冠状动脉CTA定量评估稳定型心绞痛患者斑块进展及其在心血管事件中的预测价值

本文对非创伤性血管成像技术(CTA)定量评估稳定型心绞痛患者的冠状动脉斑块进展及其在心血管事件中的预测价值进行了分析。选取2017年1月~2017年12月我院心血管科142例因新发症状或症状加重随访行两次冠状动脉CT血管造影(CCTA)的稳定型心绞痛患者作为研究对象,根据后期随访患者是否有主要不良心脏事件发生进行分组,其中82例发生主要不良心脏事件的患者作为观察组,60例未发生主要不良心脏事件的患者作为对照组,定量评估稳定型心绞痛患者斑块的进展情况。结果显示:观察组患者有糖尿病、高血脂、吸烟史的比例均高于对照组,差异有统计学意义(P<0.05)。两组随访CCTA总体斑块负荷率、冠状动脉直径狭窄率比较差异有统计学意义(P<0.05);两组斑块进展方面,脂质斑块负荷率、纤维斑块负荷率、钙化斑块负荷率、总体斑块负荷率、冠状动脉直径狭窄率比较差异有统计学意义(P<0.05)。通过多因素Logisitic回归分析,脂质斑块负荷进展与基线高血脂有关(P<0.05),总体斑块负荷进展与基线高血脂具有相关性(P<0.05),冠状动脉直径狭窄率进展与糖尿病、高血脂、吸烟史具有相关性(P<0.05)。本文证实了CCTA检查是检测稳定型心绞痛患者斑块负荷进展的一种有效方法,且心血管危险因素能加快稳定型心绞痛患者负荷进展。

Assessment of Plaque Progression in Patients with Stable Angina Pectoris by Coronary CTA Placement and Its Predictive Value in Cardiovascular Events

To evaluate the plaque progression in patients with stable angina pectoris and its predictive value in cardiovascular events by coronary CTA, from January 2017 to December 2017, 142 patients with stable angina pectoris who underwent two coronary CT angiography follow-up visits due to new symptoms and aggravation of symptoms were selected as the study subjects. According to whether there were major adverse cardiac events in the follow-up group, 82 patients in the observation group with major adverse cardiac events were compared with 60 patients without major adverse cardiac events in the control group. Quantitative evaluation of plaque progression had been proceeded in patients with stable angina pectoris. The proportion of diabetes mellitus, hyperlipidemia and smoking history in the observation group was higher than that in the control group, and the difference was statistically significant(P<0.05). There were significant differences in CCTA total plaque load rate and coronary artery diameter stenosis rate between the two groups(P<0.05). And there were significant differences in plaque progression, lipid plaque load rate, fibrous plaque load rate, calcified plaque load rate, total plaque load rate and coronary artery diameter stenosis rate between the two groups(P<0.05). Multivariate logistic regression analysis showed that the progression of lipid plaque load was related to baseline hyperlipidemia(P<0.05). The overall progression of plaque load was correlated with baseline hyperlipidemia(P<0.05). The progression of coronary artery diameter stenosis was correlated with diabetes, hyperlipidemia and smoking history(P<0.05). In conclusion, CCTA is an effective method to detect the progression of plaque load in patients with stable angina pectoris, and cardiovascular risk factors can promote the progression of plaque load in patients with stable angina pectoris.