血清炎症因子IL-6和TNF-α检测合并多层螺旋CT检测和冠状动脉造影检查,发现血清炎症因子IL-6和TNF-α检测合并多层螺旋CT检测诊断非钙化斑块稳定性的敏感性、准确性、特异性和阳性及阴性预测值分别为:100%,98.3%,93.2%,94.2%,100%。从269例患者中冠状动脉中共检出358个斑块。其中非钙化斑块258个,钙化斑块100个。非钙化斑块(软斑块和混合斑块组)组患者血清中IL-6和TNF-α明显比钙化斑块组患者高(P<0.05)。结论血清炎症因子IL-6和TNF-α检测合并多层螺旋CT检测对冠状动脉血管病变及非钙化斑块稳定性预测有较高的明感性,准确性和特异性。可以作为无症状人群非钙化斑块稳定性预测的检测方法。并可作为早期筛查冠脉狭窄程度及心肌缺血危险,区分斑块性质的检查手段。

Objective To explore the feasibility and safety of multi-slice spiral CT coronary angiography combined with IL-6 and TNF-αdetection in diagnosis of the stability of noncalcified plaque in asymptomatic patients.Methods A total of 269 asymptomatic patients who were treated in our hospital from February 2015 to February 2018 were enrolled in the study.All the patients underwent the detection of IL-6 and TNF-αcombined with multi-slice spiral CT coronary angiography.The sensitivity,accuracy,specificity and the positive and negative predictive values of IL-6 and TNF-αdetection combined with multi-slice spiral CT coronary angiography were observed and compared.Results The sensitivity,accuracy,specificity,the positive and negative predictive values of serum inflammatory factor IL-6 and TNF-αdetection combined with multi-slice spiral CT coronary angiography were 100%,98.3%,93.2%,94.2%and 100%,respectively.Of the 269 patients,358 plaques including 258 noncalcified plaques,100 calcified plaques were detected.The levels of IL-6 and TNF-αin patients with noncalcified plaques including soft plaque and mixed plaque were significantly higher than those of patients with calcified plaque(P<0.05).Conclusion The multi-slice spiral CT coronary angiography combined with IL-6 and TNF-αdetection is very valuable in predicting the stability of noncalcified plaque in asymptomatic patients,with high sensitivity,accuracy and specificity.It can be used not only in predicting the stability of noncalcified plaque in asymptomatic subjects,but also in early predicting the coronary artery stenosis and myocardial ischemia risk as well as distinguishing plaque feature.