本文選題：多層螺旋計算機(jī)斷層掃描血管造影術(shù)　切入點(diǎn)：冠狀動脈　出處：《華北理工大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本次研究通過使用256層螺旋計算機(jī)斷層掃描血管造影技術(shù),利用改良后的標(biāo)準(zhǔn)計算方法對影像下的冠狀動脈及頭頸動脈各節(jié)段的狹窄程度和斑塊性質(zhì)進(jìn)行計算,探索不同類型的斑塊在不同動脈分段上的分布特點(diǎn),并分析冠狀動脈狹窄程度和斑塊鈣化程度與頭頸動脈的狹窄程度和斑塊鈣化程度上的相關(guān)性及其對冠心病的預(yù)測價值。方法采用回顧性的病例對照研究方式,選取臨床診斷或懷疑冠心病的患者作為研究對象,采用斷層掃描血管造影術(shù)對所有患者進(jìn)行冠狀動脈和頭頸動脈的檢查,計算各動脈節(jié)段的狹窄程度評分和鈣化程度評分,利用冠狀動脈造影技術(shù)檢測出的冠狀動脈狹窄結(jié)果將所有患者分成兩組,狹窄程度≥50%為病例組,狹窄程度50%為對照組,比較兩組患者在流行病學(xué)資料和各動脈節(jié)段上狹窄程度評分和鈣化評分上的差異性,并采用logistics回歸分析冠狀動脈和頭頸動脈的狹窄程度評分和鈣化評分對冠心病診斷的預(yù)測價值,并分析冠狀動脈和頭頸動脈狹窄程度和鈣化程度之間的相關(guān)性。結(jié)果本次研究共收集207名患者,其中對照組129名,病例組78名,兩組患者在吸煙、高血壓、心房纖顫和冠心病家庭成員史上存在明顯差異。共有2905條冠狀動脈納入分析,計算機(jī)掃描下檢出狹窄節(jié)段共230條,發(fā)生部位以冠狀動脈左前降支和左回旋支為主,斑塊性質(zhì)以鈣化斑塊為主(占38.0%),對照組患者在冠狀動脈狹窄總評分和鈣化評分上均明顯小于病例組患者(0.94±1.59 vs.9.96±3.62,Z=-12.207,P0.001;1.32±4.25 vs.12.85±21.67,Z=-5.242,P0.001);1236條顱內(nèi)動脈節(jié)段中發(fā)生狹窄的共有21條,發(fā)生狹窄的主要部位為椎動脈顱內(nèi)段,斑塊性質(zhì)以軟斑塊為主(占42.9%),對照組患者在顱內(nèi)動脈的狹窄程度總評分和鈣化評分上均小于病例組患者(0.05±0.25 vs.0.37±0.78,Z=-4.111,P0.001;0.11±0.54 vs.0.47±0.92,Z=-3.903,P0.001);檢出的828條頸動脈中發(fā)生狹窄節(jié)段數(shù)為86條,主要發(fā)生部位為頸總動脈,斑塊性質(zhì)也以鈣化斑塊為主(占49.4%),對照組患者同樣在頸動脈的狹窄程度總評分和鈣化評分上低于病例組患者(0.04±0.11 vs.0.20±0.20,Z=-7.696,P0.001;0.50±1.27 vs.1.90±1.50,Z=-7.051,P0.001)。冠狀動脈狹窄程度總評分、冠狀動脈斑塊鈣化總評分和頸動脈狹窄程度總評分是影響冠心病診斷的主要因素(95%OR=1.877~5.133,P0.001;95%OR=1.021~1.232,P=0.017;95%OR=4.772~5.061*106,P=0.016),其中各動脈段上狹窄程度評分與鈣化評分存在明顯的正相關(guān),而冠狀動脈的狹窄程度評分與頸動脈狹窄程度、頸動脈鈣化程度以及顱內(nèi)動脈鈣化程度存在相關(guān)性。結(jié)論冠狀動脈造影下狹窄程度高的患者在計算機(jī)斷層掃描下的冠狀動脈、顱內(nèi)動脈和頸動脈上的狹窄程度總評分和鈣化評分也較高,其中冠狀動脈狹窄程度總評分、冠狀動脈斑塊鈣化總評分和頸動脈狹窄程度總評分是預(yù)測冠心病的主要因素,冠狀動脈狹窄情況與冠狀動脈和頭頸動脈的鈣化情況存在明顯的相關(guān)性。
[Abstract]:Objective to use 256 slice spiral computed tomography angiography through this study, the degree of stenosis and plaque by the calculation method of the improved standard of images of coronary artery and head and neck artery segments were calculated, explore the distribution characteristics of different types of vein segments in different plaque, degree of stenosis and the analysis of value relevance the severity of coronary artery stenosis and calcification of head and neck artery and plaque calcification extent and in prediction of coronary heart disease. Methods a retrospective case-control study, the clinical diagnosis or suspected coronary heart disease patients as the research object, using tomography angiography of coronary artery in all patients and the neck check calculation section the arterial stenosis score and the degree of calcification score, using coronary angiography to detect coronary Arterial stenosis results all patients were divided into two groups, more than 50% stenosis as the case group, the degree of stenosis was 50% of control group, the difference in epidemiological data and each artery segment stenosis and calcification score on the score of two groups were compared, and the regression analysis of the degree of stenosis of coronary artery and the neck artery