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目的:探讨中-重度肾功能不全患者冠状动脉(冠脉)病变的CT表现。方法:对36例临床初步诊断为中-重度肾功能不全患者进行回顾分析。所有患者均行钙化积分CT平扫、双能量冠脉扫描,并进一步分析病变节段冠脉所对应的心肌成像。结果:共分析36例中-重度肾功能不全患者的168支冠脉,其中有52支冠脉存在不同程度的钙化[20支左前降支(LAD)存在钙化,35支发生弥漫性钙化]。AJ130≥100有13例,存在冠脉病变26例,其中3支冠脉病变15例;病变总段数为126段,其中LAD近段17段,左回旋支(LCX)近段14段,右冠状动脉(RCA)近段16段;轻度狭窄88段,中度狭窄24段,重度狭窄14段;软斑68块,混合斑19块,钙化斑123块;冠脉中-重度狭窄(管腔狭窄≥50%)者,灌注缺损心肌与正常心肌CT值及碘值差异有统计学意义(P值均<0.01);冠脉轻度狭窄(管腔狭窄<50%)的患者,灌注缺损心肌与正常心肌CT值及碘值差异也有统计学意义(P值亦均<0.01)。结论:中-重度肾功能不全患者的冠脉钙化积分阳性率、冠脉病变阳性率及相应节段心肌灌注缺损率均较高。
Objective: To investigate the CT findings of coronary artery (coronary) lesions in patients with moderate-severe renal insufficiency. Methods: A retrospective analysis of 36 cases of patients with moderate to severe renal dysfunction diagnosed initially. All patients underwent plain CT scan, dual-energy coronary scan, and further analysis of myocardial lesions corresponding to coronary artery imaging. Results: A total of 168 coronary arteries of 36 patients with moderate - severe renal insufficiency were analyzed. Among them, 52 coronary arteries had calcification in varying degrees [calcification of 20 left anterior descending (LAD) and diffuse calcification of 35]. AJ130≥100 in 13 cases, coronary artery lesions in 26 cases, of which 15 cases of coronary artery lesions in 15 cases; the total number of segments of 126 segments, including LAD proximal segment 17, left circumflex branch (LCX) proximal segment 14, right coronary Arterial (RCA) proximal segment of 16; mild stenosis of 88, moderate stenosis 24, severe stenosis 14; soft spot 68, mixed plaque 19, calcified plaque 123; moderate to severe coronary stenosis (lumen Stenosis≥50%), there was significant difference between CT value and iodine value in myocardial perfusion defect and normal myocardium (all P <0.01). In patients with mild coronary stenosis (<50%), There was also a significant difference between CT value and iodine value in normal myocardium (P <0.01). Conclusion: The positive rate of coronary artery calcification, the positive rate of coronary artery lesions and the corresponding segmental myocardial perfusion defect rate were all higher in patients with moderate-severe renal insufficiency.