双源CT冠状动脉造影对冠心病患者冠状动脉狭窄的诊断价值
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摘要
目的探讨双源CT冠状动脉造影(DSCTA)对冠心病患者冠状动脉狭窄的诊断价值。方法选取2017年9月-2018年9月间收治的拟诊为冠心病的患者120例作为研究对象,所有患者均予以DSCTA、冠状动脉造影(CAG)和冠状动脉血管内超声(IVUS)检查。以CAG为金标准,评估DSCTA诊断冠脉狭窄的效能、狭窄程度准确率;以IVUS检查为金标准,评估DSCTA诊断斑块性质的效能。结果①DSCTA诊断冠脉狭窄的灵敏度为93.75%、特异度97.78%、准确率96.67、阳性预测值94.17%、阴性预测值97.62%;②DSCTA准确诊断无狭窄冠脉节段1147段、准确率97.62%,DSCTA准确诊断轻度冠脉狭窄节段124段、准确率84.93%(124/146),准确诊断中度冠脉狭窄节段106段、准确率84.80%(106/125),准确诊断重度冠脉狭窄节段163段、准确率93.14%(163/175);③IVUS共检测出394个粥样硬化斑块,DSCTA准确诊断软斑块105个、准确率82.68%(105/127),DSCTA准确诊断纤维型斑块126个、准确率89.36%(126/141),DSCTA准确诊断钙化斑块31个、准确率81.58%(31/38),DSCTA准确诊断混合斑块74个、准确率84.09%(74/88)。结论 DSCTA安全无创,在冠心病的诊断、狭窄程度评估、粥样硬化斑块的定性方面均具有较高的诊断效能。
Objective To evaluate the diagnostic value of dual-source computed tomography coronary angiography(DSCTA) in coronary artery stenosis of patients with coronary heart disease. Methods A total of 120 patients with coronary heart disease who admitted between September 2017 and September 2018 were selected for the study. All patients were given DSCTA, coronary angiography(CAG) and coronary intravascular ultrasound(IVUS). CAG was used as the gold standard to evaluate the efficacy and accuracy rate of stenosis of DSCTA in the diagnosis of coronary stenosis.IVUS examination was taken as the gold standard to evaluate the efficacy of DSCTA in diagnosing plaque properties. Results The sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of DSCTA in the diagnosis of coronary stenosis were 93.75%, 97.78%, 96.67, 94.17% and 97.62%. 1147 segments without coronary stenosis were accurately diagnosed by DSCTA and the accuracy rate was 97.62%,and 124 segments with mild coronary stenosis were diagnosed by DSCTA accurately and the accuracy rate was 84.93%(124/146), and 106 segments with moderate coronary stenosis were diagnosed and the accurate rate was 84.80%(106/125), and 163 segments with severe coronary stenosis were diagnosed and the accurate rate was 93.14%(163/175).A total of 394 atherosclerotic plaques were detected by IVUS, and 105 soft plaques were diagnosed DSCTA accurately and the accuracy rate was 82.68%(105/127), and 126 fibrous plaques were accurately diagnosed DSCTA and the accuracy rate was 89.36%(126/141),and 31 calcified plaques were diagnosed accurately by DSCTA and the accuracy rate was81.58%(31/38), and 74 mixed plaques were diagnosed by DSCTA and the accuracy rate was 84.09%(74/88). Conclusion DSCTA is safe and non-invasive, and has high efficacy in diagnosing coronary stenosis, the degree of stenosis, and the diagnosis of atherosclerotic plaque in patients with coronary heart disease.
