本文選題：冠脈狹窄 + 冠脈迂曲��； 參考：《河北醫(yī)科大學》2012年碩士論文

【摘要】：目的：采用256層螺旋CT冠脈成像，定量研究冠狀動脈無狹窄患者迂曲發(fā)生率和迂曲程度，并進一步探討其臨床價值。 方法：525例疑似冠心病患者，經冠脈CTA成像，冠狀動脈均無明顯狹窄，其中男240例，女285例，年齡33～78歲，平均55.45±11.26歲。收集心臟薄層原始圖像及后處理圖像，統(tǒng)計冠脈迂曲發(fā)生部位、發(fā)生率及程度，并觀察與年齡、性別及體重指數的相關性。 結果：525例冠脈無狹窄患者中，冠脈迂曲發(fā)生率約為40.2%（211例/525例），其中女性冠脈迂曲發(fā)生率（25.7%）高于男性（14.3%），冠脈迂曲組平均年齡高于無迂曲組（p＜0.05）。迂曲組與無迂曲組體重指數無明顯差異（p＞0.05）。左旋支迂曲發(fā)生率最高，為28.6%（150例），左前降支迂曲發(fā)生率為24.6%（129例），右冠脈迂曲發(fā)生率14.9%（78例）；單支迂曲發(fā)生率為18.3%（96例），其中發(fā)生在左旋支為8.8%（46例），前降支為6.9%（36例），右冠脈為2.9%（15例）；雙支迂曲發(fā)生率為15.4%（81例）；三支均迂曲發(fā)生率為6.3%（33例）。輕中重度迂曲發(fā)生率分別為13.52%（71例）、14.48%（76例）、12.19%（64例）。 討論：256層螺旋CT冠脈成像作為一種無創(chuàng)檢查，不僅能夠客觀顯示冠狀動脈走行迂曲，在冠心病診斷上具有重要的臨床價值。 目的：采用256層螺旋CTA定量研究冠狀動脈迂曲與冠心病發(fā)生率相關性，并進一步探討其臨床價值。 方法：對1275例疑似冠心病患者行冠狀動脈CTA成像，其中男性693例，女行582例，年齡33～78歲，平均年齡57.65±12.35歲。收集心臟薄層原始圖像及后處理圖像，統(tǒng)計冠脈狹窄程度及冠脈迂曲發(fā)生率，分析他們之間的關系，并觀察其與性別的關系。 結果：1275例行冠脈CTA成像患者中，冠脈狹窄（狹窄程度≥50%）患者336例，其中男219例（17.2%），女117例（9.2%）。冠脈迂曲患者447例，其中男192例（15.1%），女255例（20%）。冠脈迂曲組在不同冠脈狹窄程度及多支中重度狹窄時，狹窄發(fā)生率均低于無迂曲組。（p均＜0.05） 討論：256層螺旋CT可以客觀顯示冠脈的迂曲和狹窄，冠脈的迂曲和狹窄均引起了血流動力學的改變，兩者之間具有相關性，冠脈迂曲可以降低冠脈狹窄的發(fā)生率及程度。 目的：回顧性分析416例冠脈無明顯狹窄患者256層螺旋CTA數據，分析冠狀動脈走行迂曲與左室功能相關性。 方法：回顧性分析416例臨床擬診冠心病患者，均采用256iCT一次掃描同時完成冠狀動脈成像及心功能分析。其中男210例，女206例。40歲以下32例，40-60歲270例，，60歲以上114例。年齡33-83，平均年齡50.73±10.88歲。記錄患者冠脈走行有無迂曲，測量患者左室舒張末期容積（EDV）、收縮末期容積（ESV）、每搏輸出量（SV）、射血分數（EF）及心輸出量（CO）。按照不同迂曲程度、不同年齡、不同性別分組，分析冠脈迂曲對諸心功能參數的影響。 結果：不同迂曲程度、不同性別分組及40歲以上年齡分組均顯示冠脈迂曲組患者左室舒張末期容積（EDV）、收縮末期容積（ESV）、每搏輸出量（SV）、心輸出量（CO），均較無迂曲組顯著降低（＜0.05）。提示冠脈迂曲組可能影響左心功能，其嚴重程度與患者年齡及性別無關。 討論：256層螺旋CTA能夠同時完成冠脈成像及心功能分析，冠脈迂曲患者左心儲備功能的下降。
[Abstract]:Objective: to quantitatively study the tortuosity and tortuosity of patients with coronary artery stenosis by using 256 slice spiral CT coronary angiography, and to further explore its clinical value.
