64排128层螺旋CT冠状动脉成像在冠心病患者诊断中的价值研究
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摘要
目的:研究64排128层螺旋CT(64SCTA)冠状动脉成像在诊断冠心病(CHD)患者中的应用价值。方法:选取CHD患者60例,所有患者均经64SCTA诊断后,1周内进行CAG检查。测定不同冠状动脉段分支斑块的CT值,并根据CT值的不同将斑块进行分类,包括软斑块、钙化斑块、纤维斑块和混合性斑块。分别对64SCTA和CAG检测结果下冠状动脉的狭窄程度进行评估,包括正常、轻度狭窄、中度狭窄和重度狭窄。分析LM、LCX、LAD和RCA部位CAG和64SCTA诊断敏感度和特异度,并以CAG的诊断结果为金标准,计算64SCTA诊断方法的诊断敏感度和特异度。结果:不同冠状动脉分支中斑块数量差异有统计学意义(P<0.05),其中LAD中斑块数量最多(38.73%),LM中斑块数量最少(7.04%)。冠状动脉中不同斑块性质分布差异有统计学意义(P<0.05),64SCTA和CAG对冠状动脉不同狭窄程度分析结果比较,差异无统计学意义(P>0.05),64SCTA和CAG对LM、LCX、LAD和RCA对不同狭窄程度诊断结果比较,差异无统计学意义(P>0.05)。两种诊断方法对不同冠状动脉段的诊断敏感度和特异度经比较,差异无统计学意义(P>0.05)。以CAG为金标准,64SCTA的诊断阳性率为94.59%,特异度96.06%。结论:64SCTA诊断CHD狭窄程度具有较高的诊断敏感度和特异度,且能够用于评价斑块的分布和性质,可应用于CHD患者的筛查和诊断中,为一种诊断CHD可靠的无创性检测方法。
Objective:To analysis the application of 64-rows 128-slice spiral CT(64 SCTA) coronary angiography in the diagnosis of patients with coronary heart disease.Methods:60 patients with CHD were selected. All patients were diagnosed by CASC after 1 week after diagnosis by 64 SCTA. CT values of branch plaques in different coronary segments were measured, and plaques were classified according to CT values, including soft plaques, calcified plaques, fibrous plaques, and mixed plaques. Coronary artery stenosis was assessed for 64 SCTA and CAG, including normal, mild stenosis, moderate stenosis, and severe stenosis. The diagnostic sensitivity and specificity of CAG and 64 SCTA in LM, LCX, LAD and RCA sites were analyzed, and the diagnostic sensitivity and specificity of the 64 SCTA diagnostic method were calculated based on the gold standard of CAG diagnosis. Results:The number of plaques in different coronary artery branches was significantly different(P<0.05), with the largest number of plaques in LAD(38.73%) and the least number of plaques in LM(7.04%). The distribution of different plaques in coronary arteries was significantly different(P<0.05). There was no significant difference between 64 SCTA and CAG in the analysis of different degrees of coronary artery stenosis(P>0.05). 64 SCTA and CAG were used to compare the results of different stenosis diagnosis of LM, LCX, LAD and RCA, the difference was not statistically significant(P>0.05). The diagnostic sensitivity and specificity of the two diagnostic methods for different coronary segments were compared, and the difference was not statistically significant(P>0.05). With CAG as the gold standard, the diagnostic positive rate of 64 SCTA was 94.59% and the specificity was 96.06%.Conclusion:64 SCTA has a high diagnostic sensitivity and specificity for the diagnosis of CHD stenosis, and can be used to evaluate the distribution and nature of plaque. It can be applied to CHD screening and diagnosis of patients, and which is a reliable method for detecting CHD.
Objective:To analysis the application of 64-rows 128-slice spiral CT(64 SCTA) coronary angiography in the diagnosis of patients with coronary heart disease.Methods:60 patients with CHD were selected. All patients were diagnosed by CASC after 1 week after diagnosis by 64 SCTA. CT values of branch plaques in different coronary segments were measured, and plaques were classified according to CT values, including soft plaques, calcified plaques, fibrous plaques, and mixed plaques. Coronary artery stenosis was assessed for 64 SCTA and CAG, including normal, mild stenosis, moderate stenosis, and severe stenosis. The diagnostic sensitivity and specificity of CAG and 64 SCTA in LM, LCX, LAD and RCA sites were analyzed, and the diagnostic sensitivity and specificity of the 64 SCTA diagnostic method were calculated based on the gold standard of CAG diagnosis. Results:The number of plaques in different coronary artery branches was significantly different(P<0.05), with the largest number of plaques in LAD(38.73%) and the least number of plaques in LM(7.04%). The distribution of different plaques in coronary arteries was significantly different(P<0.05). There was no significant difference between 64 SCTA and CAG in the analysis of different degrees of coronary artery stenosis(P>0.05). 64 SCTA and CAG were used to compare the results of different stenosis diagnosis of LM, LCX, LAD and RCA, the difference was not statistically significant(P>0.05). The diagnostic sensitivity and specificity of the two diagnostic methods for different coronary segments were compared, and the difference was not statistically significant(P>0.05). With CAG as the gold standard, the diagnostic positive rate of 64 SCTA was 94.59% and the specificity was 96.06%.Conclusion:64 SCTA has a high diagnostic sensitivity and specificity for the diagnosis of CHD stenosis, and can be used to evaluate the distribution and nature of plaque. It can be applied to CHD screening and diagnosis of patients, and which is a reliable method for detecting CHD.
引文
[1] 何晓全,刘梅林.中国冠心病防治策略[J].中国全科医学,2015,18(2):239-240.