Objective To evaluate the diagnostic value of dual-source computed tomography coronary angiography(DSCTA) in coronary artery stenosis of patients with coronary heart disease. Methods A total of 120 patients with coronary heart disease who admitted between September 2017 and September 2018 were selected for the study. All patients were given DSCTA, coronary angiography(CAG) and coronary intravascular ultrasound(IVUS). CAG was used as the gold standard to evaluate the efficacy and accuracy rate of stenosis of DSCTA in the diagnosis of coronary stenosis.IVUS examination was taken as the gold standard to evaluate the efficacy of DSCTA in diagnosing plaque properties. Results The sensitivity, specificity, accuracy rate, positive predictive value and negative predictive value of DSCTA in the diagnosis of coronary stenosis were 93.75%, 97.78%, 96.67, 94.17% and 97.62%. 1147 segments without coronary stenosis were accurately diagnosed by DSCTA and the accuracy rate was 97.62%,and 124 segments with mild coronary stenosis were diagnosed by DSCTA accurately and the accuracy rate was 84.93%(124/146), and 106 segments with moderate coronary stenosis were diagnosed and the accurate rate was 84.80%(106/125), and 163 segments with severe coronary stenosis were diagnosed and the accurate rate was 93.14%(163/175).A total of 394 atherosclerotic plaques were detected by IVUS, and 105 soft plaques were diagnosed DSCTA accurately and the accuracy rate was 82.68%(105/127), and 126 fibrous plaques were accurately diagnosed DSCTA and the accuracy rate was 89.36%(126/141),and 31 calcified plaques were diagnosed accurately by DSCTA and the accuracy rate was81.58%(31/38), and 74 mixed plaques were diagnosed by DSCTA and the accuracy rate was 84.09%(74/88). Conclusion DSCTA is safe and non-invasive, and has high efficacy in diagnosing coronary stenosis, the degree of stenosis, and the diagnosis of atherosclerotic plaque in patients with coronary heart disease.
引文
[1]赵冬.口腔医师应该了解的我国冠心病流行病学现状和预防策略[J].中华口腔医学杂志,2016,51(7):385-386.
[2]付士辉.老年冠心病患者抗血小板药物治疗进展[J].实用老年医学,2016,30(3):184-188.
[3]刘震,韩金花,张佩娟,等.64层螺旋CT对急性冠脉综合征患者斑块成分的临床研究[J].中国CT和MRI杂志,2017,15(10):84-87.
[4]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.
[5]冉勇,王运兰.双源C T检测在冠状动脉狭窄程度诊断中的应用价值[J].医学综述,2016,22(16):3321-3323.
[6]李岳军,闫继锋.双源CT与冠状动脉血管内超声评估冠状动脉粥样硬化斑块价值的对照研究[J].中华实用诊断与治疗杂志,2016,30(5):463-466.
[7] Di Mario C1,Gorge G,Peters R,et al.Clinical application and image interpretation in i n t r a c o r o n a r y u l t r a s o u n d.Study Group on Intracoronary Imaging of the Working Group of Coronary Circulation and of the Subgroup on Intravascular U l t r a s o u n d o f t h e W o r k i n g Group of Echocardiography of t h e E u r[J]. E u r o p e a n H e a r t Journal,1998,19(2):207-229.
[8]邢坤,李文波.冠心病诊疗进展[J].心血管康复医学杂志,2017,26(3):346-349.
[9]黄丙军. 2 56层螺旋CT前、后置心电门控技术对冠脉成像质量及辐射剂量的影响[J].中国CT和MRI杂志,2017,15(7):72-74.
[10]李志红,张妍,高健元.64排螺旋CTA成像诊断冠状动脉狭窄的临床价值[J].中西医结合心脑血管病杂志,2016,14(18):2194-2195.
[11]曹阿丹,郭海燕,武乐乐,等.双源CT冠状动脉血管造影诊断冠状动脉起源变异临床价值[J].中华实用诊断与治疗杂志,2016,30(5):467-469.
[12]刘秀美,王悦喜.双源CT与冠脉造影对冠心病诊断的对比分析[J].内蒙古医科大学学报,2017,39(5):465-468.
