颈动脉速度向量成像检测对冠心病的诊断价值
发布时间：2019-06-28 14:49
【摘要】：目的：评价颈动脉速度向量成像技术(VVI)对冠状动脉粥样硬化性心脏病(CHD)的诊断价值,为CHD的早期诊断及病情观察寻求新指标。方法：选取心血管内科住院CHD患者164例,男性95例,女性69例,平均年龄(56.1+5.1)岁。CHD患者分为三组：稳定性心绞痛(SA)组(45例)、不稳定心绞痛(UA)组(65例)及首发急性心肌梗死(AMI)组(54例)。另选取健康体检者58例作为对照组,其中男性33例,女性25例,平均年龄(53.8±8.4)岁。所有受检者入院后首次采血行血清学检测,记录血清超敏C反应蛋白(hs-CRP),心肌肌钙蛋白T(c-TnT)水平。应用VVI检测并记录颈动脉光滑管壁力学参数值：各节段平均最大运动速度(Vmax)、平均最大应变(Vmax)、平均最大应变率(SRmax),及斑块(基底部、两侧肩部、顶部)最大应变值(Smax)。所有结果均取3个心动周期图像平均值,应用SPSS19.0统计软件进行统计学分析,P0.05被认为有统计学意义。结果：1.血清学结果3组病例组受检者血清hs-CRP水平均显著高于对照组(P0.01)；急性心梗组高于不稳定心绞痛组、稳定性心绞痛组；不稳定性心绞痛组高于稳定性心绞痛组。 (P0.01)。3组病例组受检者血清c-TnT水平均显著高于对照组(P0.01)；急性心梗组高于不稳定心绞痛组、稳定性心绞痛组(P0.01)；2.颈动脉VVI检测参数分析颈动脉管壁平均Vmax,平均Smax、平均SRmax比较：急性心梗组显著低于稳定性心绞痛组、对照组(P0.01)；不稳定心绞痛组显著低于稳定性心绞痛组、对照组(P0.01)；稳定性心绞痛组显著低于对照组(P0.01)。斑块肩部Smax、顶部Smax比较：急性心梗组显著高于不稳定心绞痛组、稳定性心绞痛组(P0.01)。3 颈动脉力学参数与血清学指标相关性分析164例受检者颈动脉管壁Smax与血清hs-CRP相关,相关系数为-0.323,p0.01；与血清c-TnT相关,相关系数为-0.200,p0.05。90例病例组斑块肩部Smax,斑块顶部Smax均与血清hs-CRP线性相关,相关系数分别为0.279、0.266,p0.05：与血清c-TnT呈线性相关,相关系数分别为0.235、0.252.p0.05。4 ROC曲线分析hs-CRP、c-TnT,管壁Smax联合预测曲线下面积为0.982(0.966-0.998),高于其他单独检测标志物,根据Youden旨数最大时确定诊断界值,敏感度为93.6%,特异度93.1%；管壁Smax曲线下面积0.913(0.871.0.955),稍高于hs-CRP、cTnT,确定界值时敏感度77.3%,特异度91.4%。结论：颈动脉VVI检测对冠心病的预测诊断及病情监测具有临床意义。(1)颈动脉非斑块处管壁力学参数反应冠心病动脉病变的程度,对区分低危冠心病(稳定心绞痛)与相对中高危冠心病(不稳定心绞痛、急性心肌梗死)具有预测价值。(2)颈动脉斑块处力学参数对于判断斑块稳定性具有潜在意义。形状规则的软斑块肩部、顶部Smax 3寸急性心肌梗死具有预测价值,可能会成为早期预测急性心梗发生的新指标。(3)颈动脉管壁、斑块(肩部、顶部)Smax与hs-CRP、c-TnT密切相关,颈动脉VVI联合血清hs-CRP、c-TnT水平检测对评估冠状动脉系统病变具有重要临床价值。
[Abstract]:Objective: to evaluate the diagnostic value of carotid velocity vector imaging (VVI) in coronary atherosclerotic heart disease (CHD), and to seek a new index for the early diagnosis and observation of CHD. Methods: CHD patients were divided into three groups: stable angina pectoris group (n = 45), unstable angina pectoris group (n = 65) and initial acute myocardial infarction (AMI) group, n = 54). The patients were divided into three groups: stable angina pectoris group (n = 45), unstable angina pectoris group (n = 65) and initial acute myocardial infarction (AMI) group, n = 54). In addition, 58 healthy subjects were selected as the control group, including 33 males and 25 females, with an average age of (53.8 卤8.4) years. The serum levels of high sensitive C-reactive protein (hs-CRP) and cardiac troponin T (c-TnT) were recorded for the first time after admission. The mechanical parameters of smooth tube wall of carotid artery were measured and recorded by VVI: the average maximum motion velocity of each segment was (Vmax), the average maximum strain rate of (Vmax), was (SRmax), and the maximum strain value of plaques (base, bilateral shoulder, top) was (Smax). All the results were taken from the average value of three cardiac cycle images, and the statistical analysis was carried out by SPSS19.0 statistical software. P 0.05 was considered to be statistically significant. Results: 1. The serological results showed that the serum hs-CRP levels in the three groups were significantly higher than those in the control group (P 0.01), and those in the acute myocardial infarction group were higher than those in the unstable angina pectoris group, the stable angina pectoris group, and the unstable angina pectoris group were higher than those in the stable angina pectoris group. The levels of serum c-TnT in the three groups were significantly higher than those in the control group (P 0.01), and those in the acute myocardial infarction group were higher than those in the unstable angina pectoris group and the stable angina pectoris group (P 0.01). Analysis of carotid artery VVI parameters comparison of mean Vmax, average Smax, average SRmax of carotid artery wall in acute myocardial infarction group was significantly lower than that in stable angina pectoris group (P 0.01), unstable angina pectoris group was significantly lower than stable angina pectoris group (P 0.01), stable angina pectoris group was significantly lower than control group (P 0.01). Comparison of Smax at the top of Smax, in plaque shoulder: acute myocardial infarction group was significantly higher than unstable angina pectoris group and stable angina pectoris group (P 0.01). 