血管内超声评价冠状动脉左主干病变的临床价值

发布时间：2019-03-14 07:19

【摘要】：目的:探讨血管内超声对冠状动脉左主干病变评价的临床价值,为冠心病左主干病变的病情评估及介入治疗提供更多的理论依据,同时对比冠脉CT血管造影和冠状动脉造影对冠心病的诊断结果,校正诊断误差,提高CTA及CAG的诊断价值。方法:回顾性连续收录2010年01月-2014年08月在河南科技大学第一附属医院于心内科住院择期成功行IVUS的患者368例,入院后收集相关资料,根据是否行CTA进行分组,统计IVUS、CAG及CTA对左主干直径、长度、病变狭窄程度、冠脉斑块性质的例数进行分析。结果:(1)冠状动脉左主干相对正常段直径及长度分别为:CAG测量长度:8.45±4.37mm,直径:4.46±1.29mm;CTA测量长度:9.08±4.41mm,直径:5.26±1.41mm;IVUS测量长度:9.14±4.68mm,直径:5.29±1.42mm;IVUS与CAG比较,左主干平均直径、长度均有统计学意义(P(IVUS-CAG))=0.01;0.01);IVUS与CTA比较,左主干平均直径、长度均无统计学意义(P(IVUS-CTA)=0.14;0.08)。对比IVUS和CAG、IVUS和CTA的图像,两种方法对冠状动脉左主干狭窄程度评估有明显统计学差异(P0.05)。(2)CAG与CTA对左主干病变诊断的敏感性、特异性、误诊率和Youden值:以IVUS为标准,CAG对左主干病变诊断的敏感性为44.4%,特异性为75.0%,误诊率为94.4%,Youden值为38.8%;CTA敏感性为94.3%,特异性为77.8%,误诊率为36.4%,Youden值为72.1%。(3)冠状动脉左主干斑块性质评价分别为:IVUS与CAG对冠状动脉左主干斑块识别有明显统计学差异(P0.01);IVUS与CTA对冠状动脉左主干斑块识别无明显统计学差异(P=0.11)。结论:(1)IVUS测量左主干长度是9.14±4.68mm,直径是5.29±1.42mm,CAG易低估左主干长度及直径,CTA对左主干长度及直径评价较准确;(2)CTA对病变诊断敏感性高,CAG对病变特异性较高;(3)CTA对左主干斑块识别能力较CAG强。
[Abstract]:Objective: to explore the clinical value of intravascular ultrasound in the evaluation of left main coronary artery disease, and to provide more theoretical basis for the evaluation and interventional treatment of left main coronary artery disease. At the same time, the diagnostic results of coronary CT angiography and coronary angiography were compared, the diagnostic error was corrected, and the diagnostic value of CTA and CAG was improved. Methods: from January 2010 to August 2014, 368 patients who had successfully performed IVUS in the Department of Cardiology in the first affiliated Hospital of Henan University of Science and Technology from January 2010 to August 2014 were included retrospectively. After admission, the data were collected and divided into groups according to whether or not CTA was performed, and IVUS, was counted. CAG and CTA were used to analyze the number of cases of left main diameter, length, degree of stenosis and nature of coronary plaque. Results: (1) the diameter and length of the left main coronary artery were 8.45 卤4.37mm for CAG, 9.08 卤4.41mm for 4.46 卤1.29 mm;CTA and 1.41 mm; for 5.26mm respectively. The measured length of IVUS was 9.14 卤4.68mm, the diameter was 5.29 卤1.42 mm;IVUS compared with CAG, the mean diameter and length of left trunk were statistically significant (P (IVUS-CAG) = 0.01). There was no significant difference in mean diameter and length of left trunk between IVUS and CTA (P (IVUS-CTA = 0.14 / 0.08). Comparing the images of IVUS, CAG,IVUS and CTA, there was significant difference between the two methods in evaluating the degree of left main coronary artery stenosis (P0.05). (2) the sensitivity and specificity of CAG and CTA in the diagnosis of left main coronary artery lesions. The misdiagnosis rate and Youden value: based on IVUS, the sensitivity, specificity, misdiagnosis and Youden value of CAG were 44.4%, 75.0%, 94.4% and 38.8%, respectively. The sensitivity, specificity and misdiagnosis rate of CTA were 94.3%, 77.8% and 36.4%, respectively. The Youden value was 72.1%. (3) the characteristics of left main coronary artery plaque were evaluated as follows: there was significant difference between IVUS and CAG in the identification of left main coronary artery plaque (P0.01). There was no significant difference in left main coronary plaque recognition between IVUS and CTA (P = 0. 11). Conclusion: (1) the length and diameter of the left trunk measured by IVUS were 9.14 卤4.68mm and 5.29 卤1.42mm respectively. It was easy to underestimate the length and diameter of the left trunk by CTA. CTA was more accurate in evaluating the length and diameter of the left trunk. (2) CTA was more sensitive to the diagnosis of lesions, and CAG was more specific to lesions, and (3) CTA was better than CAG in the identification of left main plaque.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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