[13]林豪,肖波,刘一江,等.双源CT冠脉成像在冠脉粥样硬化性狭窄诊断中的价值研究[J].现代生物医学进展,2017,17(20):3969-3972.
[14]魏相磊,尤克增.双源C T双能量冠状动脉C T A在冠心病诊疗中的应用[J].医学影像学杂志,2017,27(3):449-453.
[15]陈晓琳,胡越成,李艳妮,等.基于双源CT与冠状动脉造影对冠状动脉狭窄诊断的对比研究[J].天津医药,2016,44(9):1150-1154.
[16]周逸,陈曼华,戴睿,等.斑块钙化对双源CT冠状动脉造影诊断准确性的影响[J].中国动脉硬化杂志,2017,25(6):594-598.
[17]罗焕,高律萍,陈红,等.双源CT血管造影对脑梗死患者动脉粥样硬化斑块的诊断价值[J].实用心脑肺血管病杂志,2017,25(7):121-122.
[2]付士辉.老年冠心病患者抗血小板药物治疗进展[J].实用老年医学,2016,30(3):184-188.
[3]刘震,韩金花,张佩娟,等.64层螺旋CT对急性冠脉综合征患者斑块成分的临床研究[J].中国CT和MRI杂志,2017,15(10):84-87.
[4]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.
[5]冉勇,王运兰.双源C T检测在冠状动脉狭窄程度诊断中的应用价值[J].医学综述,2016,22(16):3321-3323.
[6]李岳军,闫继锋.双源CT与冠状动脉血管内超声评估冠状动脉粥样硬化斑块价值的对照研究[J].中华实用诊断与治疗杂志,2016,30(5):463-466.
[7] Di Mario C1,Gorge G,Peters R,et al.Clinical application and image interpretation in i n t r a c o r o n a r y u l t r a s o u n d.Study Group on Intracoronary Imaging of the Working Group of Coronary Circulation and of the Subgroup on Intravascular U l t r a s o u n d o f t h e W o r k i n g Group of Echocardiography of t h e E u r[J]. E u r o p e a n H e a r t Journal,1998,19(2):207-229.
[8]邢坤,李文波.冠心病诊疗进展[J].心血管康复医学杂志,2017,26(3):346-349.
[9]黄丙军. 2 56层螺旋CT前、后置心电门控技术对冠脉成像质量及辐射剂量的影响[J].中国CT和MRI杂志,2017,15(7):72-74.
[10]李志红,张妍,高健元.64排螺旋CTA成像诊断冠状动脉狭窄的临床价值[J].中西医结合心脑血管病杂志,2016,14(18):2194-2195.
[11]曹阿丹,郭海燕,武乐乐,等.双源CT冠状动脉血管造影诊断冠状动脉起源变异临床价值[J].中华实用诊断与治疗杂志,2016,30(5):467-469.
[12]刘秀美,王悦喜.双源CT与冠脉造影对冠心病诊断的对比分析[J].内蒙古医科大学学报,2017,39(5):465-468.
[13]林豪,肖波,刘一江,等.双源CT冠脉成像在冠脉粥样硬化性狭窄诊断中的价值研究[J].现代生物医学进展,2017,17(20):3969-3972.
[14]魏相磊,尤克增.双源C T双能量冠状动脉C T A在冠心病诊疗中的应用[J].医学影像学杂志,2017,27(3):449-453.
[15]陈晓琳,胡越成,李艳妮,等.基于双源CT与冠状动脉造影对冠状动脉狭窄诊断的对比研究[J].天津医药,2016,44(9):1150-1154.
[16]周逸,陈曼华,戴睿,等.斑块钙化对双源CT冠状动脉造影诊断准确性的影响[J].中国动脉硬化杂志,2017,25(6):594-598.
[17]罗焕,高律萍,陈红,等.双源CT血管造影对脑梗死患者动脉粥样硬化斑块的诊断价值[J].实用心脑肺血管病杂志,2017,25(7):121-122.