【摘要】：目的探討64排螺旋CT冠狀動脈成像(Computed tomography coronary angiography,CTA)在診斷冠脈狹窄、支架和搭橋術后隨訪中的意義及其相關影響因素。方法回顧性選取我院先后接受CTA和CAG檢查符合入選標準的患者274例,分冠心病篩查組(n=168)、支架術后隨訪組(n=68)、搭橋術后隨訪組(n=38)三部分進行研究。以后者作為“金標準”對比分析兩種檢查結果,評價CTA診斷自身冠脈狹窄病變、支架內(nèi)再狹窄和橋血管通暢性的靈敏度、特異度、陽(陰)性預測值、約登指數(shù)以及對斑塊定性診斷的準確性及相關影響因素等。CAG及CTA兩種檢查結果運用配對四格表資料或者行(R)×列(C)列表的卡方檢驗進行比較分析,若P0.05則兩者無統(tǒng)計學意義,尚不能認為兩種檢查存在統(tǒng)計學差異,即冠脈CTA檢查可以作為一種準確性較高的影像學檢查應用在冠心病患者的診療中,反之亦然。結果1冠心病篩查組:168例疑似冠心病患者,CAG確診123例,冠脈CTA正確檢出冠心病的患者120例,漏診3例,誤診5例;兩種檢查方法在冠狀動脈狹窄程度以及斑塊性質的診斷上無明顯差異,相關性好;冠脈CTA在患者例數(shù)、病變血管數(shù)、具體冠脈(LAD、LCX、RCA等)各方面診斷的準確性分別為:95.2%、93.5%、94.6%、93.5%、92.2%。2支架術后隨訪組:68例患者145枚支架中10枚支架因CTA圖像差不能評估而排除,135枚可評估支架中,11(8.1%)枚支架經(jīng)CAG診斷為ISR,其中10(7.4%)枚支架CTA正確診斷ISR,1例漏診;CTA誤診9例(其中8例支架直徑≤2.75mm)。CTA在診斷LAD、LCX、RCA等位置及直徑2.75mm、長度≤30mm支架的準確性分別為:94.3%、87.1%、93.9%、99.0%、96.5%;支架直徑≤2.75mm的再狹窄率明顯高于直徑≥3mm,支架長度30mm的再狹窄率明顯高于長度不足18mm;3搭橋術后隨訪組:38例患者共計75支橋血管其中2支因CTA無法評估而排除。CAG共檢出病變患者14人(病變血管18支,其中動脈橋血管2支,靜脈橋血管16支),CTA正確檢出12人、漏診2人、誤診2人(動脈橋血管全部正確檢出,靜脈橋血管正確檢出14支,漏診2支,誤診2支);CTA在評估橋血管通暢性方面,按照病例數(shù)、動脈橋血管和靜脈橋血管等各方面的準確性分別為89.5%、100.0%、91.1%。乳內(nèi)動脈橋血管通暢率明顯高于大隱靜脈橋血管;患者的手術年齡、性別以及綜合相關危險因素等都會影響橋血管通暢率。結論1冠脈CTA在評價自身冠脈狹窄病變、支架內(nèi)再狹窄和橋血管通暢性方面有很高的準確性,可以初步判定斑塊的性質,但是對于不穩(wěn)定斑塊的評估欠佳。2冠脈CTA檢查所需造影劑用量是CAG的2~3倍,既往有腎功能不全病史的患者應用需慎重。3冠脈CTA尚并不能完全替代CAG在臨床中的應用,而是作為一種互補的無創(chuàng)傷非侵入性影像學檢查方法用于冠心病患者的前期篩查、后期治療和隨訪中。冠脈CTA尤其適用于以下方面:1疑似冠心病患者的診斷,預測冠心病患者的愈后;2發(fā)現(xiàn)早期LM管壁的病變;3不除外主動脈夾層或肺梗塞患者胸痛三聯(lián)的一站式檢查;4 PCI術后1年無明顯癥狀患者隨訪的首選;5 CABG術后評估橋血管通暢性的首選。
[Abstract]:Objective to explore the significance and related factors of 64 row spiral CT coronary angiography (Computed tomography coronary angiography, CTA) in the diagnosis of coronary stenosis and follow-up after stent and bypass surgery. Methods a retrospective study was conducted to select 274 patients who received CTA and CAG examination in accordance with the criteria of admission, divided into coronary heart disease screening group (n=168) and stents. Follow up group (n=68) and three parts of follow-up group (n=38) after bypass surgery. After comparison and analysis of two tests as "gold standard", the sensitivity, specificity, positive (negative) predictive value, Jorden index, and qualitative diagnosis of plaque in the diagnosis of coronary stenosis, restenosis and bridging vascular patency were evaluated by CTA. The results of two kinds of.CAG and CTA tests, such as accuracy and related factors, were compared with the chi square test of paired four lattice data or line (R) x column (C) list. If P0.05 had no statistical significance, there was no statistical difference between the two types of examination, that is, the crown vein CTA examination could be used as a higher accuracy imaging examination. Results 1 coronary heart disease screening group: 168 cases of coronary heart disease screening group: 168 cases of suspected coronary heart disease, CAG confirmed 123 cases, coronary CTA correctly detected coronary heart disease patients, 3 cases, misdiagnosis 5 cases; two inspection methods in the degree of coronary artery stenosis and plaque nature diagnosis of no significant difference, correlativity is