發(fā)布時(shí)間：2018-08-21 09:41

【摘要】：目的:冠狀動(dòng)脈扭曲可以造成冠狀動(dòng)脈血流動(dòng)力學(xué)的改變,扭曲的嚴(yán)重程度被認(rèn)為與其造成的血流動(dòng)力學(xué)影響具有相關(guān)性,提出對(duì)冠狀動(dòng)脈的扭曲程度進(jìn)行準(zhǔn)確的測(cè)量評(píng)價(jià)的新方法可以為明確冠狀動(dòng)脈扭曲的所造成的影響提供有利條件。方法:連續(xù)錄入2014年7月188例臨床擬診“冠心病”且均接受256排冠狀動(dòng)脈CTA檢查患者圖像及相關(guān)臨床資料。觀測(cè)記錄患者臨床數(shù)據(jù)及實(shí)驗(yàn)室檢查結(jié)果。CTA血管圖像經(jīng)后處理后,提取心外膜下三支主要冠狀動(dòng)脈血管中軸,獲取其在三維空間中的坐標(biāo),并對(duì)扭曲系數(shù)進(jìn)行量化測(cè)量。分析扭曲系數(shù)與其他臨床觀測(cè)指標(biāo)的相關(guān)性。建模檢驗(yàn):通過(guò)對(duì)冠狀動(dòng)脈左前降支的扭曲建模,模型扭曲角度與扭曲系數(shù)呈線性相關(guān),相關(guān)系數(shù)R2=0.999。檢驗(yàn)證明該方法對(duì)扭曲評(píng)價(jià)的效果良好。結(jié)果:所有入選者平均年齡66.21±10.92歲,年齡最小者39歲,最大93歲。其中男性88例,女性100例;吸煙史陽(yáng)性患者57例;有飲酒史陽(yáng)性患者22例;診斷為冠狀動(dòng)性心臟病或既往有該病史的89例;明確診斷高血壓病患者106例;明確診斷腦卒中或既往有腦卒中患者86例;明確診斷糖尿病或既往有糖尿病患者49例;左前降支冠脈扭曲平均系數(shù)TC3DLAD為0.0906±0.0800;左回旋支扭曲系數(shù)平均值TC3DLCX為0.2368±0.2379,右冠狀動(dòng)脈扭曲系數(shù)平均值TC3DRCA為0.4242±0.3043。左前降支非扭曲組冠狀動(dòng)脈CTA提示狹窄35例(18.62%),其中顯著狹窄12例(12.77%)。扭曲組冠狀動(dòng)脈提示狹窄45例(23.94%);其中顯著狹窄21例(22.34%)。左回旋支非扭曲組中,冠狀動(dòng)脈CTA檢查提示發(fā)生狹窄14例(7.45%),其中顯著狹窄5例(5.32%)。扭曲組提示狹窄16例(8.51%),其中顯著狹窄6例(6.38%)。右冠狀動(dòng)脈非扭曲組中CTA檢查提示發(fā)生狹窄18例(9.57%),其中顯著狹窄5例(5.32%)。扭曲組提示狹窄29例(15.43%),其中顯著狹窄7例(7.45%)。三支冠狀動(dòng)的脈扭曲組中狹窄發(fā)生率均高于對(duì)照組。在臨床資料對(duì)比中,左前降支:扭曲組平均年齡68.52±10.46歲,非扭曲組平均年齡64.03±10.97歲。左回旋支:扭曲組平均年齡68.52±10.46歲,非扭曲組平均年齡64.03±10.97歲。右冠狀動(dòng)脈:扭曲組平均年齡68.52±10.46歲,非扭曲組平均年齡64.03±10.97歲。三支冠狀動(dòng)脈的扭曲組平均年齡顯著高于非扭曲組(P0.05)。結(jié)論:此方法能對(duì)冠狀動(dòng)脈在三維空間的扭曲程度進(jìn)行準(zhǔn)確的定量化分析,且結(jié)果不受造影投射面、人為測(cè)量誤差及血管長(zhǎng)度的影響。本次研究中右冠狀動(dòng)脈的扭曲系數(shù)均值最大,冠狀動(dòng)脈扭曲人群中冠狀動(dòng)脈狹窄發(fā)生率較高,提示冠狀動(dòng)脈扭曲可能與冠狀動(dòng)脈狹窄發(fā)生相關(guān)。年齡因素也可能與冠狀動(dòng)脈扭曲的發(fā)生呈正相關(guān)。
[Abstract]:Objective: coronary artery distortion can cause changes in coronary hemodynamics, and the severity of the distortion is thought to be associated with the resulting hemodynamic effects. A new method for accurate measurement and evaluation of the degree of coronary artery distortion is proposed, which can provide favorable conditions for determining the effect of coronary artery distortion. Methods: one hundred and eighty-eight consecutive patients with coronary artery disease (CHD) were recorded in July, 2014 and underwent 256-row coronary artery CTA examination. After post-processing, the central axis of three main coronary arteries under epicardium was extracted, their coordinates in three-dimensional space were obtained, and the distortion coefficient was measured quantitatively. To analyze the correlation between distortion coefficient and other clinical observation indexes. Modeling test: by modeling the left anterior descending branch of coronary artery, the torsion angle of the model was linearly correlated with the distortion coefficient, and the correlation coefficient was 0.999. The test results show that the method has good effect on distortion evaluation. Results: the average age of all the candidates was 66.21 鹵10.92 years old, the youngest was 39 years old and the oldest was 93 years old. Among them, 88 cases were male, 100 cases were female, 57 cases were positive in smoking history, 22 cases were positive in drinking history, 89 cases were diagnosed as coronary dynamic heart disease or previous history, 106 cases were diagnosed hypertension. 