發(fā)布時(shí)間：2018-02-14 23:34

  本文關(guān)鍵詞： 主動(dòng)脈彈性 冠心病 危險(xiǎn)因素 DSCT心電門控 CT冠脈造影　出處：《大連醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過分析回顧性心電門控冠狀動(dòng)脈CT造影技術(shù)測量主動(dòng)脈的彈性指標(biāo)及冠脈狹窄的程度，首先分析主動(dòng)脈彈性功能與冠脈狹窄及其程度的相關(guān)性，其次分析冠脈狹窄程度與其危險(xiǎn)因素的相關(guān)性，同時(shí)探討DSCT評價(jià)升主動(dòng)脈彈性功能的臨床價(jià)值。 方法：收集大連大學(xué)附屬中山醫(yī)院2012年8月至2013年1月期間心內(nèi)科住院患者中擬診為冠心病并行DSCT冠脈造影檢查、臨床資料完整且配合良好的患者共計(jì)104例納入本研究，其中男性54例，女性50例，年齡范圍25-83歲，平均（57.31±11.00）歲。獲取詳細(xì)臨床資料及可致冠脈狹窄的相關(guān)危險(xiǎn)因素，首先按有無冠脈狹窄及高血壓分為4組，其次按冠脈狹窄程度分為輕、中、重3組，最后按有無高血壓合并冠脈狹窄或無狹窄再分為4組。使用西門子DSCT（SOMATOMDefinition）進(jìn)行掃描，結(jié)合心電編輯功能分別獲取心電圖中T波及R波頂處主動(dòng)脈瓣收縮及舒張末期圖像進(jìn)行重建，采用INSPACE血管測量軟件測量心臟不同搏動(dòng)時(shí)期同一層面（主動(dòng)脈竇上方25mm）升主動(dòng)脈的管徑及橫截面積，同時(shí)對有狹窄的冠狀動(dòng)脈進(jìn)行評分（CAS）并進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1.升主動(dòng)脈的彈性指標(biāo)：管腔的相對直徑變化率及膨脹性（％Ao、AoD)，管壁的順應(yīng)性及僵硬度(AoC、AoSI))在冠脈狹窄組與無狹窄組間均有統(tǒng)計(jì)學(xué)意義(P0.05)，尤以AoD及AoSI為著（P＜0.001）。 2.升主動(dòng)脈各項(xiàng)彈性指標(biāo)在冠脈不同狹窄程度組間的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。 3.升主動(dòng)脈彈性指標(biāo)中管壁的僵硬度（AoSI）與Gensini評分呈顯著正相關(guān)(P＜0.0l，r=0.716)，另外管腔的直徑變化率及膨脹性（％Ao、AoD）與Gensini評分呈顯著負(fù)相關(guān)(P＜0.01，r分別為-0.428、-0.251)。 4.各組間比較顯示，高血壓、糖尿病、高血脂、吸煙及年齡是可致冠脈狹窄的危險(xiǎn)因素，其中以高血壓因素用于分組，其余的因素如吸煙、糖尿病、年齡及血清總膽固醇（TC）是導(dǎo)致冠脈狹窄的獨(dú)立危險(xiǎn)因素（P均＜0.05，OR分別為6.287/7.409、6.995、1.073、15.249）。除年齡外，其余因素持續(xù)的時(shí)間或程度與冠脈狹窄程度呈正相關(guān)（P均＜0.05）。 5.高密度脂蛋白（HDL-C）是影響冠脈狹窄的獨(dú)立保護(hù)因素，冠脈狹窄程度與其下降的水平呈負(fù)相關(guān)（P＜0.05，r=-0.314）。 結(jié)論： 1.升主動(dòng)脈彈性指標(biāo)的高低與冠狀動(dòng)脈狹窄的嚴(yán)重程度具有良好的相關(guān)性，因此，亦可視為冠心病的獨(dú)立預(yù)測因子。 2.本研究進(jìn)一步表明，高血壓、糖尿病、高血脂、吸煙及年齡等指標(biāo)為導(dǎo)致冠脈狹窄的危險(xiǎn)因素；除年齡外，，其余危險(xiǎn)因素持續(xù)時(shí)間的長短和程度同樣可影響與決定冠脈狹窄的程度。 3. DSCT能夠較為準(zhǔn)確測量與評估升主動(dòng)脈的彈性，因此亦可作為臨床上檢查主動(dòng)脈彈性和預(yù)測冠脈狹窄的影像學(xué)手段。
[Abstract]:Objective: to analyze the correlation between aortic elastic function and coronary artery stenosis by retrospective electrocardiographic gated coronary angiography (ECC). Secondly, the relationship between the degree of coronary stenosis and its risk factors was analyzed, and the clinical value of DSCT in evaluating the elastic function of ascending aorta was discussed. Methods: a total of 104 patients with coronary heart disease (CHD) and DSCT coronary angiography were collected from Zhongshan Hospital affiliated to Dalian University from August 2012 to January 2013. There were 54 males and 50 females, aged 25-83 years, with an average of 57.31 鹵11.00 years old. After obtaining detailed clinical data and risk factors associated with coronary artery stenosis, they were divided into 4 groups according to coronary artery stenosis and hypertension. The patients were divided into 3 groups according to the degree of coronary stenosis: light, medium and heavy, and then divided into 4 groups according to whether hypertension was complicated with coronary stenosis or not. The patients were scanned with Siemens DSCT SOMATOMDefinition. Combined with ECG editing function, the T wave and R wave top aortic valve systolic and diastolic images were reconstructed, respectively. The diameter and cross-sectional area of ascending aorta at the same level (25 mm above the aortic sinus) at different beating stages of the heart were measured by INSPACE software. The coronary artery with stenosis was scored and analyzed statistically. Results:. 1. The elastic index of ascending aorta: the relative diameter change rate and swelling rate of the lumen and the compliance and stiffness of the wall were significantly different between the coronary stenosis group and the non-stenosis group (P < 0. 05), especially AoD and AoSI (P < 0. 001). 2. There was significant difference in the elasticity of ascending aorta between different coronary stenosis groups (P 0.05). 3. The stiffness of ascending aorta (AoSI) was positively correlated with Gensini score (P < 0. 0l0. 716). In addition, there was a significant negative correlation between the diameter change rate of the lumen and the Gensini score (P < 0. 01, r = -0. 428-0. 251, P < 0. 01), in addition, there was a significant negative correlation between the diameter change rate of the lumen and the Gensini score (P < 0. 01, r = -0. 428-0. 251, P < 0. 01). 4. High blood pressure, diabetes, hyperlipidemia, smoking and age were the risk factors for coronary artery stenosis. Age and serum total cholesterol (TCC) were the independent risk factors for coronary stenosis (P < 0.05). The odds ratios were 6.287 / 7.409 / 6.995 / 1.073 / 15.249 respectively. Except for age, there was a positive correlation between the duration or degree of other factors and the degree of coronary stenosis (P < 0.05). 5. High density lipoprotein (HDL-C) was an independent protective factor for coronary stenosis, and the degree of coronary stenosis was negatively correlated with its decreasing level (P < 0.05). Conclusion:. 1. There is a good correlation between the elasticity of ascending aorta and the severity of coronary artery stenosis, so it can be regarded as an independent predictor of coronary artery disease. 2. This study further showed that hypertension, diabetes, hyperlipidemia, smoking and age were risk factors for coronary artery stenosis. The duration and extent of other risk factors also affect and determine the extent of coronary stenosis. 3. DSCT can accurately measure and evaluate the elasticity of ascending aorta, so it can be used as an imaging method for clinical examination of aortic elasticity and prediction of coronary artery stenosis.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R816.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張遠(yuǎn)征;;冠心病發(fā)病危險(xiǎn)因素研究現(xiàn)狀[J];第四軍醫(yī)大學(xué)學(xué)報(bào);2009年23期