good; correlativity; coronal The diagnostic accuracy of pulse CTA in the number of patients, the number of diseased vessels, the specific coronary artery (LAD, LCX, RCA, etc.) were respectively diagnosed as 95.2%, 93.5%, 94.6%, 93.5%, and followed up after 92.2%.2 stent: 10 stents of 145 stents in 68 patients were excluded because of the CTA image poor evaluation, and 135 assessment scaffolds were diagnosed as ISR by CAG in 11 (8.1%) stents, 10 of which were diagnosed as ISR. (7.4%) the stent CTA correctly diagnosed ISR and 1 cases of missed diagnosis; CTA misdiagnosed 9 cases (8 cases of stent diameter less than 2.75mm).CTA in the diagnosis of LAD, LCX, RCA and other locations and diameter 2.75mm, the accuracy of the length less than 30mm stent was 94.3%, 87.1%, 93.9%, 99%, 96.5%, and the stent diameter less than 2.75mm was significantly higher than the diameter more than 3mm, stent length narrowly narrowed. The narrowing rate was significantly higher than the length of 18mm; 3 after bypass surgery, 38 patients had 75 bridge vessels and 2 of them were excluded from.CAG to detect 14 diseased patients (18 vessels of the lesion, 2 of artery bridge, 16 veins of vein bridge), and CTA correctly detected 12, 2 missed diagnosis and 2 misdiagnosis (all artery bridge vessels were all correctly detected. " 14 branches of vein bridge were correctly detected, 2 missed diagnosis and 2 misdiagnosis. The accuracy of CTA in assessing the vascular patency of the bridge was 89.5% and 100%, respectively, according to the number of cases, the vascular patency of the artery bridge and the vein bridge, respectively. The vascular patency rate of the internal mammary artery bridge was significantly higher than that of the large saphenous vein bridge. The surgical age, sex and synthesis of the patients were significantly higher than that of the large saphenous vein bridge. Conclusion 1 coronary artery CTA has high accuracy in evaluating coronary stenosis, stent restenosis and bridging vascular patency, which can preliminarily determine the properties of plaque, but for unstable plaque assessment, the amount of contrast agent required for.2 coronary CTA examination is 2~3 times as much as CAG. Patients with a history of renal insufficiency need to be cautious about the use of.3 coronary CTA and can not completely replace CAG in clinical application, but as a complementary and noninvasive noninvasive imaging examination for early screening, later treatment and follow-up of coronary heart disease patients. Coronary CTA is especially suitable for the following aspects: 1 suspected coronary heart disease The patients were diagnosed, the prognosis of the patients with coronary heart disease was predicted; 2 the lesions of the early LM tube wall were found; 3 the one-stop examination of the three union of the chest pain in the aortic dissection or the patients with pulmonary infarction; the first choice of the patients with no obvious symptoms in 1 years after 4 PCI; and the first choice for assessing the patency of the bridge after 5 CABG.
【學位授予單位】：華北理工大學
【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：2127975