冠状动脉CT血管造影提示临界病变有易损斑块患者预后分析

doi:10.3785/j.issn.1008-9292.2020.02.07

浙江大学学报（医学版）

2020, Vol. 49

Issue (1): 76-81 DOI: 10.3785/j.issn.1008-9292.2020.02.07

原著

冠状动脉CT血管造影提示临界病变有易损斑块患者预后分析

李占鲁(

),黄翯,张文斌,王敏,傅国胜*(

)

浙江大学医学院附属邵逸夫医院心内科, 浙江杭州 310016

Prognosis of patients with vulnerable plaques indicated by coronary CT angiography

LI Zhanlu(

),HUANG He,ZHANG Wenbin,WANG Min,FU Guosheng*(

)

Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

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摘要：

目的: 分析冠状动脉CT血管造影（CCTA）提示临界病变含有易损斑块患者的预后。方法: 回顾性分析2015年2月2日至9月13日在浙江大学医学院附属邵逸夫医院行CCTA检查提示为临界病变（直径狭窄50%~70%）且不需要介入治疗的患者1963例（2728处病变）。根据CCTA提示的斑块性质分为易损斑块组（804例）和稳定斑块组（1159例）。以发生主要不良心血管事件（MACE，包括心源性死亡、非致死性急性心肌梗死及靶病变血运重建）为观察终点，比较两组的预后。结果: 平均随访（27.4±2.3）个月，易损斑块组MACE发生率高于稳定斑块组（分别为10.8%和2.3%，P < 0.01），调整年龄、性别、吸烟、高血压病、糖尿病、高脂血症等进行多因素分析显示，易损斑块组发生MACE的风险比（HR）为5.022（95% CI：3.254~7.751，P < 0.01）。亚组分析提示，易损斑块未服药组（服用抗血小板及他汀类药物3个月及以下）和易损斑块服药组（服用抗血小板及他汀类药物3个月以上）MACE发生率分别为17.0%和5.8%，易损斑块未服药组发生MACE的风险增加（HR=3.149，95% CI：1.987~4.992，P < 0.01）；而稳定斑块组未观察到此差异（HR=1.721，95% CI：0.798~3.712，P>0.05）。结论: CCTA提示临界病变含有易损斑块的患者危险性更高，而药物治疗主要作用于易损斑块，对稳定斑块是否有效有待进一步讨论。

关键词： 冠状动脉疾病/影像诊断; 斑块, 动脉粥样硬化; 冠状血管造影术; 体层摄影术, X线计算机; 预后; 随访研究

Abstract:

Objective: To investigate the prognosis of patients with vulnerable plaque indicated by coronary CT angiography (CCTA). Methods: Totally 1963 patients underwent CCTA from February 2nd 2015 to September 13th 2015, and 2728 coronary borderline lesions (stenosis of 50%-70%) were detected. Among them 804 patients had vulnerable plaques and 1159 patients had stable plaques. The primary endpoint was major cardiac adverse events (MACE), including cardiac death, acute myocardial infarction and target lesion revascularization. Results: Patients were followed up for a mean follow-up of 27.4±2.3 months. The incidence of MACE in the vulnerable plaque group was significantly higher than that in the stable plaque group (10.8%vs 2.3%, P < 0.01). After adjusting for age, gender, smoking, hypertension, diabetes, hyperlipidemia, the MACE hazard ratio (HR) in the vulnerable plaque group was 5.022 (95% CI:3.254-7.751, P < 0.01).Subgroup analysis showed that in the vulnerable plaque group, the incidence of MACE in patients taking antiplatelet and statin ≤3 months and those taking antiplatelet and statin > 3 months was 17.0%and 5.8%, respectively (HR=3.149, 95% CI:1.987-4.992, P < 0.01); but the difference did not seen in stable plaque group (HR=1.721, 95% CI:0.798-3.712, P>0.05). Conclusion: This study confirmed the risk of MACE in patients with vulnerable plaque detected by CCTA and the drug treatment may reduce the risk for patients with vulnerable plaque.

Key words: Coronary artery disease/diagnostic imaging Plaque, atherosclerotic Coronary angiography Tomography, X-ray computed Prognosis Follow-up studies

收稿日期: 2019-09-27 出版日期: 2020-06-08

CLC:

R543.3

通讯作者: 傅国胜 E-mail: alu511520@163.com;fugs@medmail.com.cn

作者简介: 李占鲁(1982—)，男，硕士，主治医师，主要从事冠心病介入诊治相关临床研究；E-mail：alu511520@163.com；https://orcid.org/0000-0001-9017-5258

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引用本文:

李占鲁,黄翯,张文斌,王敏,傅国胜. 冠状动脉CT血管造影提示临界病变有易损斑块患者预后分析[J]. 浙江大学学报（医学版）, 2020, 49(1): 76-81.

LI Zhanlu,HUANG He,ZHANG Wenbin,WANG Min,FU Guosheng. Prognosis of patients with vulnerable plaques indicated by coronary CT angiography. J Zhejiang Univ (Med Sci), 2020, 49(1): 76-81.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.02.07 或 http://www.zjujournals.com/med/CN/Y2020/V49/I1/76

表 1 易损斑块组和稳定斑块组患者基线水平比较

表 2 易损斑块组和稳定斑块组患者冠状动脉病变分布

图 1 易损斑块组和稳定斑块组无MACE事件生存曲线

图 2 服药组和未服药组无MACE事件生存曲线

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