中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2009年
12期
1088-1092
,共5页
金泽宁%吕树铮%陈韵岱%苑飞%宋现涛%吴小凡%张丽洁%任芳%葛长江%汪国忠%胥学伟
金澤寧%呂樹錚%陳韻岱%苑飛%宋現濤%吳小凡%張麗潔%任芳%葛長江%汪國忠%胥學偉
금택저%려수쟁%진운대%원비%송현도%오소범%장려길%임방%갈장강%왕국충%서학위
心绞痛%不稳定型%超卢检查%介入性%体层摄影术%螺旋计算机%冠状血管造影术
心絞痛%不穩定型%超盧檢查%介入性%體層攝影術%螺鏇計算機%冠狀血管造影術
심교통%불은정형%초로검사%개입성%체층섭영술%라선계산궤%관상혈관조영술
Angina%unstable%Ultrasonography%interventional%Tomography%spiral computed%Coronary angiography
目的 应用血管内超声(rvos)探讨不稳定性心绞痛(UAP)低、中及高危组患者动脉粥样硬化斑块的特点,评价定量冠状动脉造影(QCA)和64层螺旋CT(MDCT)的诊断价值.方法 采用IVUS、MDCT和QCA分析61例UAP患者(低危组17例,中危组33例,高危组11例)71支病变血管.分析比较3组患者斑块的形态学特点.根据IVUS斑块回声的强度,将斑块分为软斑块、纤维斑块、钙化斑块、混合斑块,计算最小面积处斑块负荷,并分为≤50%、51%～74%及≥75%3类病变.以IVUS结果为标准,评价QCA计算血管狭窄程度的可信性,MDCT诊断3类病变的敏感性和特异性,及对斑块成分诊断的可靠性.结果 QCA可估计低危组和中危组患者的斑块负荷(低危组r=0.768,P<0.01;中危组r=0.721,P<0.01).高危组患者血管重构明显(冠状动脉重构指数=1.21±0.31),QCA低估了IVUS的斑块负荷[分别为(67±14)%、(75±16)%,r=0.551,P<0.01].MDCT对冠状动脉病变有较高的阴性预测值(87.8%-96.3%),但无法区分典型粥样硬化斑块内的纤维帽(kappa=0.245)及脂质核(kappa=0.235).3组患者IVUS斑块特点分析结果表明,随着危险度程度的增加,软斑块比例、血管正性重构程度、血管外弹力膜面积、最小管腔面积、斑块负荷、斑块破裂及血栓发生率逐渐增加.结论 QCA可以相对准确地评价UAP低危和中危组患者的冠状动脉狭窄程度,同时会低估高危组患者的病变程度.MDCT对于冠心病的诊断有非常高的阴性预测值可用于排除冠心病,但是无法可靠地区分粥样硬化斑块内的纤维帽及脂质核.IVUS检查显示软斑块、正性血管重构和最小管腔面积<4mm~2者可能为UAP高危组患者.
目的 應用血管內超聲(rvos)探討不穩定性心絞痛(UAP)低、中及高危組患者動脈粥樣硬化斑塊的特點,評價定量冠狀動脈造影(QCA)和64層螺鏇CT(MDCT)的診斷價值.方法 採用IVUS、MDCT和QCA分析61例UAP患者(低危組17例,中危組33例,高危組11例)71支病變血管.分析比較3組患者斑塊的形態學特點.根據IVUS斑塊迴聲的彊度,將斑塊分為軟斑塊、纖維斑塊、鈣化斑塊、混閤斑塊,計算最小麵積處斑塊負荷,併分為≤50%、51%～74%及≥75%3類病變.以IVUS結果為標準,評價QCA計算血管狹窄程度的可信性,MDCT診斷3類病變的敏感性和特異性,及對斑塊成分診斷的可靠性.結果 QCA可估計低危組和中危組患者的斑塊負荷(低危組r=0.768,P<0.01;中危組r=0.721,P<0.01).高危組患者血管重構明顯(冠狀動脈重構指數=1.21±0.31),QCA低估瞭IVUS的斑塊負荷[分彆為(67±14)%、(75±16)%,r=0.551,P<0.01].MDCT對冠狀動脈病變有較高的陰性預測值(87.8%-96.3%),但無法區分典型粥樣硬化斑塊內的纖維帽(kappa=0.245)及脂質覈(kappa=0.235).3組患者IVUS斑塊特點分析結果錶明,隨著危險度程度的增加,軟斑塊比例、血管正性重構程度、血管外彈力膜麵積、最小管腔麵積、斑塊負荷、斑塊破裂及血栓髮生率逐漸增加.結論 QCA可以相對準確地評價UAP低危和中危組患者的冠狀動脈狹窄程度,同時會低估高危組患者的病變程度.MDCT對于冠心病的診斷有非常高的陰性預測值可用于排除冠心病,但是無法可靠地區分粥樣硬化斑塊內的纖維帽及脂質覈.IVUS檢查顯示軟斑塊、正性血管重構和最小管腔麵積<4mm~2者可能為UAP高危組患者.
