冠状动脉钙化相关危险因素分析及钙化病变特点

发布时间：2018-03-14 20:05

本文选题：冠状动脉钙化　切入点：冠脉CTA　出处：《天津医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的与背景:冠心病(CHD)是导致心源性猝死的主要原因,冠状动脉钙化(CAC)是动脉粥样硬化的一个重要危险因素,因而CAC的检测对心血管事件的发生有积极的预测价值,近年来双源CT的应用越来越广泛,应用这种无创性手段检出CAC对于CHD的诊断有重要意义。慢性肾脏病(CKD)患者心血管病的发病率及死亡率高的主要原因是CAC的存在及动脉粥样硬化的进展,CAC的早期诊断与治疗能够降低CKD患者心血管事件的发生和死亡率。本研究通过回顾性收集401例疑诊冠心病住院患者的冠脉CTA结果及相关临床资料,探讨冠脉钙化的相关危险因素,观察冠脉钙化特点尤其是合并慢性肾功能不全患者的钙化病变情况并初步分析可能的原因。方法:收集2013.7-2013.12天津市第一中心医院因疑诊冠心病行冠脉CTA检查的住院患者401例,其中冠脉CTA结果示冠脉钙化阳性患者329例,钙化阴性患者72例,通过对两组相关临床资料的比较探讨冠脉钙化的相关危险因素。钙化阳性组患者根据冠脉CTA结果进行冠脉钙化积分(CACS),运用Spearman相关分析探讨CACS与相关因素的关系。根据冠脉CTA结果观察冠脉钙化病变的特点尤其是合并肾功能不全(CRI)患者的冠脉钙化病变特点。部分接受冠脉造影(CAG)检查的患者根据冠脉狭窄情况进行Gensini积分,运用Spearman相关分析探讨CACS与Gensini积分的关系。结果:1.钙化阳性组在吸烟史、高血压、糖尿病、血脂异常患者比例上与钙化阴性组存在明显差异;2.Logistic回归分析发现年龄年龄和血磷是冠脉钙化的预测因子(P0.05);3.Spearman相关分析发现CACS与年龄、血磷、钙磷乘积呈正相关(P0.01),与GFR呈负相关(P0.01),同时分析发现GFR与钙磷乘积呈负相关(r=-0.450,P0.01);4.冠状动脉前降支钙化发生率最高(78.4%)且钙化靶血管多同时合并狭窄;5.CRI组与非CRI组比较、终末期肾病组与非CRI组比较2支以上钙化者多,差异具有统计学意义(P0.05);CRI组与非CRI组、终末期肾病组与非CRI组比较存在多发及弥漫性钙化者多,具有显著统计学差异(P0.01),终末期肾病组Cr、Ca、P、钙磷乘积显著高于非CRI组与3-4期CKD组(P0.01),GFR水平显著下降(P0.01);6.钙化靶血管同时合并狭窄的患者与单纯钙化患者比较吸烟者多,LDL-C及TC水平高,且差异具有统计学意义(P0.05);7.在接受CAG检查的患者中,Spearman相关分析发现CACS与Gensini积分呈正相关(P0.05)。结论:1.年龄、高血压、糖尿病、吸烟史及血脂异常是CAC的危险因素,年龄和血磷是CAC的预测因子,CACS与年龄、血磷、钙磷乘积及GFR相关;2.冠状动脉前降支更易出现钙化病变,钙化靶血管多合并狭窄,合并肾功能不全的患者钙化病变较肾功能正常者更复杂。
[Abstract]:Objective and background: coronary heart disease (CAD) is the main cause of sudden cardiac death, and coronary artery calcification (CACC) is an important risk factor for atherosclerosis. Therefore, the detection of CAC has positive predictive value for the occurrence of cardiovascular events. In recent years, dual-source CT has been used more and more widely. Using this noninvasive method to detect CAC is of great significance for the diagnosis of CHD. The main reasons for the high incidence and mortality of cardiovascular disease in patients with chronic kidney disease CKD are the existence of CAC and the progression of atherosclerosis. The results of coronary artery CTA and related clinical data were collected retrospectively from 401 inpatients with suspected coronary heart disease, who were treated with amputation and treatment to reduce the incidence and mortality of cardiovascular events in patients with CKD. To investigate the risk factors of coronary artery calcification, To observe the characteristics of coronary artery calcification, especially in patients with chronic renal insufficiency, and to analyze the possible causes. Methods: a total of 401 patients with suspected coronary artery disease (CTA) in Tianjin first Central Hospital from March 7 to 12, 2013 were collected. Among them, 329 cases were positive for coronary calcification and 72 cases were negative for coronary CTA. The risk factors of coronary calcification were compared between the two groups according to the results of coronary CTA. The correlation between CACS and related factors was studied by Spearman correlation analysis. According to the results of coronary CTA, the characteristics of coronary calcification lesions were observed, especially in patients with renal insufficiency (CRI). Some patients undergoing coronary angiography (CAG) received Gensini scores according to the coronary stenosis. Spearman correlation analysis was used to study the relationship between CACS and Gensini score. Results: 1. Smoking history, hypertension, diabetes mellitus in calcified positive group, Logistic regression analysis showed that age and blood phosphorus were the predictors of coronary artery calcification. 3. Spearman correlation analysis showed that CACS was associated with age and blood phosphorus. There was a positive correlation between calcium and phosphorus product (P 0.01) and a negative correlation with GFR (P 0.01). At the same time, it was found that there was a negative correlation between GFR and calcium phosphorus product. The incidence of calcification of anterior descending coronary artery was the highest (78.4%). There were more calcifications in the end stage nephropathy group than in the non CRI group, the difference was statistically significant between the CRI group and the non CRI group. The number of multiple and diffuse calcifications in the end stage nephropathy group and non CRI group was higher than that in the non CRI group. There was significant statistical difference (P 0.01). The products of Cr and Ca P in end-stage nephropathy group were significantly higher than those in non-stage CRI group and 3-4 stage CKD group. The levels of LDL-C and TC in patients with calcified target vessels with stenosis were significantly higher than those in smokers. The difference was statistically significant (P 0.05). Among the patients undergoing CAG examination, there was a positive correlation between CACS and Gensini scores (P 0.05). Conclusion 1. Age, hypertension, diabetes, smoking history and dyslipidemia are the risk factors of CAC. Age and serum phosphorus were the predictors of CAC. CACS was associated with age, blood phosphorus, calcium and phosphorus product and GFR correlation. 2. Anterior descending coronary artery was more prone to calcification, and calcified target vessels were more complicated with stenosis. Calcification lesions in patients with renal insufficiency are more complex than those with normal renal function.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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