| 王新斌,刘芳,姜海兵,等.双源 CT冠状动脉造影对冠状动脉分支狭窄程度及其临界病变的诊断价值研究[J].安徽医药,2021,25(4):718-721. |
| 双源 CT冠状动脉造影对冠状动脉分支狭窄程度及其临界病变的诊断价值研究 |
| Diagnostic value of DSCTA in the degree of coronary artery branch stenosis and critical lesions |
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| DOI：10.3969/j.issn.1009-6469.2021.04.020 |
| 中文关键词: 冠心病 冠状动脉狭窄 冠状血管造影术 计算机体层摄影血管造影术 冠状动脉临界病变 |
| 英文关键词: Coronary disease Coronary stenosis Coronary angiography Computed tomography angiography Critical coro nary artery lesion |
| 基金项目:新疆医科大学科研创新基金项目(ZYY201510) |
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| 中文摘要: |
| 目的发现 DSCTA(双源 CT冠状动脉造影)对冠心病冠状动脉不同血管狭窄程度及对冠状动脉临界病变的诊断效能。方法纳入 2016年 1月至 2017年 3月在新疆维吾尔自治区中医医院心内科就诊并拟诊为冠心病的病人 116例，签署知情同意后，行双源 CT冠状动脉造影检查，一周后行冠脉造影术检查，选取左主干、前降支近段、前降支中段、前降支远段、回旋支近段、回旋支中段、回旋支远段、右冠近段、右冠中段、右冠远段等 10个主要血管节段，以冠脉造影术(CAG)为诊断金标准，评价双源 CT冠状动脉成像术(DSCTA)对不同分支、不同程度冠状动脉狭窄及冠状动脉临界病变的诊断效能。结果共计纳入拟诊冠心病病人 116例，采集图像清晰的冠状动脉血管节段 1 113段。 DSCTA诊断冠脉狭窄的灵敏度为 94.94%(319/336)、特异度 96.40%(749/777)、阳性预测值 91.93%(317/347)、阴性预测值 97.78%(749/766)，诊断一致率 95.96%(1 068/1 113)，一致性较好；对不同血管狭窄程度的诊断效能评价发现， DSCTA对冠脉各节段不同狭窄程度的诊断一致率为 90.29%(1 005/1 113)，一致性较好(Kappa=0.802)；对冠状动脉不同节段的诊断效能分析发现， DSCTA对前降支近段(98.63%)的诊断灵敏度最优，对前降支远段(98.96%)的特异度最优，右冠近段评价一致率最高(98.17%)；对冠状动脉临界病变的诊断结果发现， DSCTA对于冠状动脉临界病变的灵敏度为 74.16%(89/120)，特异度为 96.58%(959/993)，对冠状动脉临界病变的诊断一致率一般(Kappa=0.699)。结论 DSCTA对冠心病血管狭窄的诊断效能较高，可以作为冠心病冠脉狭窄的筛查手段；对不同节段冠状动脉血管的诊断效能存在差异；对冠状动脉临界病变的诊断具有一定的临床价值，需进一步深入研究。 |
| 英文摘要: |
| Objective To find out the diagnostic efficacy of dual-source CT coronary angiography (DSCTA) in different degrees of coronary artery stenosis and critical lesions.Methods Totally 116 cases to be diagnosed as coronary heart disease who were admittedto the Department of Cardiology, Hospital of Traditional Chinese Medicine, Xinjiang Uygur Autonomous Region from January 2016 toMarch 2017 were included for the study. After signing the informed consent, DSCTA was taken, and coronary angiography (CAG) wascarried out one week after DSCTA, observing 10 major blood vessel segments including the LM,LAD1-3,LCX1-3,RCA1-3. CAG was used as the diagnostic gold standard to evaluate the diagnostic efficacy of DSCTA in different branches, different degrees of coronary artery stenosis and coronary artery critical lesions.Results A total of 116 patients to be diagnosed as coronary heart disease were included, and 1113 coronary artery segments with clear images were collected. The sensitivity, specificity, positive predictive value, negativepredictive value and diagnostic consistency of DSCTA in the diagnosis of coronary artery stenosis were 94.94% (319/336), 96.40%(749/777), 91.93% (317/347), 97.78% (749/766), and 95.96% (1068/1113),respectively. The diagnostic consistency was good. Evaluation of the diagnostic efficacy on different degrees of vascular stenosis found that the diagnostic consistency rate of DSCTA for differentdegrees of stenosis of coronary artery segments was 90.29% (1005/1113), with good consistency (Kappa=0.802). Analysis of the diagnostic efficacy of different coronary segments showed that DSCTA had the best diagnostic sensitivity to the proximal segment of the anterior descending branch (98.63%), the best specificity for the distal segment of the anterior descending branch (98.96%), and the highest rate of agreement for the proximal segment of the right coronary artery (98.17%). According to the diagnosis results of critical coronary artery lesion, DSCTA had a sensitivity rate of 74.16% (89/120) and specificity rate of 96.58% (959/993) for critical coronary arterylesion. The diagnostic coincidence rate of coronary artery critical lesions was general (Kappa=0.699).Conclusions DSCTA has a high diagnostic efficiency for coronary artery stenosis in coronary heart disease and can be used as a screening method. The diagnostic efficiencies of coronary artery in different segments are different. It has a certain clinical value for the diagnosis of critical coronary arterylesion but still needs further study. |
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