Evaluation of the changes of unstable plaque load by 320-slice CT coronary angiography
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摘要:
目的 探究320层容积CT冠状动脉血管成像在评估随访期内冠状动脉粥样硬化不稳定斑块负荷变化的应用价值。 方法 选择2013年8月~2020年12月淮北矿工总医院拟诊断为冠心病的78例住院患者作为研究对象。随访期间采用320层容积CT对其进行冠状动脉血管成像检查，同时详细记录其年龄、BMI、吸烟史、高血压、糖尿病，并对其血脂指标和超敏C反应蛋白进行测定。根据复查期间的2次CT冠状动脉血管成像检查结果，将2次CT冠状动脉成像结果均为阴性的患者作为正常对照组（n=18），其余患者在随访期结束时发现至少有1个冠脉节段存在斑块，对比第一次检查原有斑块范围增大、管腔狭窄程度增加，作为斑块进展组（n=60）。采用χ2检验和Logistic回归分析对影响斑块进展的危险因素进行分析比较，并对比78例患者在随访期间的冠状动脉狭窄、斑块性质和负荷变化。 结果 斑块进展组和正常对照组患者的平均随访间隔时间的差异无统计学意义（P > 0.05）。斑块进展组中吸烟患者的比例与正常组相比，差异有统计学意义（P < 0.05）；其余各项危险因素两组间差异无统计学意义（P > 0.05）。性别、年龄、吸烟、高血压、糖尿病、肥胖、部分血脂[总胆固醇、三酰甘油、载脂蛋白A1、载脂蛋白B、脂蛋白(a)]指数异常及超敏C反应蛋白水平的增高增加了冠状动脉斑块负荷增加的风险，导致管腔狭窄。78例患者在随访后的各血管分支狭窄程度较随访前加重，差异有统计学意义（P < 0.05）。随访后，钙化斑块的比例（26.80%）低于随访前的56.52%，非钙化斑块和混合斑块的比例（分别为42.27%、30.93%）高于随访前的23.19%、11.59%，差异有统计学意义（P < 0.05）。78例患者在随访后的右冠状动脉、左前降支、回旋支以及总体斑块负荷高于随访前，差异有统计学意义（P < 0.05）。 结论 对于存在冠心病危险因素的患者来说，冠状动脉血管成像能够在随访期间较好地对其冠状动脉狭窄以及斑块性质和负荷变化进行评估，对于预测其病情发展和变化具有重要意义。 -
关键词:
- CT冠状动脉血管成像 /
- 冠心病 /
- 冠状动脉狭窄 /
- 斑块负荷 /
- 危险因素
Abstract:Objective To explore the application value of 320-slice CT coronary angiography in evaluating the changes of unstable plaque load of coronary artery during the follow-up period. Methods Seventy-eight inpatients with coronary heart disease in Huaibei Miners General Hospital from August 2013 to December 2020 were selected as the research objects. During the follow-up period, 320-slice CT was used to examine their coronary angiography. At the same time, age, BMI, smoking history, hypertension and diabetes were recorded in detail. The blood lipid index and high-sensitivity C-reactive protein were measured. According to the results of two CT coronary angiography examinations during the review period, 18 patients with negative CT coronary angiography results were taken as the normal control group, and the rest patients found at least one coronary artery segment with plaque at the end of the follow-up period, which was regarded as the plaque progression group (n=60). The χ2 test and Logistic regression analysis were used to compare the risk factors of plaque progression. At the same time, the coronary artery stenosis, plaque properties and load changes of 78 patients during the follow- up period were compared. Result There was no significant difference in the average follow- up interval between patients with plaque and normal control group (P > 0.05). Compared with the normal group, the proportion of smokers in the plaque group was significantly different (P < 0.05). Among other risk factors, there were no significant differences between the two groups (P > 0.05). The increase of gender, age, smoking, hypertension, diabetes, obesity, the abnormal indexes of some blood lipids [total cholesterol, triglyceride, apolipoprotein A1, apolipoprotein B, lipoprotein (a)] and high-sensitivity C-reactive protein were increased the risk of increased coronary artery plaque burden, and caused stenosis of the lumen. In 78 patients, the stenosis degree of each vascular branch after follow-up were significantly worse than those before follow-up, and the differences were statistically significant (P < 0.05). After follow-up, the proportion of calcified plaque (26.80%) was significantly lower than that before follow-up (56.52%), while the proportions of non-calcified plaque and mixed plaque (42.27% and 30.93%, respectively) were significantly higher than those before follow-up (23.19% and 11.59%) (P < 0.05). After follow-up, the right coronary artery, left anterior descending artery, circumflex artery and total plaque load of 78 patients were significantly higher than those before follow-up, and the differences were statistically significant (P < 0.05). Conclusion For patients with coronary heart disease risk factors, CT coronary angiography can better evaluate the coronary artery stenosis and the changes of plaque properties and loads during follow- up, which is of great significance for predicting the development and changes of their condition. -
Key words:
- CT coronary angiography /
- coronary heart disease /
- coronary artery stenosis /
- patch load /
- risk factor
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图 1 70岁男性高血压患者的CCTA图像
A~C: 第1次CCTA检查显示右冠状动脉近段非钙化斑块, 狭窄 < 50%; D~F: 36月后的复查, 右冠状动脉近段斑块体积明显增大, 管腔狭窄 > 75%.
