血管內(nèi)超聲評價冠狀動脈左主干病變的臨床價值
發(fā)布時間：2019-03-14 07:19
【摘要】：目的:探討血管內(nèi)超聲對冠狀動脈左主干病變評價的臨床價值,為冠心病左主干病變的病情評估及介入治療提供更多的理論依據(jù),同時對比冠脈CT血管造影和冠狀動脈造影對冠心病的診斷結(jié)果,校正診斷誤差,提高CTA及CAG的診斷價值。方法:回顧性連續(xù)收錄2010年01月-2014年08月在河南科技大學(xué)第一附屬醫(yī)院于心內(nèi)科住院擇期成功行IVUS的患者368例,入院后收集相關(guān)資料,根據(jù)是否行CTA進行分組,統(tǒng)計IVUS、CAG及CTA對左主干直徑、長度、病變狹窄程度、冠脈斑塊性質(zhì)的例數(shù)進行分析。結(jié)果:(1)冠狀動脈左主干相對正常段直徑及長度分別為:CAG測量長度:8.45±4.37mm,直徑:4.46±1.29mm;CTA測量長度:9.08±4.41mm,直徑:5.26±1.41mm;IVUS測量長度:9.14±4.68mm,直徑:5.29±1.42mm;IVUS與CAG比較,左主干平均直徑、長度均有統(tǒng)計學(xué)意義(P(IVUS-CAG))=0.01;0.01);IVUS與CTA比較,左主干平均直徑、長度均無統(tǒng)計學(xué)意義(P(IVUS-CTA)=0.14;0.08)。對比IVUS和CAG、IVUS和CTA的圖像,兩種方法對冠狀動脈左主干狹窄程度評估有明顯統(tǒng)計學(xué)差異(P0.05)。(2)CAG與CTA對左主干病變診斷的敏感性、特異性、誤診率和Youden值:以IVUS為標準,CAG對左主干病變診斷的敏感性為44.4%,特異性為75.0%,誤診率為94.4%,Youden值為38.8%;CTA敏感性為94.3%,特異性為77.8%,誤診率為36.4%,Youden值為72.1%。(3)冠狀動脈左主干斑塊性質(zhì)評價分別為:IVUS與CAG對冠狀動脈左主干斑塊識別有明顯統(tǒng)計學(xué)差異(P0.01);IVUS與CTA對冠狀動脈左主干斑塊識別無明顯統(tǒng)計學(xué)差異(P=0.11)。結(jié)論:(1)IVUS測量左主干長度是9.14±4.68mm,直徑是5.29±1.42mm,CAG易低估左主干長度及直徑,CTA對左主干長度及直徑評價較準確;(2)CTA對病變診斷敏感性高,CAG對病變特異性較高;(3)CTA對左主干斑塊識別能力較CAG強。
[Abstract]:Objective: to explore the clinical value of intravascular ultrasound in the evaluation of left main coronary artery disease, and to provide more theoretical basis for the evaluation and interventional treatment of left main coronary artery disease. At the same time, the diagnostic results of coronary CT angiography and coronary angiography were compared, the diagnostic error was corrected, and the diagnostic value of CTA and CAG was improved. Methods: from January 2010 to August 2014, 368 patients who had successfully performed IVUS in the Department of Cardiology in the first affiliated Hospital of Henan University of Science and Technology from January 2010 to August 2014 were included retrospectively. After admission, the data were collected and divided into groups according to whether or not CTA was performed, and IVUS, was counted. CAG and CTA were used to analyze the number of cases of left main diameter, length, degree of stenosis and nature of coronary plaque. Results: (1) the diameter and length of the left main coronary artery were 8.45 鹵4.37mm for CAG, 9.08 鹵4.41mm for 4.46 鹵1.29 mm;CTA and 1.41 mm; for 5.26mm respectively. The measured length of IVUS was 9.14 鹵4.68mm, the diameter was 5.29 鹵1.42 mm;IVUS compared with CAG, the mean diameter and length of left trunk were statistically significant (P (IVUS-CAG) = 0.01). There was no significant difference in mean diameter and length of left trunk between IVUS and CTA (P (IVUS-CTA = 0.14 / 0.08). Comparing the images of IVUS, CAG,IVUS and CTA, there was significant difference between the two methods in evaluating the degree of left main coronary artery stenosis (P0.05). (2) the sensitivity and specificity of CAG and CTA in the diagnosis of left main coronary artery lesions. The misdiagnosis rate and Youden value: based on IVUS, the sensitivity, specificity, misdiagnosis and Youden value of CAG were 44.4%, 75.0%, 94.4% and 38.8%, respectively. The sensitivity, specificity and misdiagnosis rate of CTA were 94.3%, 77.8% and 36.4%, respectively. The Youden value was 72.1%. (3) the characteristics of left main coronary artery plaque were evaluated as follows: there was significant difference between IVUS and CAG in the identification of left main coronary artery plaque (P0.01). There was no significant difference in left main coronary plaque recognition between IVUS and CTA (P = 0. 11). Conclusion: (1) the length and diameter of the left trunk measured by IVUS were 9.14 鹵4.68mm and 5.29 鹵1.42mm respectively. It was easy to underestimate the length and diameter of the left trunk by CTA. CTA was more accurate in evaluating the length and diameter of the left trunk. (2) CTA was more sensitive to the diagnosis of lesions, and CAG was more specific to lesions, and (3) CTA was better than CAG in the identification of left main plaque.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4