2 許開元;胡國棟;王彬;朱浪濤;何祥發(fā);肖丹丹;;64層CT血管成像在冠狀動(dòng)脈彈性研究中的價(jià)值[J];放射學(xué)實(shí)踐;2010年12期

3 陳義加;查云飛;陳倫剛;徐霖;劉超;李勤祥;;MDCT評價(jià)冠狀動(dòng)脈狹窄程度與升主動(dòng)脈彈性的相關(guān)性[J];放射學(xué)實(shí)踐;2012年04期

4 王鵬飛;王叢;喬海霞;孫剛;閆旭龍;吳國霞;丁燕程;;脈搏波傳導(dǎo)速度與心腦血管事件和死亡率的隊(duì)列研究[J];臨床心血管病雜志;2011年10期

5 高長征;魏宗德;;內(nèi)皮素-1、一氧化氮與冠狀動(dòng)脈病變程度相關(guān)性研究[J];瀘州醫(yī)學(xué)院學(xué)報(bào);2006年06期

6 商錫峰;;血管內(nèi)超聲的應(yīng)用進(jìn)展[J];實(shí)用心腦肺血管病雜志;2011年04期

7 徐懿;李月華;;糖尿病合并冠狀動(dòng)脈粥樣硬化性心臟病的發(fā)病及其相關(guān)特征[J];中國臨床康復(fù);2006年20期

8 方哲;周玉杰;史冬梅;趙迎新;劉宇揚(yáng);李艷芳;楊士偉;王志堅(jiān);胡賓;賈得安;聶斌;葛海龍;王健龍;周志明;;血管內(nèi)超聲在冠狀動(dòng)脈臨界病變中的應(yīng)用研究[J];心肺血管病雜志;2010年06期

9 遲東升,劉伊麗;高血壓心肌微血管病變的研究進(jìn)展[J];高血壓雜志;2004年06期

10 郭志平;林金秀;;動(dòng)脈功能無創(chuàng)性檢測的常用指標(biāo)[J];中華高血壓雜志;2009年06期

本文編號(hào)：1511888