冠状动脉CT血管成像特征与无症状非糖尿病人群冠心病风险因素及预后的相关性研究

发布时间：2018-09-12 09:06

【摘要】：目的：调查我国无症状非糖尿病人群中，性别、年龄、高血压、高血脂、吸烟、高尿酸血症等冠心病风险因素下CT血管成像（Computed Tomography angiography，， CTA）特征，分析风险因素评分系统以及心血管事件与CTA指标间的相关性，评价CTA指标在事件预测中的价值。材料与方法：将1118名无症状、无冠心病、糖尿病病史，并行冠脉CTA检查者纳入本回顾性研究。描述人群冠脉粥样硬化情况，分析风险因素阳性组与阴性组之间CT管腔狭窄、病变支数、累及左主干、节段累及积分（segment involvement score， SIS）、节段狭窄积分（segment stenosis score， SSS）的区别；比较122名高尿酸血症者与172名尿酸正常者之间CT指标的差异；对593名检查者进行Framingham风险评分（Framingham risk score， FRS）及系统冠脉风险评价（systematic coronary riskevaluation， SCORE），分析风险因素评分与CT斑块评分的相关性；对357名检查者进行随访，比较发生心血管事件者与未发生事件者CT指标的区别。结果：一、CT结果示56.3%检查者存在冠状动脉疾病（coronary artery disease，CAD），10.4%存在中度以上CAD，1.7%存在重度CAD。性别、年龄、高血压、高血脂、吸烟均与粥样硬化斑块进展有关，风险因素个数与斑块评分具有相关性，相关系数r分别为0.26、0.23。二、单因素分析以及对传统风险因素校正后分析得出，高尿酸血症组与正常组之间各CTA指标无明显差异。三、FRS与SIS、SSS之间r为0.20，0.16，SCORE与SIS、SSS之间r为0.23，0.23。对区别轻度以上CAD，FRS、SCORE曲线下面积分别为0.59、0.59，对区别中度以上CAD，FRS、SCORE曲线下面积分别为0.59、0.58。四、CTA未见冠状动脉硬化征象者中，事件发生率为0.7%。事件阳性组轻度以上、中度以上及重度CAD发生率、累及左主干比例、病变支数、SIS、SSS及非钙化SIS、SSS均高于阴性组。对是否发生事件，SIS曲线下面积为0.75，最佳截断点为1.5，敏感度77.8%，特异度64.9%，阳性预测值10.5%，阴性预测值98.2%；SSS曲线下面积为0.71，最佳截断点为2.5，敏感度55.6%，特异度81.4%，阳性预测值13.7%，阴性预测值97.2%。结论： CT冠脉成像能够无创、准确地在一次扫描提供管腔狭窄、斑块负荷等重要信息。对无症状非糖尿病人群，除高尿酸血症外，传统风险因素以及风险因素评分系统均与CT指标存在相关性，但预测管腔狭窄、斑块负荷的能力依然有限。CT指标在预测心血管事件发生有一定排除能力，对于CT结果阴性个体，心血管事件发生率极低。
[Abstract]:Objective: to investigate the characteristics of CT angiography (Computed Tomography angiography, CTA) in asymptomatic nondiabetic patients under coronary heart disease risk factors such as sex, age, hypertension, hyperlipidemia, smoking and hyperuricemia. The risk factor scoring system and the correlation between cardiovascular events and CTA were analyzed to evaluate the value of CTA in event prediction. Materials and methods: 1118 patients with asymptomatic, coronary heart disease, diabetic history and coronary CTA examination were included in this retrospective study. To describe the coronary atherosclerosis and analyze the difference between positive and negative groups in CT lumen stenosis, number of lesion branches, involvement of left main stem and integral (segment involvement score, SIS), segment stenosis integral (segment stenosis score, SSS). The differences of CT were compared between 122 hyperuricemia patients and 172 normal subjects, and the correlation between Framingham risk score (Framingham risk score, FRS) and (systematic coronary riskevaluation, SCORE), risk factor score (systematic coronary riskevaluation, SCORE),) and CT plaque score (CT plaque score) in 593 patients was compared. A total of 357 examiners were followed up to compare the differences of CT between patients with cardiovascular events and those with no cardiovascular events. Results: the CT findings showed that 56.3% of the examiners had coronary artery disease (coronary artery disease,CAD) and 10.4% had moderate CAD,1.7% and severe CAD.. Sex, age, hypertension, hyperlipidemia and smoking were all related to the progression of atherosclerotic plaque. Secondly, univariate analysis and traditional risk factor correction analysis showed that there was no significant difference in CTA between hyperuricemia group and normal group. The r between FRS and SIS,SSS is 0.20, 0.16 and r between SIS,SSS and Scroll is 0.230.23. The area under the CAD,FRS,SCORE curve was 0.59g 0.59 for the mild and 0.59 for the moderate CAD,FRS,SCORE curve, respectively. The incidence of coronary artery sclerosis in CTA patients was 0.7. The incidence of mild, moderate and severe CAD, the ratio of involvement to the left main trunk, the number of lesion branches and non-calcified SIS,SSS in the event positive group were higher than those in the negative group. The area under the curve was 0.75, the best cut-off point was 1.5, the sensitivity was 77.8, the specificity was 64.9, the positive predictive value was 10.5 and the negative predictive value was 98.2; The area under the SSS curve was 0.71, the best cut-off point was 2.5, the sensitivity was 55.6, the specificity was 81.4, the positive predictive value was 13.7 and the negative predictive value was 97.2B. Conclusion: CT coronary angiography can provide noninvasive and accurate information on lumen stenosis and plaque load in a single scan. For asymptomatic non-diabetic patients, the traditional risk factors and risk factor scoring system were correlated with CT except hyperuricemia, but the stenosis of lumen was predicted. The ability of plaque load is still limited. Ct indicators have a certain ability to exclude the occurrence of cardiovascular events. For individuals with negative CT results, the incidence of cardiovascular events is extremely low.
【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：博士
【学位授予年份】：2012
【分类号】：R541.4;R816.2

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