本文編號：2439760
[Abstract]:Objective: to explore the clinical value of intravascular ultrasound in the evaluation of left main coronary artery disease, and to provide more theoretical basis for the evaluation and interventional treatment of left main coronary artery disease. At the same time, the diagnostic results of coronary CT angiography and coronary angiography were compared, the diagnostic error was corrected, and the diagnostic value of CTA and CAG was improved. Methods: from January 2010 to August 2014, 368 patients who had successfully performed IVUS in the Department of Cardiology in the first affiliated Hospital of Henan University of Science and Technology from January 2010 to August 2014 were included retrospectively. After admission, the data were collected and divided into groups according to whether or not CTA was performed, and IVUS, was counted. CAG and CTA were used to analyze the number of cases of left main diameter, length, degree of stenosis and nature of coronary plaque. Results: (1) the diameter and length of the left main coronary artery were 8.45 鹵4.37mm for CAG, 9.08 鹵4.41mm for 4.46 鹵1.29 mm;CTA and 1.41 mm; for 5.26mm respectively. The measured length of IVUS was 9.14 鹵4.68mm, the diameter was 5.29 鹵1.42 mm;IVUS compared with CAG, the mean diameter and length of left trunk were statistically significant (P (IVUS-CAG) = 0.01). There was no significant difference in mean diameter and length of left trunk between IVUS and CTA (P (IVUS-CTA = 0.14 / 0.08). Comparing the images of IVUS, CAG,IVUS and CTA, there was significant difference between the two methods in evaluating the degree of left main coronary artery stenosis (P0.05). (2) the sensitivity and specificity of CAG and CTA in the diagnosis of left main coronary artery lesions. The misdiagnosis rate and Youden value: based on IVUS, the sensitivity, specificity, misdiagnosis and Youden value of CAG were 44.4%, 75.0%, 94.4% and 38.8%, respectively. The sensitivity, specificity and misdiagnosis rate of CTA were 94.3%, 77.8% and 36.4%, respectively. The Youden value was 72.1%. (3) the characteristics of left main coronary artery plaque were evaluated as follows: there was significant difference between IVUS and CAG in the identification of left main coronary artery plaque (P0.01). There was no significant difference in left main coronary plaque recognition between IVUS and CTA (P = 0. 11). Conclusion: (1) the length and diameter of the left trunk measured by IVUS were 9.14 鹵4.68mm and 5.29 鹵1.42mm respectively. It was easy to underestimate the length and diameter of the left trunk by CTA. CTA was more accurate in evaluating the length and diameter of the left trunk. (2) CTA was more sensitive to the diagnosis of lesions, and CAG was more specific to lesions, and (3) CTA was better than CAG in the identification of left main plaque.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4
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相關(guān)期刊論文 前2條
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2 丁士芳,張運,張梅,陳文強,陳玉國,李貴雙,紀求尚,劉同濤,周煒;應(yīng)用血管內(nèi)超聲技術(shù)識別冠狀動脈粥樣斑塊[J];中華超聲影像學(xué)雜志;2005年05期
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