摘要
目的:探讨计算机断层扫描血管造影(CTA)评估非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉狭窄度的应用效果。方法:回顾性分析泉州医学高等专科学校附属人民医院于2018年4月至2020年4月收治的60例NSTEMI患者,均进行CTA及冠状动脉造影(CAG)检查,统计CTA检查征象,与CAG比较,评估CTA各冠状动脉节段狭窄度的符合率,并用Kappa检验分析冠状动脉狭窄度评估一致性。结果:60例NSTEMI患者经CTA检查,多伴有一种或多种征象。其中,检出狭窄闭塞49例、心肌低密度区43例、局部心室变厚34例、胸腔积液20例、心包积液14例、心肌钙化8例及室壁瘤6例;共计420个冠状动脉节段中,经CAG检查发现冠状动脉节段狭窄173个,经CTA检查发现冠状动脉节段狭窄159个,总体符合率91.91%,以左主干(LM)符合率最高,左前降支(LAD)、右冠状动脉(RCA)、左回旋支(LCX)次之;经CAG检查诊断证实单支病变7例、双支病变19例、三支病变34例,与CAG比较,CTA准确率为80.00%,经一致性Kappa检验,κ=0.700,P <0.05,提示CTA与CAG有较高一致性。结论:NSTEMI患者冠状动脉狭窄度可应用CTA进行评估,其诊断效能高,与CAG一致性较好,当检查出冠状动脉主支或相关重要分支重度以上狭窄时,可进一步实施CAG检查,避免过度诊断。
Objective To evaluate the effect of computed tomography angiography(CTA) on coronary artery stenosis in patients with non-ST-segment elevation myocardial infarction(NSTEMI). Methods Retrospective analysis was performed on 60 cases of NSTEMI patients admitted to People’s Hospital Affiliated of Quanzhou Medical College from April 2018 to April 2020.All of them underwent CTA and coronary angiography(CAG) examination. The examination signs of CTA were statistically analyzed,and the coincidence rate of each coronary artery segment stenosis of CTA was evaluated compared with that of CAG. Kappa test was used to analyze the degree of coronary artery stenosis to assess consistency. Results 60 patients with NSTEMI were found to be associated with one or more signs after CTA examination. Among them, 49 cases of stenosis and occlusion, 43 cases of myocardial low-density area, 34 cases of local ventricular thickening, 20 cases of pleural effusion, 14 cases of pericardial effusion, 8 cases of myocardial calcification and 6 cases of ventricular aneurysm were detected. In a total of 420 coronary artery segments, 173 coronary artery segment stenosis was found by CAG examination, 159 coronary artery segment stenosis was found by CTA examination, the overall coincidence rate was 91.91 %, the left coronary artery(LM) was the highest, followed by left anterior descending(LAD), right coronary artery(RCA), and left circumflex artery(LCX). The accuracy rate of CTA was 80.00 % compared with that of CAG. The consistency Kappa test(κ = 0.700, P < 0.05) indicated that there was a high consistency between CTA and CAG. Conclusion The degree of coronary artery stenosis in NSTEMI patients can be evaluated by CTA, which has high diagnostic efficacy and is in good consistency with CAG. When severe stenosis of the main branch of the coronary artery or related important branches is detected,CAG examination can be further performed to avoid over-diagnosis.
作者
陈华震
郭峰
陈小巧
CHEN Hua-zhen;GUO Feng;CHEN Xiao-qiao(People's Hospital Affiliated of Quanzhou Medical College,Fujian Quanzhou 362000)
出处
《深圳中西医结合杂志》
2022年第24期31-34,共4页
Shenzhen Journal of Integrated Traditional Chinese and Western Medicine
