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目的:应用64排多层螺旋CT冠状动脉成像评价非ST段抬高性急性综合征(Non-ST ACS)患者冠状动脉罪犯斑块的形态学特征。方法:入选50例Non-ST ACS患者、50例稳定性心绞痛(SAP)患者,对所有患者进行64排多层螺旋CT冠状动脉成像及冠状动脉造影术,比较Non-ST ACS患者罪犯斑块与SAP患者稳定斑块的特征(包括罪犯斑块体积、平均CT值、罪犯斑块类型、重构指数、钙斑)。结果Non-ST ACS组患者罪犯斑块与SAP组患者稳定斑块中非钙化性斑块、混合性斑块发生率分别为(56%比22%,P<0.005;36%比14%,P<0.05);斑块体积、平均CT值、重构指数、正性重构比例分别为[125.30±20.07mm3比109.00±15.32mm3;95.52±23.20HU比116.52±24.00HU;1.08±0.09比1.00±0.08;61%比25%]。非钙化性斑块、混合性斑块、正性重构与Non-ST ACS显著相关,危险比(95%可信区间)分别为3.15(1.50-6.59);2.92(1.19-7.12);3.31(1.68-6.52)。结论:64排多层螺旋CT冠状动脉成像显示:与稳定性心绞痛患者稳定斑块比较,Non-ST ACS患者罪犯斑块斑块体积较大而平均CT值低,非钙化性斑块、混合性斑块及血管正性重构发生率高。
OBJECTIVE: To evaluate the morphological characteristics of coronary criptal plaque in patients with non-ST-segment acute coronary syndrome (ACS) using 64-slice multislice CT coronary angiography. Methods: Totally 50 patients with non-ST ACS and 50 patients with stable angina pectoris (SAP) were enrolled in this study. All the patients underwent 64-slice multislice spiral CT coronary angiography and coronary angiography. Features of stable plaque in SAP patients (including cribble plaque volume, average CT value, cripple plaque type, remodeling index, calcium spot). Results The incidences of non-calcified plaque and mixed plaque in non-ST ACS group were significantly higher than those in SAP group (56% vs 22%, P <0.005; 36% vs 14%, P <0.05). The plaque volume, average CT value, reconstruction index and positive remodeling ratio were [125.30 ± 20.07mm3 vs 109.00 ± 15.32mm3; 95.52 ± 23.20HU vs 116.52 ± 24.00HU; 1.08 ± 0.09 vs 1.00 ± 0.08; 61% vs. 25%]. Non-calcified plaque, mixed plaque, and positive remodeling were significantly associated with Non-ST ACS. The hazard ratios (95% confidence interval) were 3.15 (1.50-6.59), 2.92 (1.19-7.12), 3.31 ( 1.68-6.52). CONCLUSIONS: 64-slice MSCT coronary angiography shows that compared with stable plaque in patients with stable angina, non-ST ACS patients have larger plaque size and lower CT values, non-calcified plaque, Plaque and vascular positive remodeling high incidence.