本文選題：冠狀動脈鈣化　切入點：冠脈CTA　出處：《天津醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的與背景:冠心病(CHD)是導致心源性猝死的主要原因,冠狀動脈鈣化(CAC)是動脈粥樣硬化的一個重要危險因素,因而CAC的檢測對心血管事件的發(fā)生有積極的預測價值,近年來雙源CT的應用越來越廣泛,應用這種無創(chuàng)性手段檢出CAC對于CHD的診斷有重要意義。慢性腎臟病(CKD)患者心血管病的發(fā)病率及死亡率高的主要原因是CAC的存在及動脈粥樣硬化的進展,CAC的早期診斷與治療能夠降低CKD患者心血管事件的發(fā)生和死亡率。本研究通過回顧性收集401例疑診冠心病住院患者的冠脈CTA結果及相關臨床資料,探討冠脈鈣化的相關危險因素,觀察冠脈鈣化特點尤其是合并慢性腎功能不全患者的鈣化病變情況并初步分析可能的原因。方法:收集2013.7-2013.12天津市第一中心醫(yī)院因疑診冠心病行冠脈CTA檢查的住院患者401例,其中冠脈CTA結果示冠脈鈣化陽性患者329例,鈣化陰性患者72例,通過對兩組相關臨床資料的比較探討冠脈鈣化的相關危險因素。鈣化陽性組患者根據(jù)冠脈CTA結果進行冠脈鈣化積分(CACS),運用Spearman相關分析探討CACS與相關因素的關系。根據(jù)冠脈CTA結果觀察冠脈鈣化病變的特點尤其是合并腎功能不全(CRI)患者的冠脈鈣化病變特點。部分接受冠脈造影(CAG)檢查的患者根據(jù)冠脈狹窄情況進行Gensini積分,運用Spearman相關分析探討CACS與Gensini積分的關系。結果:1.鈣化陽性組在吸煙史、高血壓、糖尿病、血脂異�；颊弑壤吓c鈣化陰性組存在明顯差異;2.Logistic回歸分析發(fā)現(xiàn)年齡年齡和血磷是冠脈鈣化的預測因子(P0.05);3.Spearman相關分析發(fā)現(xiàn)CACS與年齡、血磷、鈣磷乘積呈正相關(P0.01),與GFR呈負相關(P0.01),同時分析發(fā)現(xiàn)GFR與鈣磷乘積呈負相關(r=-0.450,P0.01);4.冠狀動脈前降支鈣化發(fā)生率最高(78.4%)且鈣化靶血管多同時合并狹窄;5.CRI組與非CRI組比較、終末期腎病組與非CRI組比較2支以上鈣化者多,差異具有統(tǒng)計學意義(P0.05);CRI組與非CRI組、終末期腎病組與非CRI組比較存在多發(fā)及彌漫性鈣化者多,具有顯著統(tǒng)計學差異(P0.01),終末期腎病組Cr、Ca、P、鈣磷乘積顯著高于非CRI組與3-4期CKD組(P0.01),GFR水平顯著下降(P0.01);6.鈣化靶血管同時合并狹窄的患者與單純鈣化患者比較吸煙者多,LDL-C及TC水平高,且差異具有統(tǒng)計學意義(P0.05);7.在接受CAG檢查的患者中,Spearman相關分析發(fā)現(xiàn)CACS與Gensini積分呈正相關(P0.05)。結論:1.年齡、高血壓、糖尿病、吸煙史及血脂異常是CAC的危險因素,年齡和血磷是CAC的預測因子,CACS與年齡、血磷、鈣磷乘積及GFR相關;2.冠狀動脈前降支更易出現(xiàn)鈣化病變,鈣化靶血管多合并狹窄,合并腎功能不全的患者鈣化病變較腎功能正常者更復雜。
[Abstract]:Objective and background: coronary heart disease (CAD) is the main cause of sudden cardiac death, and coronary artery calcification (CACC) is an important risk factor for atherosclerosis. Therefore, the detection of CAC has positive predictive value for the occurrence of cardiovascular events. In recent years, dual-source CT has been used more and more widely. Using this noninvasive method to detect CAC is of great significance for the diagnosis of CHD. The main reasons for the high incidence and mortality of cardiovascular disease in patients with chronic kidney disease CKD are the existence of CAC and the progression of atherosclerosis. The results of coronary artery CTA and related clinical data were collected retrospectively from 401 inpatients with suspected coronary heart disease, who were treated with amputation and treatment to reduce the incidence and mortality of cardiovascular events in patients with CKD. To investigate the risk factors of coronary artery calcification, To observe the characteristics of coronary artery calcification, especially in patients with chronic renal insufficiency, and to analyze the possible causes. Methods: a total of 401 patients with suspected coronary artery disease (CTA) in Tianjin first Central Hospital from March 7 to 12, 2013 were collected. Among them, 329 cases were positive for coronary calcification and 72 cases were negative for coronary CTA. The risk factors of coronary calcification were compared between the two groups according to the results of coronary CTA. The correlation between CACS and related factors was studied by Spearman correlation analysis. According to the results of coronary CTA, the characteristics of coronary calcification lesions were observed, especially in patients with renal insufficiency (CRI). Some patients undergoing coronary angiography (CAG) received Gensini scores according to the coronary stenosis. Spearman correlation analysis was used to study the relationship between CACS and Gensini score. Results: 1. Smoking history, hypertension, diabetes mellitus in calcified positive group, Logistic regression analysis showed that age and blood phosphorus were the predictors of coronary artery calcification. 3. Spearman correlation analysis showed that CACS was associated with age and blood phosphorus. There was a positive correlation between calcium and phosphorus product (P 0.01) and a negative correlation with GFR (P 0.01). At the same time, it was found that there was a negative correlation between GFR and calcium phosphorus product. The incidence of calcification of anterior descending coronary artery was the highest (78.4%). There were more calcifications in the end stage nephropathy group than in the non CRI group, the difference was statistically significant between the CRI group and the non CRI group. The number of multiple and diffuse calcifications in the end stage nephropathy group and non CRI group was higher than that in the non CRI group. There was significant statistical difference (P 0.01). The products of Cr and Ca P in end-stage nephropathy group were significantly higher than those in non-stage CRI group and 3-4 stage CKD group. The levels of LDL-C and TC in patients with calcified target vessels with stenosis were significantly higher than those in smokers. The difference was statistically significant (P 0.05). Among the patients undergoing CAG examination, there was a positive correlation between CACS and Gensini scores (P 0.05). Conclusion 1. Age, hypertension, diabetes, smoking history and dyslipidemia are the risk factors of CAC. Age and serum phosphorus were the predictors of CAC. CACS was associated with age, blood phosphorus, calcium and phosphorus product and GFR correlation. 2. Anterior descending coronary artery was more prone to calcification, and calcified target vessels were more complicated with stenosis. Calcification lesions in patients with renal insufficiency are more complex than those with normal renal function.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R541.4

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本文編號：1612705