造影对非ST段抬高心肌梗死患者冠脉血管病变程度的诊断定位及危险程度分析

摘要

目的 通过对非ST段抬高心肌梗死(non-ST elevated myocardial infarction,NSTEMI)患者的高肌钙蛋白Ⅰ(high troponin Ⅰ,HTnI)、高低密度脂蛋白(high low density lipoprotein- cholesterol,HLDL-C)、高尿酸、高血糖、高血压、心电图异常、心绞痛临床表现等相关因素与64排冠状动脉CT造影结果 分析,旨在探讨CT造影对NSTEMI患者冠脉血管病变程度的诊断定位及危险程度评估.方法 入选NSTEMI患者122例,均在治疗前采血查TnI、LDL-C、UA、Glu,测量血压,检查心电图,并询问病史、查体.对每一位患者行CT造影检查,依据冠脉病变程度将其分为正常组,A型组(轻度病变),B、C型组(中、重度病变).各组分别与上述危险因素对比分析.结果 B、C型组中的HTnⅠ、HLDL-C、高尿酸、高血压、高血糖的发生率均比正常组、A型组中的高,差别均具有统计学意义(P＜0.05或P＜0.01).而心电图异常和心绞痛临床表现在各组中的分布差别没有统计学意义.结论 CT造影不仅是诊断冠心病的一种无创、简易、准确筛查方法,也是判断NSTEMI患者冠脉病变程度和危险评估的最重要工具之一.对于无症状性心电图心肌缺血改变以及有症状无心电图异常的患者应行CT造影检查,有助于早期预测NSTEMI患者的风险,减少误诊率、病死率,提高治愈率.%Objective To explore the effect of 64 - slice multidetector CT coronary angiography ( CCTA) on the diagnosis of the extent of coronary lesions and risk evaluation in patients with Non - ST elevation myocardial infarction ( NSTEMI) by comparing the relative risk factors of NSTEMI patients which include high troponin I (HTnl) , high low density lipoprotein - cholesterol (HLDL - C) , high uric acid (HUA) , high glucose (HGlu) , high blood pressure (HBP) , abnormal electrocardiogram (ECG) , symptoms of angina pecto-ris. Methods According to the result of CCTA, 122 patients with NSTEMI were divided into three groups; healthy control group, group A (gentle coronary artery lesions group) , group B and C (moderate and severe coronary artery lesions group). Venous blood samples were taken to examine Tnl, LDL - C, UA, and Glu before standard treatment. The number of risk factors was compared between the three groups. Results Risk factors of HTnl, HLDL - C, HUA, HGlu, HBP in group B and C far outnumbered those of healthy control group and group A (P <0.05 or P <0.01). No significant difference in abnormal ECG and angina pectoris symptoms was observed between healthy control group and the other groups. Conclusion For those patients with NSTEMI who have either abnormal ECG or angina pectoris symptoms, CCTA should be used. CCTA is not only a noninvasive,simple and reliable technique, but also one of the most important methods to justify the extent of coronary lesions and to evaluate the risk of patients with NSTEMI. CCTA can help predict the risk of patients with NSTEMI early, reduce the rate of misdiagnosis and mortality and improve the cure rate.