放射学实践
放射學實踐
방사학실천
Radiologic Practice
2015年
9期
936-939
,共4页
冠状血管痉挛%冠状血管造影术%体层摄影术,X 线计算机%预后
冠狀血管痙攣%冠狀血管造影術%體層攝影術,X 線計算機%預後
관상혈관경련%관상혈관조영술%체층섭영술,X 선계산궤%예후
Coronary vasospasm%Coronary angiography%Tomography,X-ray computed%Prognosis
目的：了解冠状动脉痉挛（CAS）患者冠状动脉 CT（CTCA）表现特点，探讨影响 CAS 的病理基础。方法：选择临床上具有静息性胸痛或胸闷但冠状动脉造影（CAG）无重度狭窄的患者进行乙酰胆碱试验，对成功诱发了 CAS 的患者行 CTCA 检查。CAS 患者行常规内科治疗，治疗完成后行门诊和／或电话随访。结果：共有21例患者成功诱发 CAS，10例为节段性 CAS，11例为弥漫性 CAS。10例节段性 CAS 中8例冠状动脉病变处可见偏心性斑块；11例弥漫性 CAS中8例冠状动脉病变处可见弥漫向心性斑块。节段性组和弥漫性组的冠状动脉斑块平均 CT 值分别为（51±20）HU 和（78±30）HU，冠状动脉狭窄率平均值分别为（30±14）％和（45±15）％，两组差异均有统计学意义（P 值均＜0．05）。患者出院后平均随访时间为（12±7）个月。5例（23．8％，5／21）患者出院后仍有胸部不适、胸痛或类似入院症状，其中2例表现为咽部紧缩感，1例表现为胸痛、胸部压榨感，1例因反复胸痛行冠状动脉支架植入，另有1例发生猝死。结论：CAS 多发生于冠状动脉非钙化斑块基础之上，反复 CAS 发作有猝死风险。
目的：瞭解冠狀動脈痙攣（CAS）患者冠狀動脈 CT（CTCA）錶現特點，探討影響 CAS 的病理基礎。方法：選擇臨床上具有靜息性胸痛或胸悶但冠狀動脈造影（CAG）無重度狹窄的患者進行乙酰膽堿試驗，對成功誘髮瞭 CAS 的患者行 CTCA 檢查。CAS 患者行常規內科治療，治療完成後行門診和／或電話隨訪。結果：共有21例患者成功誘髮 CAS，10例為節段性 CAS，11例為瀰漫性 CAS。10例節段性 CAS 中8例冠狀動脈病變處可見偏心性斑塊；11例瀰漫性 CAS中8例冠狀動脈病變處可見瀰漫嚮心性斑塊。節段性組和瀰漫性組的冠狀動脈斑塊平均 CT 值分彆為（51±20）HU 和（78±30）HU，冠狀動脈狹窄率平均值分彆為（30±14）％和（45±15）％，兩組差異均有統計學意義（P 值均＜0．05）。患者齣院後平均隨訪時間為（12±7）箇月。5例（23．8％，5／21）患者齣院後仍有胸部不適、胸痛或類似入院癥狀，其中2例錶現為嚥部緊縮感，1例錶現為胸痛、胸部壓榨感，1例因反複胸痛行冠狀動脈支架植入，另有1例髮生猝死。結論：CAS 多髮生于冠狀動脈非鈣化斑塊基礎之上，反複 CAS 髮作有猝死風險。
목적：료해관상동맥경련（CAS）환자관상동맥 CT（CTCA）표현특점，탐토영향 CAS 적병리기출。방법：선택림상상구유정식성흉통혹흉민단관상동맥조영（CAG）무중도협착적환자진행을선담감시험，대성공유발료 CAS 적환자행 CTCA 검사。CAS 환자행상규내과치료，치료완성후행문진화／혹전화수방。결과：공유21례환자성공유발 CAS，10례위절단성 CAS，11례위미만성 CAS。10례절단성 CAS 중8례관상동맥병변처가견편심성반괴；11례미만성 CAS중8례관상동맥병변처가견미만향심성반괴。절단성조화미만성조적관상동맥반괴평균 CT 치분별위（51±20）HU 화（78±30）HU，관상동맥협착솔평균치분별위（30±14）％화（45±15）％，량조차이균유통계학의의（P 치균＜0．05）。환자출원후평균수방시간위（12±7）개월。5례（23．8％，5／21）환자출원후잉유흉부불괄、흉통혹유사입원증상，기중2례표현위인부긴축감，1례표현위흉통、흉부압자감，1례인반복흉통행관상동맥지가식입，령유1례발생졸사。결론：CAS 다발생우관상동맥비개화반괴기출지상，반복 CAS 발작유졸사풍험。
Objective:To study the characteristics of computed tomography coronary angiography (CTCA)in pa-tients with coronary artery spasm (CAS),and to evaluate the potential factors influencing the pathology of CAS.Methods:Acetylcholine test was performed in patients with chest pain or chest tightening at rest but with no severe coronary artery stenosis proved by coronary arteriography (CAG).Then CTCA was performed in these CAS patients induced by acetylcho-line test.All CAS patients were treated on medicine routinely and followed up in outpatient department or by telephone in-terview after discharge.Results:CAS was successfully induced in twenty one patients,10 patients had segmental spasm,and 11 patients had diffuse spasm.CTCA showed local eccentric plaque in 8 patients of the 10 patients with segmental spasm, and diffuse concentric plaque in 8 patients of the 11 patients with diffuse spasm.The average CT values of coronary plaque was (51±20)HU and (78±30)HU in segmental spasm and diffuse spasm group,respectively,and the average stenosis rate of coronary arteries were (30±14)% and (45±15)% for segmental spasm and diffuse spasm group,respectively,with sig-nificant statistical difference (all P values<0.05).The mean follow up period was 12±7 month after discharge from hospi-tal,5 patients (23.8%)complained of chest discomfort,chest pain or alike symptoms at admission,of them,2 showed con-strictive feeling of pharynx,1 showed chest pain and tightening,1 underwent percutaneous coronary stent placement because of recurrent chest pain,and 1 died suddenly.Conclusions:CAS usually occur in patients with non calcified plaque of coronary arteries,and recurrent CAS attacks could associate with risk of sudden death.
