摘要
目的研究冠状动脉校正性对比剂浓度(corrected coronary opacification,CCO)差值在冠心病患者冠状动脉狭窄中的诊断价值。方法选择2013年6月—2017年4月河北医科大学第二医院收治的左前降支狭窄的冠心病患者99例,以血管狭窄率≥70%为界分为狭窄率<70%组40例和狭窄率≥70%组59例。所有患者均行螺旋CT冠状动脉成像,经过CT图像工作站的后处理,测量冠状动脉左前降支狭窄段前后的CCO值,并计算CCO差值;分析CCO差值与血管狭窄率及心肌梗死溶栓(the thrombolysis in myocardial infarction,TIMI)危险评分间的相关性。采用受试者工作特征(receiver operating characteristic,ROC)曲线判断CCO差值诊断冠状动脉狭窄的最佳截断点;以数字减影血管造影(DSA)为金标准,采用诊断试验四格表法计算CCO差值在冠状动脉狭窄诊断中的灵敏度及特异度。结果狭窄率≥70%组TIMI危险评分高于狭窄率<70%组,CCO差值低于狭窄率<70%组,差异均有统计学意义(Z=-7.124,P<0.001;Z=6.318,P<0.001);CCO差值与血管狭窄率及TIMI危险评分均呈正相关(r=0.807,P<0.001;r=0.840,P<0.001)。ROC曲线分析结果显示,ROC曲线下面积为0.879,最佳截断点为0.1947;以DSA检查结果为金标准,以0.1947为CCO差值截断点诊断冠状动脉狭窄率≥70%灵敏度为80.0%、特异度为78.0%。结论 CCO差值对冠心病患者冠状动脉血管狭窄有较高的诊断效能,有望成为筛查冠状动脉缺血性疾病严重程度的新指标。
Objective To study the diagnostic value of differences in corrected coronary opacification(CCO)in coronary artery stenosis in patients with coronary heart disease(CHD).Methods We enrolled 99 CHD patients with left anterior descending branch(LAD)stenosis admitted to the Second Hospital of Hebei Medical University from June 2013 to April 2017.Based on the vascular stenosis rate of≥70%,all patients were divided into stenosis rate<70%group(n=40)and stenosis rate≥70%group(n=59).All patients were examined with spiral CT coronary angiography.By image postprocessing techniques of CT workstation,the CCO values were measured before and after LAD,to calculate CCO for difference analysis,and to analyze the correlation of rate of vascular stenosis to risk score of the thrombolysis in myocardial infarction(TIMI).Digital subtraction angiography(DSA)served as the gold standard.Four lattice table was used to calculate sensitivity and specificity of differences in CCO in the diagnosis of coronary artery stenosis.The receiver operating characteristic(ROC)curve was employed to determine the optimal cut-off point.Results TIMI risk score was higher but differences in CCO were lower in stenosis rate≥70%group than in stenosis rate<70%group,and the differences were statistically significant(Z=-7.124,P<0.001;Z=6.318,P<0.001);differences in CCO was positively correlated with vascular stenosis rate and TIMI risk score(r=0.807,P<0.001;r=0.840,P<0.001).ROC curve showed that the area under the ROC curve was 0.879,with an optimal cut-off point of 0.1947.Given the results of CAG as the gold standard and 0.1947 as cut-off point,sensitivity and specificity in the diagnosis of coronary artery stenosis rate≥70%was 80.0%and 78.0%respectively.Conclusion The differences in CCO has a high diagnostic efficiency for coronary artery stenosis in CHD patients,and is expected to become a new indicator for screening the severity of coronary ischemic disease.
作者
颜立群
张景坤
汪国石
王文燕
康建丽
穆晓丹
韩娟
YAN Li-qun;ZHANG Jing-kun;WANG Guo-shi;WANG Wen-yan;KANG Jian-li;MU Xiao-dan;HAN Juan(Department of Medical Imaging,East Branch of Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;College of International Education,Hebei Medical University,Shijiazhuang 050017,China)
出处
《临床误诊误治》
2018年第4期71-76,共6页
Clinical Misdiagnosis & Mistherapy
基金
河北省卫计委重点科技研究计划课题(20130179)