calcification score and the score of the predictive value of the diagnosis of coronary heart disease by logistics, and analyze the correlation between coronary artery and neck artery stenosis and calcification. The results of this study were collected from 207 patients, including 129 patients in the control group, 78 cases, two groups of patients in smoking, hypertension, there exist obvious differences in atrial fibrillation and coronary heart disease family a member of the history. A total of 2905 coronary arteries were included in the analysis, computer scanning detection narrow segment of a total of 230, occurred in the left anterior descending coronary artery and left circumflex artery, plaque The calcified plaques mainly (38%), the patients in the control group in the total score of coronary artery stenosis and calcification score were significantly lower than patients (0.94 + 1.59 + 3.62 vs.9.96, Z=-12.207, P0.001; 1.32 + 4.25 vs.12.85 + 21.67, Z=-5.242, P0.001); 1236 intracranial artery stenosis segment a total of 21, occurred in the main site for intracranial vertebral artery stenosis, plaque soft plaques (42.9%), the control group of patients in the intracranial artery stenosis score and total calcification score were lower than patients (0.05 + 0.25 vs.0.37 + 0.78, Z=-4.111 + 0.54 vs.0.47 + 0.11 P0.001; 0.92, Z=-3.903, P0.001); the 828 carotid arteries detected in the narrow segment number is 86, the major site for carotid artery plaque is also dominated by calcified plaque (49.4%), the control group were also in carotid artery stenosis and calcification score rating On the lower case patients (0.04 + 0.11 + 0.20 vs.0.20, Z=-7.696, P0.001; 0.50 + 1.27 vs.1.90 + 1.50, Z=-7.051, P0.001). The total score of coronary artery stenosis, coronary artery plaque calcification score and total score of carotid artery stenosis is the main factor affecting the diagnosis of coronary heart disease (95%OR=1.877~5.133, 95%OR=1.021~1.232, P0.001; P=0.017; 95%OR=4.772~5.061*106, P=0.016), in which the artery segment stenosis score and calcification score showed significantly positive correlation, and the extent of coronary artery stenosis score and the extent of carotid artery stenosis, the correlation between the degree of carotid artery calcification and intracranial artery calcification. Coronary artery in computed tomography coronary angiography by the conclusion of the degree of stenosis patients with high score, total score and the degree of stenosis of intracranial artery calcification and carotid artery were higher, the total score of coronary artery stenosis The total score of coronary atherosclerotic plaques and the degree of carotid artery stenosis are the main factors to predict coronary heart disease. There is a significant correlation between coronary artery stenosis and calcification of coronary artery and head and neck artery.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4;R816.2

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