电子束CT冠状动脉钙化积分测定在老年人冠心病诊断中的意义

摘要

目的　研究电子束CT(EBCT)冠状动脉(冠脉)钙化积分在老年人冠心病诊断中的价值。 　方法　44例有心肌梗死病史或冠脉造影证实为冠心病患者及33例无冠心病(对照组)的老年人常规进行EBCT检查，分别计算各冠脉钙化积分及冠脉总钙化积分(TCS)。　结果　两组患者在年龄、血脂水平及高血压史间差异均无显著性。冠心病组与对照组比较，冠脉钙化积分中位数（25%～75%四分位数范围）在左前降支(LAD)〔(225， 87.5～444)与(6， 0～95),P＜0.01〕、左回旋支(LCX)〔(83， 9～176)与(1， 0～47),P＜0.01〕〕、右冠状动脉(RCA)〔(90.5, 1.5～302.5)与(2, 0～84),P＜0.05〕及TCS 〔(585, 201.5～1 156)与(75, 0～425),P＜0.01〕均非常显著地升高，但两组间左主干(LM)钙化积分差异无显著性。冠心病组23例（52.3%）患者TCS＞556，而对照组仅为7例（21.2%）(χ2=7.650 ,P＜0.01)，两者之间差异有非常显著性。TCS＞556对诊断冠心病的敏感性及特异性分别为52.3%与78.8%，阳性预测值与阴性预测值分别为76.6%与55.3%。　结论　老年冠心病患者EBCT冠脉钙化积分显著高于对照组，对老年人冠心病的诊断有一定意义。对于我国老年人正常冠脉钙化积分的参考范围需进一步研究。%Objective　To study the significance of coronary calcification by electric beam computed tomography (EBCT) in elderly patients.　Methods　A routine EBCT was taken in 77 patients with coronary heart disease and controlled patients. The diagnosis of coronary heart disease was depended on history of myocardial infarction or on coronary angiography greater than 50% stenosis in 44 patients.Thirty-three persons with normal coronary artery on coronary angiography or normal thallium study and clinically ruled out coronary heart disease as control group.The coronary artery calcification score was calculated respectively in two groups. 　Results　There was no difference in age, serum lipid levels and history of hypertension between two groups. The coronary artery calcification scores (median, 25%-75% quantiles) in patients with coronary heart disease were significantly higher in LAD 〔(225,87.5-444) vs (6,0-95), P＜0.01〕, LCX 〔(83,9-176) vs (1,0-47), P＜0.01〕〕, RCA 〔(90.5,1.5-302.5) vs (2,0-84), P＜0.05〕 and TCS 〔(585,201.5-1 156) vs. (75,0-425), P＜0.01〕 compared with that in control group. The difference of coronary scores in LM was not significant.The percentage of the total calcification score(TCS) higher than 556 were 52.3% in patients with coronary heart disease and 21.2% in the control group(χ2=7.650, P＜0.01). The sensitivity and specificity of TCS more than 556 in diagnosis of coronary heart disease are 52.3% and 78.8%. The positive predictive value and negative predictive value are 76.6% and 55.3%, respectively.　Conclusions　The coronary calcification score of EBCT in elderly patients with coronary heart disease is significantly higher than that in control group .It may be helpful in diagnosing coronary heart disease, but its normal ranges in the elderly still need to be further determined.