【摘要】：目的：評價頸動脈速度向量成像技術(shù)(VVI)對冠狀動脈粥樣硬化性心臟病(CHD)的診斷價值,為CHD的早期診斷及病情觀察尋求新指標。方法：選取心血管內(nèi)科住院CHD患者164例,男性95例,女性69例,平均年齡(56.1+5.1)歲。CHD患者分為三組：穩(wěn)定性心絞痛(SA)組(45例)、不穩(wěn)定心絞痛(UA)組(65例)及首發(fā)急性心肌梗死(AMI)組(54例)。另選取健康體檢者58例作為對照組,其中男性33例,女性25例,平均年齡(53.8±8.4)歲。所有受檢者入院后首次采血行血清學(xué)檢測,記錄血清超敏C反應(yīng)蛋白(hs-CRP),心肌肌鈣蛋白T(c-TnT)水平。應(yīng)用VVI檢測并記錄頸動脈光滑管壁力學(xué)參數(shù)值：各節(jié)段平均最大運動速度(Vmax)、平均最大應(yīng)變(Vmax)、平均最大應(yīng)變率(SRmax),及斑塊(基底部、兩側(cè)肩部、頂部)最大應(yīng)變值(Smax)。所有結(jié)果均取3個心動周期圖像平均值,應(yīng)用SPSS19.0統(tǒng)計軟件進行統(tǒng)計學(xué)分析,P0.05被認為有統(tǒng)計學(xué)意義。結(jié)果：1.血清學(xué)結(jié)果3組病例組受檢者血清hs-CRP水平均顯著高于對照組(P0.01)；急性心梗組高于不穩(wěn)定心絞痛組、穩(wěn)定性心絞痛組；不穩(wěn)定性心絞痛組高于穩(wěn)定性心絞痛組。 (P0.01)。3組病例組受檢者血清c-TnT水平均顯著高于對照組(P0.01)；急性心梗組高于不穩(wěn)定心絞痛組、穩(wěn)定性心絞痛組(P0.01)；2.頸動脈VVI檢測參數(shù)分析頸動脈管壁平均Vmax,平均Smax、平均SRmax比較：急性心梗組顯著低于穩(wěn)定性心絞痛組、對照組(P0.01)；不穩(wěn)定心絞痛組顯著低于穩(wěn)定性心絞痛組、對照組(P0.01)；穩(wěn)定性心絞痛組顯著低于對照組(P0.01)。斑塊肩部Smax、頂部Smax比較：急性心梗組顯著高于不穩(wěn)定心絞痛組、穩(wěn)定性心絞痛組(P0.01)。3 頸動脈力學(xué)參數(shù)與血清學(xué)指標相關(guān)性分析164例受檢者頸動脈管壁Smax與血清hs-CRP相關(guān),相關(guān)系數(shù)為-0.323,p0.01；與血清c-TnT相關(guān),相關(guān)系數(shù)為-0.200,p0.05。90例病例組斑塊肩部Smax,斑塊頂部Smax均與血清hs-CRP線性相關(guān),相關(guān)系數(shù)分別為0.279、0.266,p0.05：與血清c-TnT呈線性相關(guān),相關(guān)系數(shù)分別為0.235、0.252.p0.05。4 ROC曲線分析hs-CRP、c-TnT,管壁Smax聯(lián)合預(yù)測曲線下面積為0.982(0.966-0.998),高于其他單獨檢測標志物,根據(jù)Youden旨數(shù)最大時確定診斷界值,敏感度為93.6%,特異度93.1%；管壁Smax曲線下面積0.913(0.871.0.955),稍高于hs-CRP、cTnT,確定界值時敏感度77.3%,特異度91.4%。結(jié)論：頸動脈VVI檢測對冠心病的預(yù)測診斷及病情監(jiān)測具有臨床意義。(1)頸動脈非斑塊處管壁力學(xué)參數(shù)反應(yīng)冠心病動脈病變的程度,對區(qū)分低危冠心病(穩(wěn)定心絞痛)與相對中高危冠心病(不穩(wěn)定心絞痛、急性心肌梗死)具有預(yù)測價值。(2)頸動脈斑塊處力學(xué)參數(shù)對于判斷斑塊穩(wěn)定性具有潛在意義。形狀規(guī)則的軟斑塊肩部、頂部Smax 3寸急性心肌梗死具有預(yù)測價值,可能會成為早期預(yù)測急性心梗發(fā)生的新指標。(3)頸動脈管壁、斑塊(肩部、頂部)Smax與hs-CRP、c-TnT密切相關(guān),頸動脈VVI聯(lián)合血清hs-CRP、c-TnT水平檢測對評估冠狀動脈系統(tǒng)病變具有重要臨床價值。
[Abstract]:Objective: to evaluate the diagnostic value of carotid velocity vector imaging (VVI) in coronary atherosclerotic heart disease (CHD), and to seek a new index for the early diagnosis and observation of CHD. Methods: CHD patients were divided into three groups: stable angina pectoris group (n = 45), unstable angina pectoris group (n = 65) and initial acute myocardial infarction (AMI) group, n = 54). The patients were divided into three groups: stable angina pectoris group (n = 45), unstable angina pectoris group (n = 65) and initial acute myocardial infarction (AMI) group, n = 54). In addition, 58 healthy subjects were selected as the control group, including 33 males and 25 females, with an average age of (53.8 鹵8.4) years. The serum levels of high sensitive C-reactive protein (hs-CRP) and cardiac troponin T (c-TnT) were recorded for the first time after admission. The mechanical parameters of smooth tube wall of carotid artery were measured and recorded by VVI: the average maximum motion velocity of each segment was (Vmax), the average maximum strain rate of (Vmax), was (SRmax), and the maximum strain value of plaques (base, bilateral shoulder, top) was (Smax). All the results were taken from the average value of three cardiac cycle images, and the statistical analysis was carried out by SPSS19.0 statistical software. P 0.05 was considered to be statistically significant. Results: 1. The serological results showed that the serum hs-CRP levels in the three groups were significantly higher than those in the control group (P 0.01), and those in the acute myocardial infarction group were higher than those in the unstable angina pectoris group, the stable angina pectoris group, and the unstable angina pectoris group were higher than those in the stable angina pectoris group. The levels of serum c-TnT in the three groups were significantly higher than those in the control group (P 0.01), and those in the acute myocardial infarction group were higher than those in the unstable angina pectoris group and the stable angina pectoris group (P 0.01). Analysis of carotid artery VVI parameters comparison of mean Vmax, average Smax, average SRmax of carotid artery wall in acute myocardial infarction group was significantly lower than that in stable angina pectoris group (P 0.01), unstable angina pectoris group was significantly lower than stable angina pectoris group (P 0.01), stable angina pectoris group was significantly lower than control group (P 0.01). Comparison of Smax at the top of Smax, in plaque shoulder: acute myocardial infarction group was significantly higher than unstable angina pectoris group and stable angina pectoris group (P 0.01). 3 correlation analysis between carotid artery mechanical parameters and serological indexes showed that Smax of carotid artery wall was correlated with serum hs-CRP, and the correlation coefficient was-0.323, p0.01; The correlation coefficient was-0.200. the Smax at the top of Smax, plaque in p0.05.90 cases was linearly correlated with serum hs-CRP, and the correlation coefficient was 0.2790.266. p0.05: there was a linear correlation with serum c-TnT, the correlation coefficient was 0.235. the correlation coefficient was 0.252.p0.05.4 ROC curve analysis hs-CRP,c-TnT,. The area under the joint prediction curve of Smax was 0.982 (0.966 鈮，

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