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冠状动脉CT血管成像钙化积分对慢性心绞痛患者冠状动脉病变及预后的评估价值

Clinical value of calcification scores of coronary artery CT angiography in evaluating coronary artery lesions and prognosis in patients with chronic angina pectoris

    摘要
  • 摘要:
      目的  探讨冠状动脉CT血管成像(CTA)钙化积分对慢性心绞痛(CAP)患者冠状动脉病变及预后的评估价值。
      方法  选取160例CAP患者为研究对象, 均给予冠状动脉血管内超声(IVUS)检查和CTA检查。以IVUS结果为金标准，分析冠状动脉CTA钙化积分评判斑块性质的准确性。采用Pearson相关分析评估冠状动脉CTA钙化积分与斑块稳定性的相关性。应用多元Logistic回归分析明确随访12个月CAP患者发生急性冠状动脉综合征(ACS)的危险因素。绘制受试者工作特征(ROC)曲线，分析冠状动脉CTA钙化积分对随访12个月CAP患者发生ACS的预测价值。
      结果  2种方法对脂质斑块、纤维斑块的检测结果差异无统计学意义(P < 0.05), 但冠状动脉CTA钙化积分对钙化斑块的检测结果优于冠状动脉IVUS, 差异有统计学意义(P=0.004)。以IVUS为金标准，冠状动脉CTA钙化积分诊断冠状动脉易损斑块的敏感度为81.4%, 特异度为69.4%, 阳性预测值为42.9%, 阴性预测值为92.9%。Pearson相关分析显示，冠状动脉CTA钙化积分与斑块稳定性呈正相关(P < 0.05)。多元Logistic回归分析显示，斑块性质、冠状动脉CTA钙化积分均为随访12个月CAP患者发生ACS的影响因素(OR=2.872、0.559, P=0.020、0.012)。ROC曲线显示, CTA钙化积分截断值为385.5, 预测随访12个月CAP患者ACS发生的曲线下面积为0.849, 敏感度为87.4%, 特异度为79.2%。
      结论  冠状动脉CTA钙化积分能有效评判CAP患者冠状动脉斑块稳定性，且评估患者近期预后转归的准确度较高。

     

    Abstract:
      Objective  To explore the calcification scores of coronary artery CT angiography (CTA) in evaluating coronary artery lesions and prognosis in patients with chronic angina pectoris (CAP).
      Methods  A total of 160 patients with CAP in our hospital were collected and received the examinations of intravascular artery ultrasound (IVUS) and CTA. Regarding the coronary IVUS as golden standard, the accuracy of the calcification scores of coronary CTA in evaluating the stability of coronary plaque was analyzed. The correlation of calcification scores of coronary CTA with stability of coronary plaque was analyzed by Pearson linear correlation analysis. Multivariate Logistic regression analysis was used to determine the risk factors for acute coronary syndrome (ACS) in CAP patients at 12 months of follow-up. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of calcification score of coronary artery CTA for CAP patients with ACS at 12-month of follow-up.
      Results  The occurrences of lipid plaques and fibrous plaque showed no significant difference between two examinations (P>0.05). However, the detection result of calcification score of coronary CTA on calcified plaque was better than that of coronary IVUS (P=0.004). Using IVUS as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of calcification score of coronary artery CTA for the diagnosis of coronary artery vulnerable plaques were 81.4%, 69.4%, 42.9% and 92.9%, respectively. Pearson correlation analysis showed that coronary artery CTA calcification score was positively correlated with plaque stability (P < 0.05). Multivariate Logistic regression analysis showed that plaque nature and calcification score of coronary artery CTA were the influencing factors for ACS in CAP patients after followed-up for 12 months (OR=2.872, 0.559, P=0.020, 0.012). ROC curve showed that the cut-off value of CTA calcification score was 385.5, and the area under the curve to predict the occurrence of ACS in CAP patients during the follow-up of 12 months was 0.849, the sensitivity was 87.4%, and the specificity was 79.2%.
      Conclusion  The calcification scores of coronary CTA can assess the stability of coronary plaque, and has higher accuracy in evaluating short-term prognosis of patients with CAP.

     

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