MSCT评价主动脉弹性与冠状动脉狭窄程度及钙化积分的相关性

发布时间：2018-04-15 10:38

本文选题：X线计算机体层摄影术 + 冠状动脉狭窄　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的利用256层螺旋CT探讨主动脉弹性与冠状动脉狭窄程度、冠状动脉钙化积分与狭窄程度、主动脉弹性与冠状动脉钙化积分的相关性。方法搜集华北理工大学附属医院2015年9月至2016年9月拟诊为冠心病顺利行冠状动脉CT血管造影(Coronary Artery Computed Tomography Angiography,CCTA)检查病例,将图像质量能满足主动脉弹性测量的142例患者纳为研究对象。根据CCTA结果,将研究对象分为无狭窄组(n=55)、狭窄组(n=87),狭窄组根据狭窄程度分为轻、中、重3组。根据冠状动脉有无钙化分为钙化阴性组(n=74)、钙化阳性组(n=68),按照钙化积分值大小将钙化阳性组分为轻、中、重3组,按照CCTA结果进一步将钙化阴性组分为冠脉正常组、非钙化斑块组。重组升主动脉5%-99.9%R-R间期间隔5%的图像,采用AVA软件自动测量各R-R间期主动脉横截面积及直径,计算评价主动脉弹性的四个参考指标直径变化率(%A_0)、动脉可扩张度(A_0D,mm Hg-1)、动脉顺应性(A_0C,mm2/mm Hg)及动脉僵硬度(A_0SI)。同时记录斑块位置、病变支数并对狭窄程度进行Gensini等级评分。分析主动脉弹性与冠状动脉狭窄程度、冠状动脉钙化积分与狭窄程度、主动脉弹性与冠状动脉钙化积分的关系。结果1无狭窄组%A_0:17.70±4.28、A_0D:2.82±1.32 mm Hg-1、A_0C:2.16±0.84mm2/mm Hg、A_0SI:3.05±1.12,狭窄组%A_0:13.29±3.96、A_0D:1.55±0.66 mm Hg-1、A_0C:1.34±0.47 mm2/mm Hg,A_0SI:4.79±1.93,两组差异有统计学意义(P0.05)。轻度狭窄组%A_0:14.77±4.56、A_0D:1.73±0.75 mm Hg-1、A_0C:1.45±0.45mm2/mm Hg、A_0SI:4.29±1.89;中度狭窄组%A_0:12.02±2.44、A_0D:1.44±0.53mm Hg-1、A_0C:1.34±0.50 mm2/mm Hg、A_0SI:5.24±1.93;重度狭窄组%A_0:11.27±2.25、A_0D:1.27±0.43 mm Hg-1、A_0C:1.06±0.35 mm2/mm Hg、A_0SI:5.43±1.80。轻、重度狭窄组间%A_0、A_0C、A_0SI比较有统计学差异(P0.05);轻、中度狭窄组间%A_0、A_0SI比较有统计学差异(P0.05);中、重度组间主动脉弹性差异均无统计学意义(P0.05)。Pearson相关分析显示冠状动脉Gensini评分与%A_0、A_0D、A_0C呈负相关(r分别为-0.428、-0.361、-0.394,P0.05),与A_0SI呈正相关(r=0.404,P0.05)。主动脉僵硬度影响因素的多元线性回归分析显示,年龄、脉压、Gensini评分是主动脉僵硬度的独立影响因子。2冠状动脉正常组、轻、中、重度狭窄组平均钙化积分分别为0,97.68±158.15,372.47±367.88,463.09±451.71,组间比较差异有统计学意义(P0.05);冠状动脉钙化积分与冠状动脉狭窄程度Gensini评分及病变支数均呈正相关(r分别为0.625、0.530,P0.01);不同狭窄程度组间冠状动脉四大主干钙化积分比较,轻度狭窄右冠状动脉(Right coronary artery,RCA):10.09±18.57、左主干(Left main coronary artery,LM):2.51±6.17、左冠状动脉前降支(Left anterior descending,LAD):14.14±18.43、左回旋支(Left circumflex,LCX):1.26±2.39;中度狭窄RCA:48.09±55.98、LM:2.97±11.58、LAD:117.40±85.14、LCX:35.60±75.88;重度狭窄RCA:179.13±157.20、LM:20.25±77.00、LAD:403.15±256.59、LCX:120.29±154.73。除LM外,RCA、LAD、LCX比较差异有统计学意义(P0.01)。3钙化阴性组%A_0:17.46±4.33、A_0D:2.56±1.29 mm Hg-1、A_0C:2.00±0.79 mm2/mm Hg、A_0SI:3.10±1.08,钙化阳性组%A_0:12.32±3.22、A_0D:1.49±0.61 mm Hg-1、A_0C:1.28±0.47 mm2/mm Hg,A_0SI:5.21±1.93,两组差异有统计学意义(P0.05);轻度钙化组%A_0:13.33±4.16、A_0D:1.64±0.78 mm Hg-1、A_0C:1.34±0.48 mm2/mm Hg、A_0SI:4.79±1.80;中度钙化组%A_0:11.81±2.87、A_0D:1.48±0.56 mm Hg-1、A_0C:1.30±0.50 mm2/mm Hg、A_0SI:5.57±2.11;重度钙化组%A_0:12.05±2.44、A_0D:1.33±0.45 mm Hg-1、A_0C:1.17±0.42 mm2/mm Hg、A_0SI:5.01±1.76。钙化阳性组轻、中、重三组间主动脉弹性差异没有统计学意义(P0.05)。冠脉正常组%A_0:18.72±3.85、A_0D:3.02±1.42 mm Hg-1、A_0C:2.24±0.86 mm2/mm Hg、A_0SI:2.83±0.98;非钙化斑块组%A_0:16.12±4.45、A_0D:2.07±0.93 mm Hg-1、A_0C:1.75±0.64 mm2/mm Hg、A_0SI:3.39±1.12,两组间%A_0、A_0D、A_0C、A_0SI比较均有统计学差异(P0.05)。Pearson相关分析显示%A_0、A_0D、A_0C与钙化积分呈负相关(r分别为-0.336、-0.296,-0.308,P0.01),A_0SI与钙化积分呈正相关(r=0.322,P0.01)。结论1主动脉弹性指标与冠状动脉狭窄程度呈正相关,狭窄程度达中度以上,相关趋势不明显,主动脉弹性可以作为早期冠心病诊断的敏感因子。2冠状动脉钙化积分与狭窄程度及病变支数呈正相关,钙化积分可以作为冠心病评价的有效指标。3主动脉弹性与冠状动脉钙化积分有相关性,两者相结合,可以为临床早期诊断冠心病提供影像学依据。
