| 罗 琦,范志刚,周新军,马永刚,王 洋.基于冠状动脉斑块定量分析探讨经皮冠状动脉介入术后心肌损伤的影响因素及预测价值分析[J].,2024,(6):1129-1134 |
| 基于冠状动脉斑块定量分析探讨经皮冠状动脉介入术后心肌损伤的影响因素及预测价值分析 |
| Explore the Influencing Factors and Predictive Value of Myocardial Injury after Percutaneous Coronary Intervention Based on Quantitative Analysis of Coronary Plaque |
| 投稿时间：2023-08-23 修订日期：2023-09-18 |
| DOI：10.13241/j.cnki.pmb.2024.06.024 |
| 中文关键词: 冠状动脉斑块 PCI 心肌损伤 影响因素 预测价值 |
| 英文关键词: Coronary artery plaque PCI Myocardial injury Influencing factors Predictive value |
| 基金项目:陕西省重点研发计划项目（2021SF-044）；宝鸡市卫生健康科研项目（2023-023） |
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| 中文摘要: |
| 摘要 目的：基于冠状动脉斑块定量分析探讨经皮冠状动脉介入（PCI）术后心肌损伤（PMI）的影响因素及预测价值。方法：回顾性分析2020年8月-2022年12月在我院住院并经择期PCI手术治疗的患者251例作为研究对象，根据PCI术后有无血清生物标志物的升高分为PMI阳性组（n=106）和PMI阴性组（n=145）。所有患者术前1周均行冠状动脉CT血管成像（CCTA）检查，且在PCI术前和术后24 h内均测量患者高敏心肌肌钙蛋白T（hs-cTnT）水平。采用半自动斑块分析软件标注并分析斑块特征，主要测量冠脉解剖学狭窄程度并对斑块成分和形态特征进行定量分析。采用单因素方差分析比较两组患者的临床资料和斑块定量指标。通过多因素Logistic回归分析确定PCI术后PMI发生的危险因素。采用受试者工作特征曲线（ROC）分析冠脉斑块定量指标对PCI术后PMI发生的诊断价值。结果：单因素方差分析显示，最大面积狭窄率、斑块总体积、斑块负荷、脂质斑块体积、脂质斑块占比和纤维斑块体积与PCI术后PMI的发生有关（P＜0.05）；而斑块长度、管腔最窄处面积、纤维斑块占比、钙化斑块体积、钙化斑块占比、斑点状钙化、餐巾环征、重构指数和偏心指数与PCI术后PMI的发生无关（P＞0.05）。多因素Logistic回归分析结果显示，最大面积狭窄率和脂质斑块占比是PCI术后PMI发生的危险因素（P＜0.05）。ROC结果显示最大面积狭窄率和脂质斑块占比联合应用的诊断价值高于两者单独应用。结论：冠脉斑块定量分析对PCI患者PMI的发生具有一定临床诊断价值，其中最大面积狭窄率和脂质斑块占比对PMI的诊断准确性更高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the influencing factors and predictive value of perioperative myocardial injury (PMI) after percutaneous coronary intervention (PCI) based on quantitative analysis of coronary plaque. Methods: A retrospective analysis of 251 patients who were hospitalized in our hospital from August 2020 to December 2022 and underwent elective PCI surgery was performed. According to the presence or absence of elevated serum biomarkers after PCI, they were divided into PMI positive group (n=106) and PMI negative group (n=145). All patients underwent coronary CT angiography (CCTA) 1 week before PCI, and the level of high-sensitivity cardiac troponin T (hs-cTnT) was measured before and 24 hours after PCI. Semi-automatic plaque analysis software was used to label and analyze plaque characteristics, mainly to measure the degree of coronary anatomical stenosis and to quantitatively analyze plaque composition and morphological characteristics. The clinical data and plaque quantitative indexes of the two groups were compared by one-way analysis of variance. The risk factors of PMI after PCI were determined by multivariate Logistic regression analysis. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of quantitative indexes of coronary plaque for PMI after PCI. Results: One-way analysis of variance showed that the maximum area stenosis rate, total plaque volume, plaque load, lipid plaque volume, lipid plaque proportion and fibrous plaque volume were related to the occurrence of PMI after PCI(P<0.05), while the Plaque length, the narrowest area of lumen, the proportion of fibrous plaque, the calcified plaque volume, the proportion of calcified plaque, Spotted calcification, ring sign of napkin, reconstruction index and eccentricity index were not related to the occurrence of PMI after PCI (P>0.05). Multivariate Logistic regression analysis showed that the maximum area stenosis rate and the proportion of lipid plaques were risk factors for PMI after PCI(P<0.05). ROC results showed that the diagnostic value of the combined application of the maximum area stenosis rate and the proportion of lipid plaques was higher than that of the two alone. Conclusion: Quantitative analysis of coronary plaque has a certain clinical diagnostic value for the occurrence of PMI in PCI patients, among which the maximum area stenosis rate and the proportion of lipid plaque have higher diagnostic accuracy for PMI. |
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