摘要
目的:了解冠状动脉痉挛(CAS)患者冠状动脉CT(CTCA)表现特点,探讨影响CAS的病理基础。方法:选择临床上具有静息性胸痛或胸闷但冠状动脉造影(CAG)无重度狭窄的患者进行乙酰胆碱试验,对成功诱发了CAS的患者行CTCA检查。CAS患者行常规内科治疗,治疗完成后行门诊和/或电话随访。结果:共有21例患者成功诱发CAS,10例为节段性CAS,11例为弥漫性CAS。10例节段性CAS中8例冠状动脉病变处可见偏心性斑块;11例弥漫性CAS中8例冠状动脉病变处可见弥漫向心性斑块。节段性组和弥漫性组的冠状动脉斑块平均CT值分别为(51±20)HU和(78±30)HU,冠状动脉狭窄率平均值分别为(30±14)%和(45±15)%,两组差异均有统计学意义(P值均<0.05)。患者出院后平均随访时间为(12±7)个月。5例(23.8%,5/21)患者出院后仍有胸部不适、胸痛或类似入院症状,其中2例表现为咽部紧缩感,1例表现为胸痛、胸部压榨感,1例因反复胸痛行冠状动脉支架植入,另有1例发生猝死。结论:CAS多发生于冠状动脉非钙化斑块基础之上,反复CAS发作有猝死风险。
Objective：To study the characteristics of computed tomography coronary angiography （CTCA）in pa-tients with coronary artery spasm （CAS）,and to evaluate the potential factors influencing the pathology of CAS.Methods：Acetylcholine test was performed in patients with chest pain or chest tightening at rest but with no severe coronary artery stenosis proved by coronary arteriography （CAG）.Then CTCA was performed in these CAS patients induced by acetylcho-line test.All CAS patients were treated on medicine routinely and followed up in outpatient department or by telephone in-terview after discharge.Results：CAS was successfully induced in twenty one patients,10 patients had segmental spasm,and 11 patients had diffuse spasm.CTCA showed local eccentric plaque in 8 patients of the 10 patients with segmental spasm, and diffuse concentric plaque in 8 patients of the 11 patients with diffuse spasm.The average CT values of coronary plaque was （51＆#177;20）HU and （78＆#177;30）HU in segmental spasm and diffuse spasm group,respectively,and the average stenosis rate of coronary arteries were （30＆#177;14）% and （45＆#177;15）% for segmental spasm and diffuse spasm group,respectively,with sig-nificant statistical difference （all P values＆lt;0.05）.The mean follow up period was 12＆#177;7 month after discharge from hospi-tal,5 patients （23.8%）complained of chest discomfort,chest pain or alike symptoms at admission,of them,2 showed con-strictive feeling of pharynx,1 showed chest pain and tightening,1 underwent percutaneous coronary stent placement because of recurrent chest pain,and 1 died suddenly.Conclusions：CAS usually occur in patients with non calcified plaque of coronary arteries,and recurrent CAS attacks could associate with risk of sudden death.
出处
《放射学实践》
北大核心
2015年第9期936-939,共4页
Radiologic Practice
