冠状动脉CTA、超敏C反应蛋白在急性冠脉综合征患者诊断中的应用价值

摘要

目的：探讨多层螺旋CT（MSCT）冠状动脉成像（冠脉CTA）联合超敏C反应蛋白（hsCRP）在急性冠脉综合征（ACS）患者诊断中的应用价值。方法对80例临床诊断急性心肌梗死患者分别进行冠脉CTA、冠状动脉血管造影（CAG）检查，以CAG检查结果与冠脉CTA检查结果相比较，并采用免疫比浊法检查不同狭窄程度患者的血清hsCRP水平。结果采用CAG、冠脉CTA均检出320支血管，其中冠脉CTA检出无狭窄68支、轻度狭窄152支、中度狭窄68支、重度狭窄32支，CAG检出无狭窄74支、轻度狭窄160支、中度狭窄59支、重度狭窄27支，冠脉CTA与CAG检出结果分别比较差异均不具有统计学意义（P＞0.05）。冠脉CTA检出狭窄血管252支、其检出左主干、左前降支、回旋支、右冠状动脉的狭窄率与CAG检出结果分别比较差异均不具有统计学意义（P＞0.05）。冠脉CTA检出软斑块215个（85.32%）与CAG检出的206个（81.75%）比较差异均不具有统计学意义（P＞0.05）。三支及以上冠脉血管病变组的hsCRP水平显著的高于单支病变、双支病变组（P＜0.05），双支病变组hsCRP水平显著的高于单支病变（P＜0.05）。结论冠脉CTA诊断ACS患者的诊断结果与CAG的结果高度一致，但具有无创的优点，同时联合hsCRP进行判断具有更高的临床应用价值。%Objective To investigate the application value of coronary computed tomographic angiography (CTA) of multiple spiral computed tomography (MSCT) and high sensitivity C-reactive protein (hs-CRP) in diagnosis in patients with acute coronary syndrome (ACS). Methods ACS patients (n=80) were given examinations of coronary CTA and coronary angiography (CAG), and the results of CAG was compared with those of coronary CTA. The level of serum hs-CRP was detected by using immunoturbidimetry in patients with varying coronary stenosis degrees. Results A total 320 vessels were detected by CAG and CTA, and 68 vessels without stenosis, 152 with mild stenosis, 68 with moderate stenosis and 32 with severe stenosis were detected by CTA, and 74 without stenosis, 160 with mild stenosis, 59 with moderate stenosis and 27 with severe stenosis detected by CAG (P>0.05). A total 252 stenosis vessels were detected by coronary CTA, and the detective stenosis rates of left main stem, left anterior descending vessel, circumflex vessel and right coronary artery had no statistical significance compared with those detected by CAG (P>0.05). Coronary CTA detected 215 (85.32%) soft plaques, which had no statistical significance compared with those (206, 81.75%) detected by CAG (P>0.05). The level of hs-CRP was significantly higher in 3-vessel lesion group than that in 1-vessel lesion group and 2-vessel lesion group (P<0.05), and significantly higher in 2-vessel lesion group than that in 1-vessel lesion group (P<0.05). Conclusion The diagnostic results of coronary CTA is highly similar to those of CAG in ACS patients, but CTA has non-invasive advantage. Coronary CTA combining hs-CRP has more significant value in clinic in diagnosis of ACS.