[Abstract]:Objective To study the relationship between aortic elasticity and coronary artery stenosis , coronary artery calcification score , stenosis degree , aortic elasticity and coronary artery calcification score by using 256 - slice spiral CT . The results showed that there were no stenosis group ( n = 55 ) , stenosis group ( n = 87 ) , and stenosis degree was divided into three groups : calcification negative group ( n = 74 ) , calcification positive group ( n = 68 ) . There was significant difference between the two groups ( P0.05 ) . There was a significant difference between the two groups ( P0.05 ) . - 0.361 , - 0.394 , P0.05 ) , positive correlation with A _ 0SI ( r = 0.404 , P0.05 ) . There was significant difference between coronary artery calcification score ( RCA ) : 10.09 卤 18.57 , left main coronary artery ( RCA ) : 10.09 卤 18.57 , left main coronary artery ( RCA ) : 14.14 卤 6.17 , left main coronary artery ( LCX ) : 14.14 卤 6.17 , left main coronary artery ( LCX ) : 14.14 卤 6.17 , left main coronary artery ( LCX ) : 14.14 卤 6.17 , left main coronary artery ( LCX ) : 10.09 卤 18.43 , LCX : 20.25 卤 77.00 , LAD : 403.15 卤 256.59 , LCX : 120.29 卤 154.73 . In addition to LM , RCA , LAD , LCX were statistically significant ( P0.01 ) . 2 . 56 卤 1 . 29 mm Hg - 1 , A _ 0C : 2.00 卤 0.79 mm2 / mm Hg , A _ 0SI : 3.10 卤 1.08 , calcification positive group % A _ 0 : 12 . 32 卤 3 . 22 , A _ 0D : 1 . 49 卤 0 . 61 mm Hg - 1 , A _ 0 SI : 1 . 28 卤 0 . 47 mm2 / mm Hg , A _ 0 SI : 1 . 28 卤 0 . 47 mm2 / mm Hg , A _ 0 SI : 1 . 28 卤 0 . 47 mm2 / mm Hg , A _ 0 SI : 5 . 21 卤 2 . 87 , A _ 0D : 1 . 48 卤 0 . 56 mm Hg - 1 , A _ 0 SI : 5.57 卤 2.11 ; severe calcification group % A _ 0 : 12.05 卤 2.44 , A _ 0D : 1.33 卤 0.45 mm Hg - 1 , A _ 0C : There was no significant difference in aortic elasticity between the two groups ( P0.05 ) . Pearson correlation analysis showed that % A _ 0 , A _ D , A _ 0C were negatively correlated with calcification score ( r = - 0.336 , - 0.296 , - 0.308 , P0.01 ) , and A _ 0SI was positively correlated with calcification score ( r = 0.322 , P0.01 ) . Conclusion The aortic elastic index is positively correlated with the degree of coronary artery stenosis , the degree of stenosis is more than moderate , the related trend is not obvious , the aortic elasticity can be used as the sensitive factor for the early diagnosis of coronary heart disease . The calcification score can be used as an effective index for the assessment of coronary heart disease .

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2

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