作者：宋宇，陈代文，许尚文，肖慧，陈自谦，陈梅贤

单位：

中国人民解放军联勤保障部队第九〇〇医院放射诊断科

Units：

Department of Diagnostic Radiology, the 900th Hospital of the Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou 350000, China Corresponding author: CHEN Daiwen, E-mail: davion1983@163.com

关键词：

冠心病; 体层摄影术,螺旋计算机; 螺旋CT检查; 经皮冠状动脉介入治疗; 支架内再狭窄; 诊断;

Keywords：

Coronary disease; Tomography, spiral computed; Spiral CTs; Percutaneous coronary intervention; In-stent restenosis; Diagnosis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.292

Funds：

摘要：

目的 分析多层螺旋CT(MSCT)在冠心病患者经皮冠状动脉介入术(PCI)后随访中的应用价值。方法 选取2019年3月至2021年3月于中国人民解放军联勤保障部队第九〇〇医院行PCI的冠心病患者105例为研究对象。对患者进行MSCT、冠状动脉造影(CAG)检查，以CAG检查结果为“金标准”，计算MSCT检查诊断冠心病患者PCI后发生支架内再狭窄(ISR)、管壁厚度<0.1 mm、管径<3 mm的灵敏度、特异度、正确率、阳性预测值、阴性预测值，并采用Kappa检验分析MSCT、CAG检查诊断冠心病患者PCI后发生ISR、管壁厚度<0.1 mm、管径<3 mm的一致性。结果 CAG检查结果显示，105例冠心病患者中，PCI后发生ISR 27例，未发生ISR 78例；MSCT检查结果显示，105例冠心病患者中，PCI后发生ISR 25例，未发生ISR 80例。MSCT检查诊断冠心病患者PCI后发生ISR的灵敏度为85.2%，特异度为97.4%，正确率为94.3%，阳性预测值为92.0%，阴性预测值为95.0%。Kappa检验结果显示，MSCT检查与CAG检查诊断冠心病患者PCI后发生ISR的一致性很好(Kappa值=0.877，P<0.001)。MSCT检查诊断冠心病患者PCI后发生管壁厚度<0.1 mm的灵敏度为37.8%，特异度为55.9%，正确率为49.5%，阳性预测值为31.8%，阴性预测值为62.3%。Kappa检验结果显示，MSCT检查与CAG检查诊断冠心病患者PCI后发生管壁厚度<0.1 mm的一致性较好(Kappa值=0.611，P=0.035)。MSCT检查诊断冠心病患者PCI后发生管径<3 mm的灵敏度为61.7%，特异度为57.8%，正确率为60.0%，阳性预测值为66.1%，阴性预测值为53.1%。Kappa检验结果显示，MSCT检查与CAG检查诊断冠心病患者PCI后发生管径<3 mm的一致性较好(Kappa值=0.602，P=0.045)。结论 MSCT检查对冠心病患者PCI后发生ISR有较好的诊断价值，对冠心病患者PCI后发生管壁厚度<0.1 mm、管径<3 mm有一定诊断价值，其可作为患者PCI后随访复诊的首选检查方法。

Abstract：

【Abstract】 Objective To analyze the application value of multi-slice spiral CT (MSCT) in the follow-up of patients with coronary heart disease after percutaneous coronary intervention (PCI) . Methods A total of 105 patients with coronary heart disease who underwent PCI in the 900th Hospital of the Joint Logistics Support Force of Chinese People's Liberation Army from March 2019 to March 2021 were selected as the research subjects. The patients were examined by MSCT and coronary angiography (CAG) , the results of CAG examination were as the "gold standard" , and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT in diagnosing in-stent restenosis (ISR) , tube wall thickness < 0.1 mm, and tube diameter < 3 mm in patients with coronary heart disease after PCI were calculated. The Kappa test was used to analyze the consistency of MSCT and CAG in the diagnosis of ISR, wall thickness < 0.1 mm, and diameter < 3 mm in patients with coronary heart disease after PCI. Results The results of CAG examination showed that among the 105 patients with coronary heart disease, 27 had ISR after PCI, and 78 did not have ISR. The results of MSCT examination showed that among the 105 patients with coronary heart disease, 25 had ISR and 80 did not have ISR after PCI. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT examination in diagnosing ISR in patients with coronary heart disease after PCI were 85.2%, 97.4%, 94.3%, 92.0% and 95.0% respectively. Kappa test results showed that MSCT and CAG examination had good consistency in diagnosing ISR in patients with coronary heart disease after PCI (Kappa value=0.877, P < 0.001) . The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT examination in the diagnosis of wall thickness < 0.1 mm in patients with coronary heart disease after PCI were 37.8%, 55.9%, 49.5%, 31.8% and 62.3% respectively. Kappa test results showed that MSCT and CAG examination had good consistency in diagnosing wall thickness < 0.1 mm in patients with coronary heart disease after PCI (Kappa value=0.611, P=0.035) . The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MSCT examination in diagnosing diameter < 3 mm in patients with coronary heart disease after PCI were 61.7%, 57.8%, 60.0%, 66.1% and 53.1% respectively. Kappa test results showed that MSCT and CAG examination had a good consistency in diagnosing diameter < 3 mm in patients with coronary heart disease after PCI ( Kappa value=0.602, P=0.045) . Conclusion MSCT examination has a good diagnostic value for ISR in patients with coronary heart disease after PCI, and has a certain diagnostic value for wall thickness < 0.1 mm and diameter < 3 mm in patients with coronary heart disease after PCI. It can be used as the preferred method for follow-up of patients after PCI.

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