目的 探讨64排CT诊断冠状动 脉易损斑块的临床价值及分析危险因 素。方法 收集行64排CTA和冠状动脉造 影的112例冠心病患者，检测其血清内皮 素-1、基质金属蛋白酶-9(MMP-9)、白介 素-6(IL-6)、肿瘤坏死因子-a(TNF-α) 和超敏C反应蛋白(hs-CRP)。用64排CT检 测冠状动脉斑块，根据斑块性质将患者 分为易损斑块组(51例)和非易损斑块组 (61例)，分析易损斑块的危险因素。结 果 64排CT检测冠状动脉斑块的灵敏度为 88.6％，特异度为89.2％，阳性预测值 84.1％，阴性预测值92.3％。易损斑块 组和非易损斑块组的MMP-9、IL-6、hsCRP、冠状动脉病变数及诊断、性别和糖 尿病的构成比比较差异有统计学意义。 Logistic回归分析显示MMP-9>5.231 ng/ L(P=0.0215，OR=2.33，95% CI 1.13- 4.79)、hs-CRP>3.583 mg/L(P=0.0008， 0R=4.32，95% CI 1.84-10.15)和不稳 定心绞痛(P=0.0339，0R=4.33，95% CI 1.12-16.77)是易损斑块的独立危险因 素。结论 64排CT可无创性诊断冠状动脉 易损斑块，MMP-9、hs-CRP和不稳定心绞 痛是易损斑块的独立危险因素。

Objective To explore the value of 64-slice computed tomographycoronary angiography(64-CTA)in detecting the coronary artery plaque and to analyze the risk factorsfor vulnerableplaque. Methods A total of l12 inpatients who had been diagnosed as coronary arterydisease by catheter coronary angiography(CAG) received64-CTA. The levels of serum endothelin-1(ET-1), matrix metalloproteinase-9(MMP-9), interleukin6(IL-6), tumor necrosis factor-a(TNF-a)and highsensitivity C-reactive protein(hsCRP)were measured．The effect of 64-CTA indetecting the coronary artery plaque was evaluated as compared with CAG. The patients were dividedinto vulnerable plaque group(n=51)and non-vulnerable plaquegroup(n=61)according to the CT value of theplaque. The differences of the indexes between two groups and therisk factors for vulnerable plaque were analyzed. Results The sensitivity, specificity, positive predictive value and negative predictive valueof 64-CTA in detecting coronary artery plaque were88.6％, 89.2％, 84.1％ and 92.3％respectively. There were significant differences between vulnerable plaque group and non- vulnerable plaque group in MMP-9, IL-6, Hs-CRP, the number of coronary lesions and the composition ratios of gender, diagnosis and diabetes. Logistic regression analysis showed that MMP-9>5.231 ng/L(P=0.0215, OR=2.33, 95%CI 1.13-4.79), hs-CRP>3.583 mg/L(P=0.0008, 0R=4.32, 95%CI 1.84-10.15) and unstable angina pectoris(P=0.0339, 0R=4.33, 95%CI 1.12-16.77)were the risk factors for vulnerable plaque. Conclusion 64-CTA is one of most reliable noninvasive methods to detect coronary plaques. MMP-9, hs-CRP and unstable angina pectoris are independent risk factors forvulnerable plaque．