主动脉弹性与冠状动脉狭窄及相关危险因素的DSCT临床研究

发布时间：2018-02-14 23:34

本文关键词： 主动脉弹性冠心病危险因素 DSCT心电门控 CT冠脉造影　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：通过分析回顾性心电门控冠状动脉CT造影技术测量主动脉的弹性指标及冠脉狭窄的程度，首先分析主动脉弹性功能与冠脉狭窄及其程度的相关性，其次分析冠脉狭窄程度与其危险因素的相关性，同时探讨DSCT评价升主动脉弹性功能的临床价值。方法：收集大连大学附属中山医院2012年8月至2013年1月期间心内科住院患者中拟诊为冠心病并行DSCT冠脉造影检查、临床资料完整且配合良好的患者共计104例纳入本研究，其中男性54例，女性50例，年龄范围25-83岁，平均（57.31±11.00）岁。获取详细临床资料及可致冠脉狭窄的相关危险因素，首先按有无冠脉狭窄及高血压分为4组，其次按冠脉狭窄程度分为轻、中、重3组，最后按有无高血压合并冠脉狭窄或无狭窄再分为4组。使用西门子DSCT（SOMATOMDefinition）进行扫描，结合心电编辑功能分别获取心电图中T波及R波顶处主动脉瓣收缩及舒张末期图像进行重建，采用INSPACE血管测量软件测量心脏不同搏动时期同一层面（主动脉窦上方25mm）升主动脉的管径及横截面积，同时对有狭窄的冠状动脉进行评分（CAS）并进行统计学分析。结果： 1.升主动脉的弹性指标：管腔的相对直径变化率及膨胀性（％Ao、AoD)，管壁的顺应性及僵硬度(AoC、AoSI))在冠脉狭窄组与无狭窄组间均有统计学意义(P0.05)，尤以AoD及AoSI为著（P＜0.001）。 2.升主动脉各项弹性指标在冠脉不同狭窄程度组间的差异具有统计学意义(P0.05)。 3.升主动脉弹性指标中管壁的僵硬度（AoSI）与Gensini评分呈显著正相关(P＜0.0l，r=0.716)，另外管腔的直径变化率及膨胀性（％Ao、AoD）与Gensini评分呈显著负相关(P＜0.01，r分别为-0.428、-0.251)。 4.各组间比较显示，高血压、糖尿病、高血脂、吸烟及年龄是可致冠脉狭窄的危险因素，其中以高血压因素用于分组，其余的因素如吸烟、糖尿病、年龄及血清总胆固醇（TC）是导致冠脉狭窄的独立危险因素（P均＜0.05，OR分别为6.287/7.409、6.995、1.073、15.249）。除年龄外，其余因素持续的时间或程度与冠脉狭窄程度呈正相关（P均＜0.05）。 5.高密度脂蛋白（HDL-C）是影响冠脉狭窄的独立保护因素，冠脉狭窄程度与其下降的水平呈负相关（P＜0.05，r=-0.314）。结论： 1.升主动脉弹性指标的高低与冠状动脉狭窄的严重程度具有良好的相关性，因此，亦可视为冠心病的独立预测因子。 2.本研究进一步表明，高血压、糖尿病、高血脂、吸烟及年龄等指标为导致冠脉狭窄的危险因素；除年龄外，，其余危险因素持续时间的长短和程度同样可影响与决定冠脉狭窄的程度。 3. DSCT能够较为准确测量与评估升主动脉的弹性，因此亦可作为临床上检查主动脉弹性和预测冠脉狭窄的影像学手段。
[Abstract]:Objective: to analyze the correlation between aortic elastic function and coronary artery stenosis by retrospective electrocardiographic gated coronary angiography (ECC). Secondly, the relationship between the degree of coronary stenosis and its risk factors was analyzed, and the clinical value of DSCT in evaluating the elastic function of ascending aorta was discussed. Methods: a total of 104 patients with coronary heart disease (CHD) and DSCT coronary angiography were collected from Zhongshan Hospital affiliated to Dalian University from August 2012 to January 2013. There were 54 males and 50 females, aged 25-83 years, with an average of 57.31 卤11.00 years old. After obtaining detailed clinical data and risk factors associated with coronary artery stenosis, they were divided into 4 groups according to coronary artery stenosis and hypertension. The patients were divided into 3 groups according to the degree of coronary stenosis: light, medium and heavy, and then divided into 4 groups according to whether hypertension was complicated with coronary stenosis or not. The patients were scanned with Siemens DSCT SOMATOMDefinition. Combined with ECG editing function, the T wave and R wave top aortic valve systolic and diastolic images were reconstructed, respectively. The diameter and cross-sectional area of ascending aorta at the same level (25 mm above the aortic sinus) at different beating stages of the heart were measured by INSPACE software. The coronary artery with stenosis was scored and analyzed statistically. Results:. 1. The elastic index of ascending aorta: the relative diameter change rate and swelling rate of the lumen and the compliance and stiffness of the wall were significantly different between the coronary stenosis group and the non-stenosis group (P < 0. 05), especially AoD and AoSI (P < 0. 001). 2. There was significant difference in the elasticity of ascending aorta between different coronary stenosis groups (P 0.05). 3. The stiffness of ascending aorta (AoSI) was positively correlated with Gensini score (P < 0. 0l0. 716). In addition, there was a significant negative correlation between the diameter change rate of the lumen and the Gensini score (P < 0. 01, r = -0. 428-0. 251, P < 0. 01), in addition, there was a significant negative correlation between the diameter change rate of the lumen and the Gensini score (P < 0. 01, r = -0. 428-0. 251, P < 0. 01). 4. High blood pressure, diabetes, hyperlipidemia, smoking and age were the risk factors for coronary artery stenosis. Age and serum total cholesterol (TCC) were the independent risk factors for coronary stenosis (P < 0.05). The odds ratios were 6.287 / 7.409 / 6.995 / 1.073 / 15.249 respectively. Except for age, there was a positive correlation between the duration or degree of other factors and the degree of coronary stenosis (P < 0.05). 5. High density lipoprotein (HDL-C) was an independent protective factor for coronary stenosis, and the degree of coronary stenosis was negatively correlated with its decreasing level (P < 0.05). Conclusion:. 1. There is a good correlation between the elasticity of ascending aorta and the severity of coronary artery stenosis, so it can be regarded as an independent predictor of coronary artery disease. 2. This study further showed that hypertension, diabetes, hyperlipidemia, smoking and age were risk factors for coronary artery stenosis. The duration and extent of other risk factors also affect and determine the extent of coronary stenosis. 3. DSCT can accurately measure and evaluate the elasticity of ascending aorta, so it can be used as an imaging method for clinical examination of aortic elasticity and prediction of coronary artery stenosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.2

【参考文献】