宝石ct冠状动脉成像临床应用分析-analysis of clinical application of gem ct coronary angiography.docxVIP

汕头 汕头大学医学院硕士学位论文 汕头 汕头大学医学院硕士学位论文 摘 要 研究目的 以选择性冠状动脉造影（Selective Coronary Angiography，SCA）为对照，探讨宝 石 CT 冠状动脉血管成像（Gemstone Computed Tomography Coronary Angiography，GCTCA） 在诊断冠状动脉狭窄的诊断价值。 对象与方法 收集汕头大学医学院第一附属医院 2010 年 3 月至 2013 年 2 月住院临床诊断或疑似冠 心病(coronary heart disease, CAD)患者病历资料 89 例作为本课题研究对象。全部患者 均行 GCTCA 和 SCA，前后时间差不超过 1 周。按照美国心脏学会(AHA)冠状动脉分段法将冠 状动脉分为 15 段，采用目测直径法判断冠脉狭窄程度，以 SCA 为诊断 CAD 的“金标准”， 计算 GCTCA 检出中度及中度以上（≥50%）冠状动脉狭窄的敏感性（Sensitivity，Se）、 特异性（Specificity，Sp）、阳性预测值（Positive predictive value，PPV）、阴性预 测值（Negative predictive value，NPV）和诊断符合率。 结果 宝石 CT 冠状动脉血管成像中，89 例共计 910 个冠状动脉节段可用于评价，197 个节段发 现狭窄性病变;宝石 CT 诊断冠状动脉节段≥50%狭窄与 SCA 符合率为 96.9%，诊断冠脉节段 或主要分支血管狭窄≥50%的 Se、Sp、PPV、NPV 及诊断符合率分别为 80.6%、98.9%、90.6%、 96.9%。 结论 宝石CT对冠状动脉狭窄诊断及狭窄程度的判断有较高的准确性,可作为高危人群普查筛选 的首选方法之一。 关键词 宝石 CT;冠状动脉造影;冠心病 I Abstract Objective The objective of the current study was to evaluate the accuracy and feasibility of Gemstone Computed Tomography Coronary Angiography（GCTCA）in detecting coronary artery stenosis in patients probability with coronary heart disease (CAD) when compared with selective coronary angiography (SCA), and to explore the diagnosis of CAD and its clinical signification with GCTCA. Subjects and Methods Eighty-nine patients with known or suspected CAD in the First Affiliated Hospital of Shantou University Medical College during Mar. 2010 to Feb.2013 were studied. Each patient underwent GCTCA and conventional catheter-based selective coronary angiography (SCA) which served as gold standard in 1 week. For the analysis of gemstone CTA and CAG, the coronary artery tree was broken down in 15 segments after a modified American Heart Association (AHA) classification and all segments were analysed individually. A luminal narrowing of ≥ 50% based on visual estimation was considered significant in both modalities. The diagnostic accuracy of gemstone CTA was expressed as sensitivity, specificity, positive predictive value, negative predictive value and diagnose accordance rate. Results Of a t