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目的:采用64排螺旋CT冠状动脉成像(CTCA)评价冠状动脉斑块的稳定性,探讨斑块稳定性与急性冠脉综合征(ACS)的关系。方法:选取79例冠心病患者,均进行64排螺旋CT冠状动脉成像检查,其中稳定型心绞痛(SAP)29例,ACS 50例。比较SAP组和ACS组患者冠状动脉的斑块类型,并分析冠状动脉狭窄程度及斑块类型与ACS发病的关系。结果:79例冠心病患者共检出斑块147个,其中SAP组检出50个,ACS组检出97个。SAP组和ACS组患者的斑块类型间差异有统计学意义(P<0.01);SAP组以硬斑块为主(占72.0%),ACS组以软斑块为主(占64.9%)。随访5个月,20例患者再发ACS,分析其随访之前的螺旋CT冠状动脉成像结果,发现不同类型的ACS患者,其冠状动脉狭窄程度间差异无统计学意义(P>0.05),而冠状动脉斑块类型间差异有统计学意义(P<0.05),多为软斑块。结论:64排螺旋CT可通过对不同密度斑块及相应层面对比剂CT值测量,从数值上区分硬斑块及软斑块,以判别斑块的稳定性,指导临床治疗。
Objective: To evaluate the stability of coronary plaque using 64-slice spiral CT coronary angiography (CTCA) and to explore the relationship between plaque stability and acute coronary syndrome (ACS). Methods: Totally 79 patients with coronary heart disease were examined by 64-slice spiral CT coronary angiography, including 29 cases of stable angina pectoris (SAP) and 50 cases of ACS. The plaque types of coronary artery in SAP group and ACS group were compared and the relationship between coronary artery stenosis and plaque type and ACS was analyzed. Results: A total of 147 plaques were detected in 79 patients with coronary heart disease, of which 50 were detected in the SAP group and 97 in the ACS group. There were significant differences in plaque types between SAP group and ACS group (P <0.01). Hard plaque was the main group (72.0%) in SAP group, and soft plaque was the main group (64.9%). During the follow-up period of 5 months, 20 patients underwent ACS again. The results of spiral CT coronary angiography before follow-up were analyzed. There was no significant difference in the degree of coronary artery stenosis among the different types of ACS (P> 0.05) The difference of arterial plaque type was statistically significant (P <0.05), mostly soft plaque. Conclusion: The 64-slice spiral CT can differentiate the hard plaques from the soft plaques by contrast CT measurement of different density plaques and the corresponding layers to discriminate the plaque stability and guide the clinical treatment.