冠状动脉及头颈动脉CTA的应用价值及相关性分析

发布时间：2018-03-21 23:06

本文选题：多层螺旋计算机断层扫描血管造影术　切入点：冠状动脉　出处：《华北理工大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本次研究通过使用256层螺旋计算机断层扫描血管造影技术,利用改良后的标准计算方法对影像下的冠状动脉及头颈动脉各节段的狭窄程度和斑块性质进行计算,探索不同类型的斑块在不同动脉分段上的分布特点,并分析冠状动脉狭窄程度和斑块钙化程度与头颈动脉的狭窄程度和斑块钙化程度上的相关性及其对冠心病的预测价值。方法采用回顾性的病例对照研究方式,选取临床诊断或怀疑冠心病的患者作为研究对象,采用断层扫描血管造影术对所有患者进行冠状动脉和头颈动脉的检查,计算各动脉节段的狭窄程度评分和钙化程度评分,利用冠状动脉造影技术检测出的冠状动脉狭窄结果将所有患者分成两组,狭窄程度≥50%为病例组,狭窄程度50%为对照组,比较两组患者在流行病学资料和各动脉节段上狭窄程度评分和钙化评分上的差异性,并采用logistics回归分析冠状动脉和头颈动脉的狭窄程度评分和钙化评分对冠心病诊断的预测价值,并分析冠状动脉和头颈动脉狭窄程度和钙化程度之间的相关性。结果本次研究共收集207名患者,其中对照组129名,病例组78名,两组患者在吸烟、高血压、心房纤颤和冠心病家庭成员史上存在明显差异。共有2905条冠状动脉纳入分析,计算机扫描下检出狭窄节段共230条,发生部位以冠状动脉左前降支和左回旋支为主,斑块性质以钙化斑块为主(占38.0%),对照组患者在冠状动脉狭窄总评分和钙化评分上均明显小于病例组患者(0.94±1.59 vs.9.96±3.62,Z=-12.207,P0.001;1.32±4.25 vs.12.85±21.67,Z=-5.242,P0.001);1236条颅内动脉节段中发生狭窄的共有21条,发生狭窄的主要部位为椎动脉颅内段,斑块性质以软斑块为主(占42.9%),对照组患者在颅内动脉的狭窄程度总评分和钙化评分上均小于病例组患者(0.05±0.25 vs.0.37±0.78,Z=-4.111,P0.001;0.11±0.54 vs.0.47±0.92,Z=-3.903,P0.001);检出的828条颈动脉中发生狭窄节段数为86条,主要发生部位为颈总动脉,斑块性质也以钙化斑块为主(占49.4%),对照组患者同样在颈动脉的狭窄程度总评分和钙化评分上低于病例组患者(0.04±0.11 vs.0.20±0.20,Z=-7.696,P0.001;0.50±1.27 vs.1.90±1.50,Z=-7.051,P0.001)。冠状动脉狭窄程度总评分、冠状动脉斑块钙化总评分和颈动脉狭窄程度总评分是影响冠心病诊断的主要因素(95%OR=1.877~5.133,P0.001;95%OR=1.021~1.232,P=0.017;95%OR=4.772~5.061*106,P=0.016),其中各动脉段上狭窄程度评分与钙化评分存在明显的正相关,而冠状动脉的狭窄程度评分与颈动脉狭窄程度、颈动脉钙化程度以及颅内动脉钙化程度存在相关性。结论冠状动脉造影下狭窄程度高的患者在计算机断层扫描下的冠状动脉、颅内动脉和颈动脉上的狭窄程度总评分和钙化评分也较高,其中冠状动脉狭窄程度总评分、冠状动脉斑块钙化总评分和颈动脉狭窄程度总评分是预测冠心病的主要因素,冠状动脉狭窄情况与冠状动脉和头颈动脉的钙化情况存在明显的相关性。
[Abstract]:Objective to use 256 slice spiral computed tomography angiography through this study, the degree of stenosis and plaque by the calculation method of the improved standard of images of coronary artery and head and neck artery segments were calculated, explore the distribution characteristics of different types of vein segments in different plaque, degree of stenosis and the analysis of value relevance the severity of coronary artery stenosis and calcification of head and neck artery and plaque calcification extent and in prediction of coronary heart disease. Methods a retrospective case-control study, the clinical diagnosis or suspected coronary heart disease patients as the research object, using tomography angiography of coronary artery in all patients and the neck check calculation section the arterial stenosis score and the degree of calcification score, using coronary angiography to detect coronary Arterial stenosis results all patients were divided into two groups, more than 50% stenosis as the case group, the degree of stenosis was 50% of control group, the difference in epidemiological data and each artery segment stenosis and calcification score on the score of two groups were compared, and the regression analysis of the degree of stenosis of coronary artery and the neck artery calcification score and the score of the predictive value of the diagnosis of coronary heart disease by logistics, and analyze the correlation between coronary artery and neck artery stenosis and calcification. The results of this study were collected from 207 patients, including 129 patients in the control group, 78 cases, two groups of patients in smoking, hypertension, there exist obvious differences in atrial fibrillation and coronary heart disease family a member of the history. A total of 2905 coronary arteries were included in the analysis, computer scanning detection narrow segment of a total of 230, occurred in the left anterior descending coronary artery and left circumflex artery, plaque The calcified plaques mainly (38%), the patients in the control group in the total score of coronary artery stenosis and calcification score were significantly lower than patients (0.94 + 1.59 + 3.62 vs.9.96, Z=-12.207, P0.001; 1.32 + 4.25 vs.12.85 + 21.67, Z=-5.242, P0.001); 1236 intracranial artery stenosis segment a total of 21, occurred in the main site for intracranial vertebral artery stenosis, plaque soft plaques (42.9%), the control group of patients in the intracranial artery stenosis score and total calcification score were lower than patients (0.05 + 0.25 vs.0.37 + 0.78, Z=-4.111 + 0.54 vs.0.47 + 0.11 P0.001; 0.92, Z=-3.903, P0.001); the 828 carotid arteries detected in the narrow segment number is 86, the major site for carotid artery plaque is also dominated by calcified plaque (49.4%), the control group were also in carotid artery stenosis and calcification score rating On the lower case patients (0.04 + 0.11 + 0.20 vs.0.20, Z=-7.696, P0.001; 0.50 + 1.27 vs.1.90 + 1.50, Z=-7.051, P0.001). The total score of coronary artery stenosis, coronary artery plaque calcification score and total score of carotid artery stenosis is the main factor affecting the diagnosis of coronary heart disease (95%OR=1.877~5.133, 95%OR=1.021~1.232, P0.001; P=0.017; 95%OR=4.772~5.061*106, P=0.016), in which the artery segment stenosis score and calcification score showed significantly positive correlation, and the extent of coronary artery stenosis score and the extent of carotid artery stenosis, the correlation between the degree of carotid artery calcification and intracranial artery calcification. Coronary artery in computed tomography coronary angiography by the conclusion of the degree of stenosis patients with high score, total score and the degree of stenosis of intracranial artery calcification and carotid artery were higher, the total score of coronary artery stenosis The total score of coronary atherosclerotic plaques and the degree of carotid artery stenosis are the main factors to predict coronary heart disease. There is a significant correlation between coronary artery stenosis and calcification of coronary artery and head and neck artery.

【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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