| Objective:Coronary artery disease (CHD) is the most common and harmful heart disease at home and abroad. About70%of the CHD patients died of coronary plaque rapture, thrombosis and myocardial infarction caused by the instability coronary artery atherosclerosis plaques. Detecting the easy rupture and thrombosis patches as early as possible through new testing technology holds significant value for the prevention and control of ACS. The present study will discuss the clinical value of64spiral CT in the discrimination of coronary artery plaque through the contrast between the results of64spiral CT in CHD patients and that of selective coronary angiography and the analysis of the changes of C-reaction protein in those patients.Methods:21CHD patients [15male,6female, age range from39-80(58.1±10.9)] with typical clinical symptoms who were admitted in the department of cardiology at the Second Xiangya Hospital of Central South University from June2011-March2012were enrolled in the study. According to Braunwald angina pectoris classification standard and chest pain history, ECG changes and related laboratory results, patients were divided into stable angina group and unstable angina group. Both of dual-source coronary artery spiral CT imaging and coronary angiography will be used to evaluate the stenosis degree and the plaque lesions of the same coronary artery. Many indexes of MDCT in diagnosing CHD and judging the stenosis degree of coronary artery such as sensitivity, specificity, the positie predictie alue, negatie predictie value will be evaluated by the evaluation criterion based on the results of coronary angiography. We will also preliminary analyse the relationship between different clinical diagnosis forms and coronary artery pathological changes.Results:1. The serum level of hs-CRP of patients with unstable angina pectoris (3.72±0.76mg/L) was higher than that of patients with stable angina pectoris (2.6±0.72mg/L), the difference had statistical significance (P<0.05).2. Among all the assessable189(21x9) periods of coronary artery segments of21patients, coronary angiography detected52coronary lesions section, while the number of64layer spiral CT was47, the difference had not statistical significance (P>0.05). Compared with coronary angiography, the detection sensitivity of MDCT was93.6%, specificity was94.3%, the positie predictie alue was84.6%and the negatie predictie alue was97%. The comparison between MDCT and CAG for different degrees of narrow lesions detection had no statistical significance (P>0.05).3. Between the two groups, the comparison of MDCT results in narrow lesions distribution of coronary artery had no statistical significance (minimum P value is0.217>0.05). Among the MDCT detection results of the two groups, severe stricture is the major detection of SA group, while moderate narrow was primary in UA group. The comparison between two groups in different stenosis degree of coronary artery had no statistical significance (P>0.05). However, the comparison between moderate and severe stenosis degree had a statistical significance (P=0.04).4. Hard plaque is primary lesions in SA group, while soft patch is the main lesion of UA group. All the three groups (soft patch group, fiber plaques group and hard plaques group) are compared in pairs, and the difference between each two of them had no statistical significance (P>0.05). The comparison between soft patch group and hard plaques group had statistical significance (P<0.05).Conclusions:1. It is useful for us to evaluate the stability of the plaques of the patients with acute coronary syndrome according to the elevated extent of hs-CRP. 2. MDCT coronary artery imaging can judge the coronary artery stenosis and the quantitative of coronary artery plaques with high accuracy, noninvasively evaluate the shape and composition of coronary artery plaque.3. MDCT coronary artery imaging have higher accuracy in judging coronary artery stenosis and quantitative of plaques. MDCT combined with hs-CRP, can be used as a noninvasive, safe and reliable detection technology and play an important role in detecting coronary heart disease patients in high-risk group. |
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