作者：苗珂，葛洪，夏蕾，徐秋贞

单位：

210048 江苏省南京市，东南大学附属中大医院江北院区放射科

Units：

Radiology Department, Jiangbei Hospital, Zhongda Hospital Affiliated to Southeast University, Nanjing 210048, China

关键词：

冠心病；冠状动脉狭窄；斑块，动脉粥样硬化；CT血管造影；冠状动脉造影

Keywords：

Coronary disease; Coronary stenosis; Plaque, atherosclerotic; CT angiography; Coronary angiography

CLC：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2022.00.039

Funds：

江苏省医学会伦琴影像科研专项资金项目〔SYH-3201150-009（2021004）〕

摘要：

背景　CT血管造影（CTA）已成为影像学研究的热点，近年被越来越多地应用于临床。目的　探讨 CTA在冠状动脉狭窄程度及其斑块类型评估中的应用价值。方法　选取东南大学附属中大医院江北院区2018年8月至 2020年8月收治的冠心病（CHD）患者98例，均接受CAG和CTA检查。记录CTA对冠状动脉管腔的评价结果，以CAG为 诊断冠状动脉节段狭窄程度的“金标准”，采用Kappa检验分析CTA与CAG诊断结果的一致性，基于CTA比较不同狭窄 程度的冠状动脉节段斑块类型。结果　98例CHD患者中满足管腔评价要求的冠状动脉节段704段（占84.0%）。CTA与 CAG诊断冠状动脉节段狭窄程度的Kappa值为0.926。98例患者通过CTA共检出228个冠状动脉斑块，其中非钙化斑块92 个、混合斑块76个、钙化斑块60个。中/重度狭窄冠状动脉节段的非钙化斑块及混合斑块发生率高于无/轻度狭窄的冠 状动脉节段，钙化斑块发生率低于无/轻度狭窄的冠状动脉节段（P＜0.001）。结论　CTA对CHD患者冠状动脉节段狭 窄程度的诊断价值较高。且基于CTA发现，中度及重度狭窄的冠状动脉节段多存在非钙化斑块及混合斑块。

Abstract：

Background CT angiography (CTA) has become a hot spot in imaging research and has been more and more used in clinic in recent years. Objective To analyze the application value of CTA in evaluating the degree of coronary artery stenosis and plaque type. Method A total of 98 patients with coronary heart disease (CHD) admitted to Jiangbei Hospital of Zhongda Hospital Affiliated to Southeast University from August 2018 to August 2020 were examined by coronary angiography (CAG) and CTA. The evaluation results of CTA on coronary lumen were recorded. CAG was used as the "gold standard" for the diagnosis of coronary segmental stenosis. The consistency between CTA and CAG was analyzed by Kappa test, and the plaque types in patients with different degrees of coronary segmental stenosis was compared. Results A total of 704 coronary segments in 98 patients with CHD could meet the requirements of lumen evaluation. The Kappa value of CTA and CAG in the diagnosis of coronary segmental stenosis was 0.926. A total of 228 plaques were detected by CTA，including 92 non calcified plaques, 76 mixed plaques and 60 calcified plaques. The incidence of non calcified plaque and mixed plaque in coronary segments with moderate/severe stenosis was higher than that in coronary segments without/mild stenosis, incidence of calcified plaque was lower than that in coronary segments without/mild stenosis (P < 0.001) . Conclusion CTA is of high value in the diagnosis of coronary segmental stenosis in patients with CHD. CTA findings, moderate and severe coronary segmental stenosis were mostly non calcified plaques and mixed plaques.

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