Methods: 525 cases of suspected coronary heart disease, coronary artery CTA imaging, coronary artery stenosis, including 240 men, 285 women, age 33~78 years old, mean 55.45 + 11.26 years old. Collect the original image of the heart thin layer and post-processing image, statistics of the location of coronary circuitous, incidence and degree, and observe the age, sex and body mass index of the phase Customs.
Results: among the 525 patients with no stenosis, the incidence of coronary tortuosity was about 40.2% (211 cases of /525 cases). The incidence of coronary tortuosity in women (25.7%) was higher than that of men (14.3%). The average age of the coronary tortuosity group was higher than that in the non tortuous group (P < 0.05). There was no significant difference between the tortuous group and the non tortuous group (P > 0.05). The incidence of the left circumflex was the highest. For 28.6% (150 cases), the incidence of left anterior descending branch was 24.6% (129 cases), and the incidence of right coronary tortuosity was 14.9% (78 cases), and the incidence of single branch tortuosity was 18.3% (96 cases), including 8.8% (46 cases) in the left lateral branch, 6.9% in the anterior descending branch and 2.9% in the right coronary artery (36 cases), and the incidence of double collateral tortuosity. The incidence of light, moderate and severe tortuosity was 13.52% (71 cases), 14.48% (76 cases) and 12.19% (64 cases) respectively.
Discussion: 256 slice spiral CT coronary angiography, as a noninvasive examination, not only can objectively show the coronary artery to take the tortuosity, but also has important clinical value in the diagnosis of coronary heart disease.
Objective: To study the correlation between coronary artery tortuosity and the incidence of coronary heart disease (CHD) by 256 slice spiral CTA, and to further explore its clinical value.
Methods: 1275 patients with suspected coronary heart disease were performed coronary artery CTA imaging, including 693 males and 582 women, 33~78 years old, with an average age of 57.65 + 12.35 years old. The original image of thin layer of heart and post-processing image were collected, the degree of coronary stenosis and the incidence of coronary tortuosity were counted, the relationship between them was analyzed, and the relationship between them and sex was observed.
Results: of the 1275 patients with coronary CTA imaging, there were 336 cases of coronary stenosis (degree of stenosis more than 50%), of which 219 cases were male (17.2%), 117 cases (9.2%) and 447 cases of coronary tortuosity, including 192 cases (15.1%) and 255 cases (20%). The incidence of stenosis in coronary artery circuitous group was lower than that in non tortuous group. P < 0.05)
Discussion: 256 layers of spiral CT can objectively display the tortuosity and stenosis of the coronary artery. The coronary tortuosity and stenosis all cause the change of hemodynamics. There is a correlation between the two. The coronary tortuosity can reduce the incidence and degree of coronary stenosis.
Objective: To retrospectively analyze 256 slice spiral CTA data of 416 patients with coronary artery stenosis without stenosis, and to analyze the correlation between coronary artery bypass and left ventricular function.
Methods: the coronary artery imaging and cardiac function analysis were performed in 416 cases of coronary heart disease, including 210 male cases, 206 female patients under.40 years, 270 cases of 40-60 years old and 114 cases above 60 years old. The age 33-83 and average age 50.73 + 10.88 years were recorded. Left ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and cardiac output (CO). The effects of coronary tortuosity on cardiac function parameters were analyzed according to different degrees of tortuosity, age and sex.
Results: different degrees of tortuosity, different sex groups and age groups over 40 years of age all showed left ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and cardiac output (CO), which were significantly lower than that in no tortuous group (< 0.05). The age and sex of the patient were not related.
Discussion: 256 slice spiral CTA can simultaneously perform coronary imaging and cardiac function analysis, and the left ventricular reserve function of patients with coronary artery tortuosity is decreased.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R541.4;R816.2

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