冠状动脉钙化积分与冠心病危险因素的相关性

摘要

Objective The coronary artery calcification (CAC) score determined by multi-detector row computed tomography ( MDCT) predicts the onset of coronary artery disease (CAD). In addition, cardiovascular risk factors also predict the mortality of CAD. Therefore, the aim of this study was to assess whether or not the CAC score is associated with cardiovascular risk factors. Methods A total of 9847 consecutive patients with suspected coronary artery disease underwent coronary angiography between January 2001 and March 2007 at 20 centers of China were enrolled. The subjects consisted of 311 consecutive patients with suspected CAD who underwent MDCT. The body mass index, blood pressure, blood glucose, and serum total cholesterol, triglyceride and low-density lipoprotein cholesterol ( LDL-C) and high-density lipoprotein cholesterol ( HDL-C) were measured. Results When the patients were divided into three groups according to the CAC score [low (0-12 IU), intermediate ( 13 - 445 ) and high ( 5* 446) ], the classification score was significantly associated with age, prevalence of cardiovascular history and diabetes mellitus and HDL-C. In multivariate logistic regression analysis, age ( P = 0. 013) and plasma levels of high-density lipoprotein cholesterol ( P = 0.020 ) remained significant independent variables for the classification. Conclusions Age, prevalence of cardiovascular history and diabetes mellitus and HDL-C were significantly associated with the classification according to the CAC score. The detection of CACS by MSCT could provide reliable and efective evidence for diagnosis of CHD in patients with cardiovascular risk factors.%目的 经多层冠状动脉CT检查测定的冠状动脉钙化积分对冠心病的诊断具有一定预测价值.而冠心病的危险因素与冠心病的发生、发展、结局和预后密切相关.我们旨在探讨冠状动脉钙化积分与冠心病诸多危险因素之间是否具有相关性.方法 入选2001年1月至2007年3月在全国20家医院住院疑诊冠心病患者,采用16排或64排螺旋CT进行冠状动脉增强扫描,并运用自动分析软件进行冠脉钙化积分分析,共入选患者311例,根据冠状动脉钙化积分值分为低分值组(0～12)、中分值组(13 ～445)和高分值组(446以上),比较冠状动脉钙化积分与冠心病危险因素之间的关系.结果 不同冠状动脉钙化积分分组之间,平均年龄、冠心病家族史比例、高密度脂蛋白数值和糖尿病比例等方面存在差异,P ＜0.05.多元Logistic回归分析显示,疑诊冠心病患者年龄(OR=1.061,95％ CI 1.004～1.121,P=0.036)和低HDL-C水平(OR=0.321,95％CI0.113 ～0.909,P=0.032)是冠状动脉钙化积分的显著相关危险因素.结论 年龄、冠心病家族史、低HDL和糖尿病等冠心病危险因素与冠状动脉钙化密切相关,合并多种冠心病危险因素的患者,尤其是老年和低HDL-C患者,行多层冠状动脉CT检查及冠状动脉钙化积分测定,对冠心病的早期诊断具有一定帮助.