3 correlation analysis between carotid artery mechanical parameters and serological indexes showed that Smax of carotid artery wall was correlated with serum hs-CRP, and the correlation coefficient was-0.323, p0.01; The correlation coefficient was-0.200. the Smax at the top of Smax, plaque in p0.05.90 cases was linearly correlated with serum hs-CRP, and the correlation coefficient was 0.2790.266. p0.05: there was a linear correlation with serum c-TnT, the correlation coefficient was 0.235. the correlation coefficient was 0.252.p0.05.4 ROC curve analysis hs-CRP,c-TnT,. The area under the joint prediction curve of Smax was 0.982 (0.966 鈮，
本文编号：2507377
[Abstract]:Objective: to evaluate the diagnostic value of carotid velocity vector imaging (VVI) in coronary atherosclerotic heart disease (CHD), and to seek a new index for the early diagnosis and observation of CHD. Methods: CHD patients were divided into three groups: stable angina pectoris group (n = 45), unstable angina pectoris group (n = 65) and initial acute myocardial infarction (AMI) group, n = 54). The patients were divided into three groups: stable angina pectoris group (n = 45), unstable angina pectoris group (n = 65) and initial acute myocardial infarction (AMI) group, n = 54). In addition, 58 healthy subjects were selected as the control group, including 33 males and 25 females, with an average age of (53.8 卤8.4) years. The serum levels of high sensitive C-reactive protein (hs-CRP) and cardiac troponin T (c-TnT) were recorded for the first time after admission. The mechanical parameters of smooth tube wall of carotid artery were measured and recorded by VVI: the average maximum motion velocity of each segment was (Vmax), the average maximum strain rate of (Vmax), was (SRmax), and the maximum strain value of plaques (base, bilateral shoulder, top) was (Smax). All the results were taken from the average value of three cardiac cycle images, and the statistical analysis was carried out by SPSS19.0 statistical software. P 0.05 was considered to be statistically significant. Results: 1. The serological results showed that the serum hs-CRP levels in the three groups were significantly higher than those in the control group (P 0.01), and those in the acute myocardial infarction group were higher than those in the unstable angina pectoris group, the stable angina pectoris group, and the unstable angina pectoris group were higher than those in the stable angina pectoris group. The levels of serum c-TnT in the three groups were significantly higher than those in the control group (P 0.01), and those in the acute myocardial infarction group were higher than those in the unstable angina pectoris group and the stable angina pectoris group (P 0.01). Analysis of carotid artery VVI parameters comparison of mean Vmax, average Smax, average SRmax of carotid artery wall in acute myocardial infarction group was significantly lower than that in stable angina pectoris group (P 0.01), unstable angina pectoris group was significantly lower than stable angina pectoris group (P 0.01), stable angina pectoris group was significantly lower than control group (P 0.01). Comparison of Smax at the top of Smax, in plaque shoulder: acute myocardial infarction group was significantly higher than unstable angina pectoris group and stable angina pectoris group (P 0.01). 3 correlation analysis between carotid artery mechanical parameters and serological indexes showed that Smax of carotid artery wall was correlated with serum hs-CRP, and the correlation coefficient was-0.323, p0.01; The correlation coefficient was-0.200. the Smax at the top of Smax, plaque in p0.05.90 cases was linearly correlated with serum hs-CRP, and the correlation coefficient was 0.2790.266. p0.05: there was a linear correlation with serum c-TnT, the correlation coefficient was 0.235. the correlation coefficient was 0.252.p0.05.4 ROC curve analysis hs-CRP,c-TnT,. The area under the joint prediction curve of Smax was 0.982 (0.966 鈮，
本文编号：2507377
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