CTA和CAG检查在冠心病诊疗中的对比研究

发布时间：2018-07-16 23:09

【摘要】：目的探讨64排螺旋CT冠状动脉成像(Computed tomography coronary angiography,CTA)在诊断冠脉狭窄、支架和搭桥术后随访中的意义及其相关影响因素。方法回顾性选取我院先后接受CTA和CAG检查符合入选标准的患者274例,分冠心病筛查组(n=168)、支架术后随访组(n=68)、搭桥术后随访组(n=38)三部分进行研究。以后者作为“金标准”对比分析两种检查结果,评价CTA诊断自身冠脉狭窄病变、支架内再狭窄和桥血管通畅性的灵敏度、特异度、阳(阴)性预测值、约登指数以及对斑块定性诊断的准确性及相关影响因素等。CAG及CTA两种检查结果运用配对四格表资料或者行(R)×列(C)列表的卡方检验进行比较分析,若P0.05则两者无统计学意义,尚不能认为两种检查存在统计学差异,即冠脉CTA检查可以作为一种准确性较高的影像学检查应用在冠心病患者的诊疗中,反之亦然。结果1冠心病筛查组:168例疑似冠心病患者,CAG确诊123例,冠脉CTA正确检出冠心病的患者120例,漏诊3例,误诊5例;两种检查方法在冠状动脉狭窄程度以及斑块性质的诊断上无明显差异,相关性好;冠脉CTA在患者例数、病变血管数、具体冠脉(LAD、LCX、RCA等)各方面诊断的准确性分别为:95.2%、93.5%、94.6%、93.5%、92.2%。2支架术后随访组:68例患者145枚支架中10枚支架因CTA图像差不能评估而排除,135枚可评估支架中,11(8.1%)枚支架经CAG诊断为ISR,其中10(7.4%)枚支架CTA正确诊断ISR,1例漏诊;CTA误诊9例(其中8例支架直径≤2.75mm)。CTA在诊断LAD、LCX、RCA等位置及直径2.75mm、长度≤30mm支架的准确性分别为:94.3%、87.1%、93.9%、99.0%、96.5%;支架直径≤2.75mm的再狭窄率明显高于直径≥3mm,支架长度30mm的再狭窄率明显高于长度不足18mm;3搭桥术后随访组:38例患者共计75支桥血管其中2支因CTA无法评估而排除。CAG共检出病变患者14人(病变血管18支,其中动脉桥血管2支,静脉桥血管16支),CTA正确检出12人、漏诊2人、误诊2人(动脉桥血管全部正确检出,静脉桥血管正确检出14支,漏诊2支,误诊2支);CTA在评估桥血管通畅性方面,按照病例数、动脉桥血管和静脉桥血管等各方面的准确性分别为89.5%、100.0%、91.1%。乳内动脉桥血管通畅率明显高于大隐静脉桥血管;患者的手术年龄、性别以及综合相关危险因素等都会影响桥血管通畅率。结论1冠脉CTA在评价自身冠脉狭窄病变、支架内再狭窄和桥血管通畅性方面有很高的准确性,可以初步判定斑块的性质,但是对于不稳定斑块的评估欠佳。2冠脉CTA检查所需造影剂用量是CAG的2~3倍,既往有肾功能不全病史的患者应用需慎重。3冠脉CTA尚并不能完全替代CAG在临床中的应用,而是作为一种互补的无创伤非侵入性影像学检查方法用于冠心病患者的前期筛查、后期治疗和随访中。冠脉CTA尤其适用于以下方面:1疑似冠心病患者的诊断,预测冠心病患者的愈后;2发现早期LM管壁的病变;3不除外主动脉夹层或肺梗塞患者胸痛三联的一站式检查;4 PCI术后1年无明显症状患者随访的首选;5 CABG术后评估桥血管通畅性的首选。
[Abstract]:Objective to explore the significance and related factors of 64 row spiral CT coronary angiography (Computed tomography coronary angiography, CTA) in the diagnosis of coronary stenosis and follow-up after stent and bypass surgery. Methods a retrospective study was conducted to select 274 patients who received CTA and CAG examination in accordance with the criteria of admission, divided into coronary heart disease screening group (n=168) and stents. Follow up group (n=68) and three parts of follow-up group (n=38) after bypass surgery. After comparison and analysis of two tests as "gold standard", the sensitivity, specificity, positive (negative) predictive value, Jorden index, and qualitative diagnosis of plaque in the diagnosis of coronary stenosis, restenosis and bridging vascular patency were evaluated by CTA. The results of two kinds of.CAG and CTA tests, such as accuracy and related factors, were compared with the chi square test of paired four lattice data or line (R) x column (C) list. If P0.05 had no statistical significance, there was no statistical difference between the two types of examination, that is, the crown vein CTA examination could be used as a higher accuracy imaging examination. Results 1 coronary heart disease screening group: 168 cases of coronary heart disease screening group: 168 cases of suspected coronary heart disease, CAG confirmed 123 cases, coronary CTA correctly detected coronary heart disease patients, 3 cases, misdiagnosis 5 cases; two inspection methods in the degree of coronary artery stenosis and plaque nature diagnosis of no significant difference, correlativity is good; correlativity; coronal The diagnostic