86 patients with stroke or with stroke, 49 with diabetes and 49 with diabetes. The mean distortion coefficient of left anterior descending coronary artery (TC3DLAD), left circumflex artery (TC3DLCX) and right coronary artery (TC3DRCA) were 0.0906 鹵0.0800, 0.2368 鹵0.2379 and 0.4242 鹵0.3043, respectively. The coronary artery stenosis was found in 35 cases (18.62%) by CTA in the left anterior descending branch group, of which 12 cases (12.77%) had significant stenosis. 45 cases (23.94%) showed coronary artery stenosis and 21 cases (22.34%) had significant stenosis. Coronary artery stenosis was found in 14 cases (7.45%) by CTA in left circumflex branch group, of which 5 cases (5.32%) had significant stenosis. In twisted group, 16 cases (8.51%) showed stenosis, 6 cases (6.38%) showed significant stenosis. In the non-twisted right coronary artery group, 18 cases (9.57%) showed stenosis by CTA, 5 cases (5.32%) had significant stenosis. 29 cases (15.43%) showed stenosis in twisted group, 7 cases (7.45%) showed significant stenosis. The incidence of stenosis in the three-branch coronary motility group was higher than that in the control group. In comparison of clinical data, the mean age of the left anterior descending branch was 68.52 鹵10.46 years in the twisted group and 64.03 鹵10.97 years in the non-twisted group. The mean age of the left circumflex branch was 68.52 鹵10.46 years in the twisted group and 64.03 鹵10.97 years in the non-twisted group. The mean age of the right coronary artery was 68.52 鹵10.46 years in the twisted group and 64.03 鹵10.97 years in the non-twisted group. The mean age of the three coronary artery twisted group was significantly higher than that of the non-twisted group (P 0.05). Conclusion: this method can accurately quantify the degree of distortion of coronary artery in three dimensional space, and the results are not affected by projection surface, artificial measurement error and vascular length. In this study, the mean value of right coronary artery distortion coefficient was the highest, and the incidence of coronary artery stenosis was higher in patients with coronary artery distortion, suggesting that coronary artery distortion may be associated with coronary artery stenosis. Age factors may also be positively correlated with the occurrence of coronary artery distortion.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.4

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本文編號(hào)：2195313