目的探讨冠脉CT血管成像(CTA) 对急性冠脉综合征(ACS)患者斑块性质的 诊断价值。方法 选取2015年4月-2018年 4月我院心内科收治的30例ACS患者为研 究对象，并选取同期30例稳定型心绞痛 (SAP)作为对照，所有患者均行CTA检查， 比较两组CTA定量参数，并计算CTA诊断 ACS易损斑块的敏感度、特异度、阳性预 测值、阴性预测值。结果 ACS组非钙化斑 块负荷、重建指数(RI)均明显高于SAP组 (P<0.05)，斑块最小密度CT值明显低于 SAP组(P <0.05)；而两组在血管体积、总 斑块体积、非钙化斑块体积、钙化斑块体 积、钙化斑块负荷、管腔狭窄程度等比较 上差异无统计学意义(P >0.05)。斑块最 小CT值<35HU及正性重塑(RI>1)在ACS出现 比例明显高于SAP组(P <0.05)；以斑块最 小CT值<35HU及RI>1诊断ACS易损斑块的敏 感度、特异度、阳性预测值、阴性预测值 分别为73.33%、90.00%、88.00%、77.14% 和80.00%、76.67%、77.42%、79.31%。结 论 CTA在区分ACS与SAP斑块负荷差异上有 重要作用，若存在CT值<35HU、RI>1等特 征可高度提示为易损斑块。

Objective To investigate the value of coronary CT angiography (CTA) in diagnosing the nature of plaques in patients with acute coronary syndrome (ACS). Methods Thirty patients with ACS treated in the department of cardiology of the hospital from April 2015 to April 2018were selected as the study subjects. Thirty patients with stable angina pectoris (SAP) were selected as controls. All patients underwent CTA examination and quantitative parameters were compared between the two groups. The sensitivity, specificity, positive predictive value and negative predictive value of CTA in the diagnosis of ACS vulnerable plaques were calculated. Results The non-calcified plaque burden and remodeling index(RI) in ACS group were significantly higher than those in SAP group (P<0.05), and the CT value of plaque minimal density was significantly lower than that in SAP group (P<0.05). There was no significant difference invascular volume, total plaque volume, non-calcified plaque volume, calcified plaque volume, calcified plaque load or degree of lumen stenosis (P>0.05). The incidence of the minimum CT value <35HU and positive remodeling (RI>1) in ACS group were significantly higher than those in SAP group (P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of the minimum plaque CT <35HU and RI>1 in diagnosing ACS vulnerable plaques were 73.33%, 90.00%, 88.00%, 77.14% and 80.00%, 76.67%, 77.42% and 79.31%, respectively. Conclusion CTA plays an important role in differentiating the plaque load between ACS and SAP. The CT value <35HU andRI >1suggestvulnerable plaques.