[2] 黄延锦,张平,曾颖.冠心病高危人群疾病知识认知水平及影响因素分析[J].中国护理管理,2013,13(1):51-54.
[3] 卢刚,吕方方,张泉,等.64排螺旋CT血管造影和冠状动脉造影诊断冠心病的临床比较[J].医疗卫生装备,2015,36(3):76-78.
[4] 李娜.64排螺旋CT对冠状动脉狭窄程度诊断的敏感性和特异性与传统冠脉造影的差别研究[D].河北医科大学,2018.
[5] 王波,王临池,赵翼洪,等.2009-2013年苏州20岁及以上居民冠心病发病率变化趋势及类型分析[J].中国全科医学,2015,18(24):2952-2956.
[6] 杨伟宪,杨铮,窦克非,等.217例青年冠心病患者临床特点分析[J].中国循环杂志,2014,29(5):339-342.
[7] 郑宏,张丽莉,李艳华.早发冠心病临床危险因素分析及其与预后的相关性探讨[J].中国卫生统计,2013,30(3):382-384.
[8] 申燕艳,李荣富.64排螺旋CT冠状动脉成像与冠脉造影对冠心病诊断的对比研究[J].广西医科大学学报,2012,29(2):243-245.
[9] 曾文军,候青,高彦文.64排冠脉CT在冠心病诊断中的应用[J].中国老年学杂志,2015,35(21):6115-6117.
[10] 谢光彤,王锋,程琳,等.评价与分析冠脉CTA在冠心病诊断中的价值[J].影像研究与医学应用,2018,2(21):49-51.
[11] 马海川,张龙,刘彬,等.64排128层螺旋CT冠状动脉成像与冠脉造影诊断冠状动脉粥样硬化性心脏病的临床价值探讨[J].陕西医学杂志,2014,43(1):57-59.
[12] 周静.多排螺旋CT冠状动脉成像诊断价值的研究[D].郑州大学,2014.
[13] 丁辉.64排螺旋 CT 冠脉成像(CTA)在冠心病诊断中的应用价值分析[J].中国实验诊断学,2016,20(2):224-226.
[14] Oda S,Katahira K,Utsunomiya D,et al.Improved image quality at 256-slice coronary CT angiography in patients with a high heart rate and coronary artery disease:,comparison with 64-slice CT imaging[J].Acta Radiologica,2015,56(11):1308-1314.
[15] 刘彬.64排128层螺旋CT在冠心病诊断及冠心病PCI术后应用价值[J].陕西医学杂志,2013,42(12):1586-1587.
[16] 吴启源,袁明远,许建荣,等.双源CTA对冠状动脉临界狭窄病变斑块判断的价值[J].中国医学计算机成像杂志,2017,23(3):217-221.
[17] 郭道通,孙占国,王彦富,等.冠状动脉 CT 血管成像综合评估斑块的研究进展[J].山东医药,2016,53(5):94-96.
[2] 黄延锦,张平,曾颖.冠心病高危人群疾病知识认知水平及影响因素分析[J].中国护理管理,2013,13(1):51-54.
[3] 卢刚,吕方方,张泉,等.64排螺旋CT血管造影和冠状动脉造影诊断冠心病的临床比较[J].医疗卫生装备,2015,36(3):76-78.
[4] 李娜.64排螺旋CT对冠状动脉狭窄程度诊断的敏感性和特异性与传统冠脉造影的差别研究[D].河北医科大学,2018.
[5] 王波,王临池,赵翼洪,等.2009-2013年苏州20岁及以上居民冠心病发病率变化趋势及类型分析[J].中国全科医学,2015,18(24):2952-2956.
[6] 杨伟宪,杨铮,窦克非,等.217例青年冠心病患者临床特点分析[J].中国循环杂志,2014,29(5):339-342.
[7] 郑宏,张丽莉,李艳华.早发冠心病临床危险因素分析及其与预后的相关性探讨[J].中国卫生统计,2013,30(3):382-384.
[8] 申燕艳,李荣富.64排螺旋CT冠状动脉成像与冠脉造影对冠心病诊断的对比研究[J].广西医科大学学报,2012,29(2):243-245.
[9] 曾文军,候青,高彦文.64排冠脉CT在冠心病诊断中的应用[J].中国老年学杂志,2015,35(21):6115-6117.
[10] 谢光彤,王锋,程琳,等.评价与分析冠脉CTA在冠心病诊断中的价值[J].影像研究与医学应用,2018,2(21):49-51.
[11] 马海川,张龙,刘彬,等.64排128层螺旋CT冠状动脉成像与冠脉造影诊断冠状动脉粥样硬化性心脏病的临床价值探讨[J].陕西医学杂志,2014,43(1):57-59.
[12] 周静.多排螺旋CT冠状动脉成像诊断价值的研究[D].郑州大学,2014.
[13] 丁辉.64排螺旋 CT 冠脉成像(CTA)在冠心病诊断中的应用价值分析[J].中国实验诊断学,2016,20(2):224-226.
[14] Oda S,Katahira K,Utsunomiya D,et al.Improved image quality at 256-slice coronary CT angiography in patients with a high heart rate and coronary artery disease:,comparison with 64-slice CT imaging[J].Acta Radiologica,2015,56(11):1308-1314.
[15] 刘彬.64排128层螺旋CT在冠心病诊断及冠心病PCI术后应用价值[J].陕西医学杂志,2013,42(12):1586-1587.
[16] 吴启源,袁明远,许建荣,等.双源CTA对冠状动脉临界狭窄病变斑块判断的价值[J].中国医学计算机成像杂志,2017,23(3):217-221.
[17] 郭道通,孙占国,王彦富,等.冠状动脉 CT 血管成像综合评估斑块的研究进展[J].山东医药,2016,53(5):94-96.