Figure 1. CCTA images of a 70-year-old male with hypertension.
表 1 78例患者的随访基本资料比较
Table 1. Comparison of basic follow-up data of 78 patients [n(%)]
随访基本资料 斑块进展组（n=60） 正常对照组（n=18） t/χ2 P 随访间隔时间（月, Mean±SD） 43.73±5.32 43.44±5.61 0.200 0.842 年龄（岁） 0.670 0.413 ≥60 37(61.67) 13(72.22) ＜60 23(38.33) 5(27.78) 性别 2.447 0.118 男 42(70.00) 9(50.00) 女 18(30.00) 9(50.00) 吸烟 6.983 0.008 有 23(38.33) 1(5.56) 无 37(61.67) 17(94.44) 高血压 1.387 0.239 有 48(80.00) 12(66.67) 无 12(20.00) 6(33.33) 高血糖 3.414 0.051 有 21(35.00) 2(11.11) 无 39(65.00) 15(83.33) BMI 0.029 0.864 升高 38(63.33) 11(61.11) 正常 22(36.67) 7(38.89) TC 1.105 0.293 异常 9(15.00) 1(5.56) 正常 51(85.00) 17(94.44) TG 1.269 0.260 异常 14(23.33) 2(11.11) 正常 46(76.67) 16(88.89) HDL-C 0.150 0.698 异常 5(8.33) 1(5.56) 正常 55(91.67) 17(94.44) LDL-C 2.080 0.149 异常 12(20.00) 1(5.56) 正常 48(80.00) 17(94.44) ApoA1 1.387 0.239 异常 12(20.00) 6(33.33) 正常 48(80.00) 12(66.67) ApoB 0.263 0.608 异常 17(28.33) 4(22.22) 正常 43(71.67) 14(77.78) Lp（a） 1.887 0.169 异常 16(26.67) 2(11.11) 正常 44(73.33) 16(88.89) hs-CRP 0.212 0.645 异常 13(21.67) 3(16.67) 正常 47(78.33) 15(83.33) TC: 总胆固醇; TG: 三酰甘油; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇; Apo A1: 载脂蛋白A1; Apo B: 载脂蛋白B: Lp(a): 脂蛋白（a）; hs-CRP: 超敏C反应蛋白. 
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表 2 斑块进展危险因素的回归分析
Table 2. Regression analysis of risk factors for plaque progression
危险因素 OR 95% CI P 性别 3.202 2.491~4.117 ＜0.001 年龄 0.970 0.957~0.983 ＜0.001 吸烟 6.278 4.274~9.221 ＜0.001 高血压 1.169 0.850~1.607 0.336 糖尿病 2.531 1.842~3.478 ＜0.001 BMI 0.310 0.236~0.407 ＜0.001 TC 16.322 9.032~29.496 ＜0.001 TG 14.576 9.644~22.032 ＜0.001 HDL-C 1.474 0.826~2.629 0.189 LDL-C 1.138 0.717~1.806 0.583 ApoA1 0.135 0.101~0.180 ＜0.001 ApoB 0.327 0.247~0.433 ＜0.001 Lp(a) 4.454 3.061~6.481 ＜0.001 hs-CRP 0.549 0.399~0.755 ＜0.001
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表 3 78例患者的冠状动脉狭窄进展情况
Table 3. Progress of coronary artery stenosis in 78 patients [n(%)]
冠脉分支 狭窄程度 随访前 随访后 χ2 P 无狭窄 31(39.74) 18(23.08) 总体 狭窄＜50% 35(44.87) 4(5.13) 56.561 ＜0.001 狭窄≥50% 12(15.38) 56(71.79) 无狭窄 56(71.79) 44(56.41) RCA 狭窄＜50% 15(19.23) 5(6.41) 19.884 ＜0.001 狭窄≥50% 7(8.97) 29(37.18) 无狭窄 54(69.23) 41(52.56) LM-LAD 狭窄＜50% 19(24.36) 6(7.69) 27.317 ＜0.001 狭窄≥50% 5(6.41) 31(39.74) 无狭窄 72(92.31) 61(78.21) LCX 狭窄＜50% 3(3.85) 8(10.26) 6.183 0.045 狭窄≥50% 3(3.85) 9(11.54) RCA: 右冠状动脉; LM-LAD: 左前降支; LCX: 回旋支.
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表 4 78例患者冠状动脉斑块的性质变化
Table 4. Changes of coronary artery plaque in 78 patients [n(%)]
时间 斑块数(n) 钙化斑块 非钙化斑块 混合斑块 随访前 63 39(56.52) 16(23.19) 8(11.59) 随访后 97 26(26.80) 41(42.27) 30(30.93) χ2 19.509 4.740 7.009 P ＜0.001 0.029 0.008
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表 5 78例患者冠状动脉斑块的负荷变化
Table 5. 78 Changes of coronary artery plaque load in patients (n=78, Mean±SD)
时间 总体斑块负荷 RCA LM-LAD LCX 随访前 35.58±8.31 37.29±8.49 33.41±8.51 36.27±8.13 随访后 42.13±11.23 44.74±11.57 41.26±11.08 44.04±11.72 t 4.141 4.585 4.962 4.811 P ＜0.001 ＜0.001 ＜0.001 ＜0.001
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