CAJ | 학술논문

目的以冠状动脉CT血管造影(CCTA)和侵入性冠状动脉造影(ICA)为手段,分析其中合并代谢综合征患者冠状动脉粥样硬化斑块负荷和冠状动脉病变特点.方法连续入选2008年1月至201 1年6月因冠心病或疑诊冠心病在我院3个月内同时行CCTA和ICA检查的患者,排除既往接受冠状动脉旁路移植术(CABG)或直接经皮冠状动脉介入治疗(PCI)者.冠状动脉病变按16节段分析,比较代谢综合征和非代谢综合征2组患者在钙化积分、斑块特征及梗阻性病变程度的差异.结果共纳入872例患者,平均年龄(60.2±10.0)岁,男性634例(72.70％).代谢综合征组377例,非代谢综合征组495例.冠状动脉钙化积分中位数为102(10,410),明显高于非代谢综合征组的58(0,274)(P＜0.01).与非代谢综合征组比较,代谢综合征组无钙化患者所占比例较低[19.63％(74/377)比30.71％ (152/495),P＜0.01],而钙化积分≥1000的重度钙化所占比例较高[8.22％(31/377)比4.65％ (23/495),P=0.03];左主干及各支冠状动脉中远段钙化斑块所占比例较高(P均＜0.05);单支病变患者所占比例较低[23.61％ (89/377)比36.77％(182/495),P＜0.01],而二支病变[29.71％ (112/377)比22.83％(113/495),P＜0.05]和三支病变[35.54％(134/377)比24.44％(121/495),P＜0.01]所占比例较高.结论代谢综合征患者冠状动脉重度钙化多,左主干和各支冠状动脉中、远段钙化斑块数显著增高,钙化病变更弥漫,且梗阻性病变累及的血管数更多.
목적 이관상동맥CT혈관조영(CCTA)화침입성관상동맥조영(ICA)위수단,분석기중합병대사종합정환자관상동맥죽양경화반괴부하화관상동맥병변특점.방법 련속입선2008년1월지201 1년6월인관심병혹의진관심병재아원3개월내동시행CCTA화ICA검사적환자,배제기왕접수관상동맥방로이식술(CABG)혹직접경피관상동맥개입치료(PCI)자.관상동맥병변안16절단분석,비교대사종합정화비대사종합정2조환자재개화적분、반괴특정급경조성병변정도적차이.결과 공납입872례환자,평균년령(60.2±10.0)세,남성634례(72.70％).대사종합정조377례,비대사종합정조495례.관상동맥개화적분중위수위102(10,410),명현고우비대사종합정조적58(0,274)(P＜0.01).여비대사종합정조비교,대사종합정조무개화환자소점비례교저[19.63％(74/377)비30.71％ (152/495),P＜0.01],이개화적분≥1000적중도개화소점비례교고[8.22％(31/377)비4.65％ (23/495),P=0.03];좌주간급각지관상동맥중원단개화반괴소점비례교고(P균＜0.05);단지병변환자소점비례교저[23.61％ (89/377)비36.77％(182/495),P＜0.01],이이지병변[29.71％ (112/377)비22.83％(113/495),P＜0.05]화삼지병변[35.54％(134/377)비24.44％(121/495),P＜0.01]소점비례교고.결론 대사종합정환자관상동맥중도개화다,좌주간화각지관상동맥중、원단개화반괴수현저증고,개화병변경미만,차경조성병변루급적혈관수경다.
Purpose To compare coronary plaque burden,composition,distribution and the degree of coronary artery stenosis in invasive coronary angiography (ICA) diagnosed coronary artery disease (CAD)patients with or without metabolic syndrome (MetS).Methods From January 2008 to June 2011,consecutive patients underwent both coronary computed tomography angiography (CCTA) and ICA within three months were enrolled.Patients with history of previous percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) were excluded.Plaque characteristics and maximal luminal diameter stenosis were analyzed on a 16-segment basis as suggested by the American Heart Association classification.Results The study population consisted of 872 patients [age (60.2 ± 10.0) years,72.70％ males] including 377 patients with MetS and 495 patients without MetS.The median coronary artery calcium score (CACS) was higher in MetS patients than in non-MetS patients [102(10,410) vs.58(0,274),P ＜ 0.01].Percentage of patients with no coronary artery calcium was significantly lower in MetS group than in non-MetS group [19.63％ (74/377) vs.30.71％ (152/495),P ＜ 0.01],while percentage of patients with severe coronary calcium (CACS ≥ 1000) were significantly higher in MetS than non-MetS group [8.22％ (31/377) vs.4.65％ (23/495),P =0.03].The proportion of patients with 1-vessel disease was lower [23.61％ (89/377) vs.36.77％ (182/495),P ＜ 0.01],2-vessel [29.71 ％ (112/377) vs.22.83 ％ (113/ 495),P ＜ 0.05] and 3-vessel disease [35.54％ (134/377) vs.24.44％ (121/495),P ＜ 0.01] were higher in MetS group than in non-NetS group.Calcified plaque of LM and the middle and distal coronary artery were significantly higher in MetS group than in non-MetS group(all P ＜ 0.05).Conclusions CAD patients with MetS are associated with severer coronary artery calcium deposition and higher percentage of calcified plaque in the middle and distal coronary arteries and severer obstructive coronary vessels.