冠状动脉瘤样扩张与冠心病患者电子束CT冠状动脉钙化的比较研究

Comparison of coronary artery calcification detected by electron beam computed tomography in coronary artery ectasia and in stenotic coronary artery disease

目的 比较粥样硬化性冠状动脉瘤样扩张 (CAE)与冠心病 (CHD)患者电子束CT(EBCT)冠状动脉钙化的差异。方法 经选择性冠状动脉造影确诊的 2 4例CAE与 2 4例年龄、性别和病变程度匹配的无瘤样扩张CHD患者行EBCT检查以计算钙化积分 ,分析CAE与CHD患者冠状动脉钙化程度的差异。结果 (1)两组患者的临床基线资料、狭窄病变程度及病变部位差异均无显著性。 (2 )CAE组钙化积分显著低于CHD组 ,其自然对数转换值 (LN[CS +1])的均数分别为 3 4 1±2 4 4和 4 88± 2 4 8(P <0 0 5 )。 (3)瘤样扩张冠状动脉的钙化程度与病变类型有关 ,弥漫性扩张血管LN[CS +1]显著低于局限性扩张动脉 (1 2 6± 1 85比 2 6 7± 1 93,P <0 0 5 )。 (4)单纯瘤样扩张动脉及瘤样扩张并狭窄血管的钙化阳性率和LN[CS +1]均显著低于单纯狭窄病变动脉 (P <0 0 1或0 0 5 )。结论 粥样硬化性冠状动脉瘤样扩张患者的冠状动脉钙化轻于无瘤样扩张的冠心病患者 ,且钙化程度与病变类型有关 ,提示斑块钙化程度可能与瘤样扩张形成和血管重塑有一定关系。

Objective To compare the difference of coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) in atherosclerotic coronary artery ectasia and in stenotic coronary artery disease. Methods 24 patients with atherosclerotic coronary artery ectasia (group CAE) underwent EBCT for calculating calcium score (CS). Their calcium extent was compared with 24 patients with stenotic coronary artery disease but without any evidence of ectasia (group CHD), matched for sex, age and stenotic severity with the patients in group CAE. Results (1) There were no significant differences between groups in clinical baseline data, stenotic severity and lesion arteries. (2) The natural logarithm transformation of CS (LN[CS+1]) was 3 41±2 44 in group CAE vs. 4 88±2 48 in group CHD ( P <0 05). (3) The calcium extent was related to lesion type of ectasia, and LN[CS+1] was significantly lower in vessels with diffuse ectasia than in those with discrete ectasia (1 26±1 85 vs 2 67±1 93, P <0 05). (4) The LN[CS+1] of the arteries with ectasia alone and those with both ectasia and stenosis were significantly lower than that of the vessels with stenosis alone ( P <0 01 or 0 05). Conclusion Coronary artery calcification is less extensive in patients with atherosclerotic coronary artery ectasia than in those with coronary artery disease without ectasia, and the calcium score is related to lesion type. Our findings suggest that plaque calcification might be associated with the pathogenesis of ectasia.