中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
2期
107-110
,共4页
来春林%刘晓红%冀友瑞%原杰%邢金平
來春林%劉曉紅%冀友瑞%原傑%邢金平
래춘림%류효홍%기우서%원걸%형금평
冠状动脉疾病%断层摄影术,X线计算机%危险因素
冠狀動脈疾病%斷層攝影術,X線計算機%危險因素
관상동맥질병%단층섭영술,X선계산궤%위험인소
Coronary disease%Tomography,X-Ray Computed%Risk Factors
目的 探讨64层螺旋CT冠状动脉成像(64SCTA)检测冠状动脉粥样斑块的价值,分析形成不稳定斑块的危险因素.方法 选择112例住院冠心病患者行64SCTA和导管法冠状动脉造影,均检测血清内皮素-1、基质金属蛋白酶-9(MMP-9)、白介素-6(IL-6)、肿瘤坏死因子-α和超敏C反应蛋白(hs-CRP).以冠状动脉造影为标准评价64SCTA检测冠状动脉斑块的作用;根据检测正确的粥样斑块CT值将患者分为软斑块组(51例)和非软斑块组(61例),比较两组各检测指标的差异,分析软斑块形成的危险因素. 结果 64SCTA检测冠状动脉斑块的灵敏度为87.4%,特异度为87.1%,阳性预测值82.2%,阴性预测值91.0%.软斑块组与非软斑块组比较,MMP-9、IL-6、hs-CRP、冠状动脉病变数及诊断、性别和糖尿病的构成比差异有统计学意义.Logistic回归分析显示,MMP-9>5.231 ng/L(P=0.0215,OR=2.33,95%CI 1.13～4.79)、hs-CRP>3.583 mg/L(P=0.0008,OR=4.32,95%CI 1.84～10.15)和不稳定心绞痛(P=0.0339,0R=4.33,95%CI 1.12～16.77)为软斑块形成的危险因素.结论 64SCTA检测冠状动脉斑块价值较高,是目前无创方法检测冠状动脉斑块最为可靠的手段之一.MMP-9、hs-CRP和不稳定心绞痛为不稳定斑块的独立危险因素.
目的 探討64層螺鏇CT冠狀動脈成像(64SCTA)檢測冠狀動脈粥樣斑塊的價值,分析形成不穩定斑塊的危險因素.方法 選擇112例住院冠心病患者行64SCTA和導管法冠狀動脈造影,均檢測血清內皮素-1、基質金屬蛋白酶-9(MMP-9)、白介素-6(IL-6)、腫瘤壞死因子-α和超敏C反應蛋白(hs-CRP).以冠狀動脈造影為標準評價64SCTA檢測冠狀動脈斑塊的作用;根據檢測正確的粥樣斑塊CT值將患者分為軟斑塊組(51例)和非軟斑塊組(61例),比較兩組各檢測指標的差異,分析軟斑塊形成的危險因素. 結果 64SCTA檢測冠狀動脈斑塊的靈敏度為87.4%,特異度為87.1%,暘性預測值82.2%,陰性預測值91.0%.軟斑塊組與非軟斑塊組比較,MMP-9、IL-6、hs-CRP、冠狀動脈病變數及診斷、性彆和糖尿病的構成比差異有統計學意義.Logistic迴歸分析顯示,MMP-9>5.231 ng/L(P=0.0215,OR=2.33,95%CI 1.13～4.79)、hs-CRP>3.583 mg/L(P=0.0008,OR=4.32,95%CI 1.84～10.15)和不穩定心絞痛(P=0.0339,0R=4.33,95%CI 1.12～16.77)為軟斑塊形成的危險因素.結論 64SCTA檢測冠狀動脈斑塊價值較高,是目前無創方法檢測冠狀動脈斑塊最為可靠的手段之一.MMP-9、hs-CRP和不穩定心絞痛為不穩定斑塊的獨立危險因素.
목적 탐토64층라선CT관상동맥성상(64SCTA)검측관상동맥죽양반괴적개치,분석형성불은정반괴적위험인소.방법 선택112례주원관심병환자행64SCTA화도관법관상동맥조영,균검측혈청내피소-1、기질금속단백매-9(MMP-9)、백개소-6(IL-6)、종류배사인자-α화초민C반응단백(hs-CRP).이관상동맥조영위표준평개64SCTA검측관상동맥반괴적작용;근거검측정학적죽양반괴CT치장환자분위연반괴조(51례)화비연반괴조(61례),비교량조각검측지표적차이,분석연반괴형성적위험인소. 결과 64SCTA검측관상동맥반괴적령민도위87.4%,특이도위87.1%,양성예측치82.2%,음성예측치91.0%.연반괴조여비연반괴조비교,MMP-9、IL-6、hs-CRP、관상동맥병변수급진단、성별화당뇨병적구성비차이유통계학의의.Logistic회귀분석현시,MMP-9>5.231 ng/L(P=0.0215,OR=2.33,95%CI 1.13～4.79)、hs-CRP>3.583 mg/L(P=0.0008,OR=4.32,95%CI 1.84～10.15)화불은정심교통(P=0.0339,0R=4.33,95%CI 1.12～16.77)위연반괴형성적위험인소.결론 64SCTA검측관상동맥반괴개치교고,시목전무창방법검측관상동맥반괴최위가고적수단지일.MMP-9、hs-CRP화불은정심교통위불은정반괴적독립위험인소.
Objective To explore the value of 64-slice multi-detector computed tomography coronary angiography (64SCTA) in detecting the coronary artery plaque and to analyze the risk factors for unstable plaque. Methods A total of 112 inpatients who had been diagnosed as coronary artery disease by 64SCTA received catheter coronary angiography (CAG). The levels of serum endothelin-1 (ET-1), matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP) were measured. The effect of 64SCTA in detecting the coronary artery plaque was evaluated as compared with CAG. The patients were divided into the soft plaque group (n=51) and non-soft plaque group (n=61) according to the CT value of correctly detected plaque. The differences in the above detection indexes between two groups and the risk factors for soft plaque forming were analyzed. Results The 64SCTA had 87.4% sensitivity and 87.1% specificity in detecting coronary artery plaque, the positive predictive value was 82.2% and the negative predictive value was 91.0%. There were significant differences between soft plaque group and non-soft plaque group in the levels of MMP-9, IL-6, hs-CRP, the number of coronary lesions and the composition ratios of gender, diagnosis and diabetes. Logistic regression analysis showed that MMP-9>5.231 ng/L (P=0.0215, OR=2.33, 95%CI 1.13-4.79), hs-CRP>3.583 mg/L (P=0.0008, OR=4.32, 95%CI 1.84-10.15) and unstable angina pectoris (P=0. 0339, OR=4.33, 95% CI 1.12-16.77) were the risk factors for soft plaque formation. Conclusions 64SCTA has highervalue in detecting the coronary artery plaque, and is one of most reliable means in non-invasive methods. MMP-9, hs-CRP and unstable angina pectoris are independent risk factors of plaque instability.
