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64层螺旋CT心脏一 站式检查联合BNP、 hs-cTnT在急性冠脉 综合征的应用价值*

作者:曾仲刚1 李雪霞1 漆 强1 朱刚明1 李 刚1 李扬彬2

所属单位:1.东莞东华医院放射科 (广东 东莞 523110) 2.广州医科大学附属第二医院放射 科 (广东 广州 510000)

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摘要

目的 应用64层螺旋CT心脏一站 式检查联合脑钠肽(BNP)、高敏肌钙蛋白 T(hs-cTnT)对急性冠状动脉综合征(ACS) 患者心功能的评估价值。方法 59例急性 冠脉综合征(ACS)及11例健康志愿者均进 行CT心脏一站式检查,分别对冠状动脉及 左心室射血分数(LVEF)进行CT数据分析, 并测定血浆BNP值、hs-cTnT值,比较冠状 动脉病变与心功能分级的关系,心功能分 级与BNP、hs-cTnT、LVEF的差异及相关性 分析。结果 冠状动脉病变支数、狭窄程 度与LVEF呈反比关系。左前降支、左回旋 支、右冠状动脉对于左心室LVEF的影响程 度依次递减。各级心功能患者血浆BNP浓 度、hs-cTnT浓度明显高于健康志愿者, 差异均有统计学意义(P<0.01)。不同心功 能级别患者、BNP、hs-cTnT与LVEF均呈明 显负相关(r=-0.953、-0.832、-0.943, P<0.01)。结论 ACS患者在进行心脏CT一 站式检查,除了明确冠状动脉有否狭窄 外,还能通过对原始数据的后处理对其左 心室功能(LVEF)进行分析,并且同时结合 血浆BNP、hs-cTnT检测,为临床诊治提供 客观指标。

Objective To study the value of the One-stop cardiac inspection by 64-slice CT combined with BNP and hs-cTnT in acute coronary syndromes patient assessment. Methods 59 patients with ACS and 11 healthy volunteers were selected in this study, who underwent 64-slice CT One-stop cardiac inspection, and the CT data of coronary stenosis and left ventricular ejection fraction (LVEF), the level of BNP and hs-cTnT, the coronary stenosis, the value of LVEF, the level of BNP and hs-cTnT, and variable heart function were compared and analyzed. Results Count of coronary artery lesion is inversely proportional with degree of stenosis and LVEF. Left anterior descending and left circumflex branch and right coronary artery for diminishing the influence degree of the left ventricle LVEF into an inverse. Moreover, Cardiac function I, II, III and IV patients' concentration of BNP and hs-cTnT level were obviously higher than volunteers. Differences were statistically significant(P<0.01). Different level of cardiac function in patients with hs-cTnT, BNP was a negative correlation with LVEF (r=-0.953, -0.832, -0.943, P<0.01). Conclusion 64-slice CT One-stop cardiac inspection processed in patients with ACS, we could not only judge the stenosis of coronary artery, but also analysis the left ventricular function. LVEF combined with the plasma BNP & hs-cTnT detection can provide the quantitative analysis of heart function damage causing by the ACS. So as to provide objective index to clinical diagnosis and treatment.

【关键词】体层摄影术;X线计算机;左 心室功能;脑钠肽;高敏肌钙 蛋白T

【中图分类号】R543.3.1;R445.3;R541.4

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.10.025

前言

近年来,随着CT的不断发展以及CT在心血管疾病诊断领域的深入 研究,冠状动脉CTA与心功能分析一站式检查已经成为可能,并且已 经初步应用于临床[1-2]。但国内尚未见研究报道CT心功能分析与临床 心功能评估、心肌酶学检查等之间的关系。本研究在前期的研究基础 上[2],探讨急性冠状动脉综合征(ACS)的NYHA临床分级、冠状动脉病变 程度与左心室CT测定的射血分数(LVEF)、脑钠肽(brain natriuretic peptide,BNP)、血清高敏肌钙蛋白T(hs-cTnT)水平的相关性,提高冠 状动脉CTA一站式检查的临床应用价值。