accuracy of pulse CTA in the number of patients, the number of diseased vessels, the specific coronary artery (LAD, LCX, RCA, etc.) were respectively diagnosed as 95.2%, 93.5%, 94.6%, 93.5%, and followed up after 92.2%.2 stent: 10 stents of 145 stents in 68 patients were excluded because of the CTA image poor evaluation, and 135 assessment scaffolds were diagnosed as ISR by CAG in 11 (8.1%) stents, 10 of which were diagnosed as ISR. (7.4%) the stent CTA correctly diagnosed ISR and 1 cases of missed diagnosis; CTA misdiagnosed 9 cases (8 cases of stent diameter less than 2.75mm).CTA in the diagnosis of LAD, LCX, RCA and other locations and diameter 2.75mm, the accuracy of the length less than 30mm stent was 94.3%, 87.1%, 93.9%, 99%, 96.5%, and the stent diameter less than 2.75mm was significantly higher than the diameter more than 3mm, stent length narrowly narrowed. The narrowing rate was significantly higher than the length of 18mm; 3 after bypass surgery, 38 patients had 75 bridge vessels and 2 of them were excluded from.CAG to detect 14 diseased patients (18 vessels of the lesion, 2 of artery bridge, 16 veins of vein bridge), and CTA correctly detected 12, 2 missed diagnosis and 2 misdiagnosis (all artery bridge vessels were all correctly detected. " 14 branches of vein bridge were correctly detected, 2 missed diagnosis and 2 misdiagnosis. The accuracy of CTA in assessing the vascular patency of the bridge was 89.5% and 100%, respectively, according to the number of cases, the vascular patency of the artery bridge and the vein bridge, respectively. The vascular patency rate of the internal mammary artery bridge was significantly higher than that of the large saphenous vein bridge. The surgical age, sex and synthesis of the patients were significantly higher than that of the large saphenous vein bridge. Conclusion 1 coronary artery CTA has high accuracy in evaluating coronary stenosis, stent restenosis and bridging vascular patency, which can preliminarily determine the properties of plaque, but for unstable plaque assessment, the amount of contrast agent required for.2 coronary CTA examination is 2~3 times as much as CAG. Patients with a history of renal insufficiency need to be cautious about the use of.3 coronary CTA and can not completely replace CAG in clinical application, but as a complementary and noninvasive noninvasive imaging examination for early screening, later treatment and follow-up of coronary heart disease patients. Coronary CTA is especially suitable for the following aspects: 1 suspected coronary heart disease The patients were diagnosed, the prognosis of the patients with coronary heart disease was predicted; 2 the lesions of the early LM tube wall were found; 3 the one-stop examination of the three union of the chest pain in the aortic dissection or the patients with pulmonary infarction; the first choice of the patients with no obvious symptoms in 1 years after 4 PCI; and the first choice for assessing the patency of the bridge after 5 CABG.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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