双源CT在冠状动脉Gensini评分及左心功能指数中的评价价值

摘要

Objective To explore the clinical value of CT to evaluate the extent of coronary artery steno-sis,in the evaluation of coronary Gensini score and left ventricular function index of the value of dual source CT.Methods A total of 87 coronary heart disease patients in Huai′an First Hospital Affiliated to Nanjing Medical University from Oct.2015 to Feb.2014 were included as the research objects.All patients comple-ted the coronary artery CTA examination within 3 d after admission,and dual source CT coronary artery steno-sis display was observed.According to Gensini score the patients were grouped:the Gensini score<6 divided into G1 group(30 cases),6≤Gensini score<26 divided into G2 group(25 cases), 26≤Gensini score<60 into G3 group(17 cases), Gensini score≥60 divided into G4 group(15 cases).The difference of left ven-tricular function among the four groups were compared , and the correlation between Gensini score and left ventricular function index was analyzed.Results A total of 346 coronary artery stenosis were shown,among which the left anterior descending coronary artery had the highest incidence , followed by the right coronary artery.The mild and moderate stenosis were the mostly common seen ,while occlusion was rare.With coronary Gensini score in G1-G4 group,the left ventricular ejection fraction[(65 ±11)% vs (57 ±9) % vs (45 ± 8)% vs (37 ±8)%] decreased gradually,and the differences between the groups were statistically signifi-cant(P<0.01);with coronary Gensini score increase, left ventricular myocardial mass[(136 ±15) g vs (152 ±18) g vs (166 ±20) g vs (183 ±23) g], left ventricular enddiastolic volume[(111 ±32) mL vs (121 ±39) mL vs (139 ±41) mL vs (165 ±56) mL] and left ventricular endsystolic volume[(42 ± 11) mL vs (52 ±13) mL vs (74 ±21) mL vs (95 ±32) mL] increased gradually,and the differences between groups were statistically significant ( P<0.01 ) .The Spearman correlation analysis showed that coro-nary Gensini score and left ventricular enddiastolic volume,left ventricular endsystolic volume and left ven-tricular myocardial mass were positively correlated(r=0.624,0.867,0.785,P <0.01),and were signifi-cantly negatively correlated with left ventricular ejection fraction (r =-0.793,P <0.01).Conclusion Dual source CT can clearly display the coronary artery stenosis to evaluate left ventricular function .Coronary Gensini score and left ventricular enddiastolic volume,left ventricular endsystolic volume and left ventricular myocardial mass are positively correlated ,negatively correlated with left ventricular ejection fraction .%目的：探讨双源CT对冠状动脉狭窄程度评价情况，分析双源CT在冠状动脉Gensini评分及左心功能指数中的评价价值。方法选择2014年10月至2015年2月南京医科大学附属淮安第一医院收治的87例冠心病患者作为研究对象，患者均于入院后3 d内完成冠状动脉 CT造影（ CTA）检查，观察双源CT对冠状动脉狭窄的显示情况，根据 Gensini评分对患者进行分组，其中 Gensini评分＜6分为G1组30例，Gensini评分6～＜26分为 G2组25例，Gensini 评分26～＜60分为 G3组17例，Gensini评分≥60分为G4组15例，比较各组左心功能的差异，并分析Gensini评分与左心功能指标的相关性。结果共显示346处冠状动脉狭窄，其中左冠状动脉前降支发病率最高，其次为右冠状动脉。狭窄程度以轻度和中度多见，闭塞最少。随着冠状动脉 Gensini 评分升高，G1～G4组患者左心射血分数逐渐降低，分别为（65±11）％、（57±9）％、（45±8）％、（37±8）％，组间比较差异有统计学意义（P＜0.01）；随着冠状动脉 Gensini 评分升高，G1～G4组患者左心室心肌质量[分别为（136±15） g、（152±18） g、（166±20） g、（183±23） g]、左心室舒张末期容积[分别为（111±32） mL、（121±39） mL、（139±41） mL、（165±56） mL]及左心室收缩末期容积[分别为（42±11） mL、（52±13） mL、（74±21） mL、（95±32） mL]逐渐升高，组间比较差异有统计学意义（P ＜0.01）。经Spearman相关分析，冠状动脉Gensini评分与左心室舒张末期容积、左心室收缩末期容积及左心室心肌质量呈显著正相关（ r＝0.624，0.867，0.785，均P＜0.01），与左心室射血分数呈显著负相关（r＝－0.793，P＜0.01）。结论双源CT可以清晰显示冠状动脉狭窄情况，并能够对左心功能进行评价。冠状动脉Gensini评分与左心室舒张末期容积、左心室收缩末期容积及左心室心肌质量呈显著正相关，与左心室射血分数呈显著负相关。