목적 응용혈관내초성(rvos)탐토불은정성심교통(UAP)저、중급고위조환자동맥죽양경화반괴적특점,평개정량관상동맥조영(QCA)화64층라선CT(MDCT)적진단개치.방법 채용IVUS、MDCT화QCA분석61례UAP환자(저위조17례,중위조33례,고위조11례)71지병변혈관.분석비교3조환자반괴적형태학특점.근거IVUS반괴회성적강도,장반괴분위연반괴、섬유반괴、개화반괴、혼합반괴,계산최소면적처반괴부하,병분위≤50%、51%～74%급≥75%3류병변.이IVUS결과위표준,평개QCA계산혈관협착정도적가신성,MDCT진단3류병변적민감성화특이성,급대반괴성분진단적가고성.결과 QCA가고계저위조화중위조환자적반괴부하(저위조r=0.768,P<0.01;중위조r=0.721,P<0.01).고위조환자혈관중구명현(관상동맥중구지수=1.21±0.31),QCA저고료IVUS적반괴부하[분별위(67±14)%、(75±16)%,r=0.551,P<0.01].MDCT대관상동맥병변유교고적음성예측치(87.8%-96.3%),단무법구분전형죽양경화반괴내적섬유모(kappa=0.245)급지질핵(kappa=0.235).3조환자IVUS반괴특점분석결과표명,수착위험도정도적증가,연반괴비례、혈관정성중구정도、혈관외탄력막면적、최소관강면적、반괴부하、반괴파렬급혈전발생솔축점증가.결론 QCA가이상대준학지평개UAP저위화중위조환자적관상동맥협착정도,동시회저고고위조환자적병변정도.MDCT대우관심병적진단유비상고적음성예측치가용우배제관심병,단시무법가고지구분죽양경화반괴내적섬유모급지질핵.IVUS검사현시연반괴、정성혈관중구화최소관강면적<4mm~2자가능위UAP고위조환자.
Objective To compare the value of intravascular ultrasound (IVUS) and assess the value of quantitative coronary angiography ( QCA) and 64 multi-detector computed tomography ( MDCT) on unstable anginas (UAP) risk stratification. Method A total of 61 UAP patients (low risk; 17, middle risk; 33 and high risk; 11) were recruited, 71 vessels were examined by MDCT, QCA and IVUS. Plaque characteristics (soft, fibrous, calcified and mixed plaques) and plaque burden at minimum area ( ≤50% , 51%-74% and ≥75%) were detected, calculated and analyzed. Results derived from various detection methods were compared. Results Plaque burden detection by QCA was comparable to IVUS results for low and middle risk UAP ( r = 0. 768 and r = 0. 721, respectively; all P < 0. 01 ) but not for high risk UAP ( 67% ± 14% vs. 75% ± 16% , P < 0. 01) due to significant positive vessel remodeling ( remodeling index = 1.21±0.31). The high negative predict value of MDCT for stenosed coronary vessels(87. 8%-96. 3%) was valuable for exclusion of coronary heart disease but MDCT was not able to identify fibrous cap( kappa = 0. 235) and lipid core ( kappa = 0. 245 ) . Extent of remodeling index, external elastic membrane area, minimum lumen area, plaque burden, plaque rupture and thrombosis increased in proportion to increasing risks of UAP patients. Conclusions QCA is a suitable tool for assessing UAP patients with low and middle vessel stenosis but underestimated the stenosis degree in UAP patients with high vessel stenosis. MDCT is valuable for exclusion vessel disease but not useful for identifying soft and fibrous plaque. Soft plaque with positive remodeling index and minimum lumen area <4 mm~2 derived from IVUS could correctly identify UAP patients with high degree of vessel stenosis.
