冠状动脉造影与冠状动脉内超声检查对钙化斑块检出的比较The comparison of detecting coronary arterial calcification between intracoronary ultrasound and coronary angiography
韩丁,朱文玲,黄超联,沈珠军,姜秀春,李燕华
摘要(Abstract)：
目的 探讨冠状动脉造影（CAG）检查结合临床资料分析能否正确检出患者在拟行介入治疗的冠状动脉狭窄段有无钙化,并与冠状动脉内超声（ICUS）检查结果进行比较分析,进一步评价在冠状动脉介入治疗前应用ICUS确定钙化的范围和严重程度的价值作进一步的评价。方法 对150例拟行冠状动脉介入治疗的患者行CAG同时行ICUS检查,评价靶血管狭窄处的钙化情况。结果有113例（75.3％）靶血管狭窄处被ICUS检出钙化。而CAG检出52例有钙化。两种方法的检查结果有75例相符,75例不相符合。CAG对钙化检出的敏感性为38.9％,特异性为86.5％。在靶血管狭窄段CAG检出钙化的平均弧度（n=52）较ICUS检出的（n=113）要大。CAG判定表浅型钙化的敏感性和特异性分别为35.3％和95.2％。在98例靶血管狭窄处CAG判定为无钙化的患者中,68例患者ICUS检出有不同程度的钙化。而CAG在非靶血管狭窄段检出钙化是ICUS在98例患者中检出钙化惟一的预期值（P=0.003,OR=1.16,95％可信区间为1.1～1.3）。有73例CAG在冠状动脉丛任何处均未见钙化,而ICUS检出44例（60.3％）有钙化,其中>90弧度的表浅型钙化仅9例（12.3％）。结论CAG检出靶血管狭窄段有钙化存在提示可能为弧度较大的表浅型钙化。在CAG检不出靶血管狭窄处钙化的病例中,若患者的年龄较大,旦发?
关键词(KeyWords)： 冠状动脉造影;冠状动脉内超声;冠状动脉钙化
基金项目(Foundation): 国家教委博士点资金资助（95020’72）
作者(Author): 韩丁,朱文玲,黄超联,沈珠军,姜秀春,李燕华
参考文献(References)：
- 1 Blankenhom DH. Coronary arterial calcification. A review. Am J Med Sci, 1961,242:4-49.
- 2 Warburten RK, Tampas JP, Soule AB, et al. Coronary artery calcification: its relationship to coronary artery stenosis and myocardial infarction. Radiology, 1968,91:109-115.
- 3 Frink RJ, Achor RWP, Braun AL Jr, et al. Significance of calcification of the coronary arteries. Am J Cardiol, 1983, 51:403-421.
- 4 Mintz GS, Pichard AD, Kovach JA, et al. Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease. Am J Cardiol, 1994, 73:423-430.
- 5 Fitzgerald PJ, Ports TA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound. Circulation, 1992,86:64-70.
- 6 DeFranco AC, Nissen SE, Tuzcu EM, et al. Ultrasound plaque morphology predicts major dissections following stand-alone and adjunctive balloon angioplasty [abstract]. Circulation, 1994,90:SupplI:I-59.
- 7 Hinohara T, Robertson GC, Simpson JB. Directional coronary atherectomy. In : Topol EJ editor Textbook of Interventional Cardiology, Vol,l. 2nd ed. Philadelphia: Saunders, 1994:641-658.
- 8 Mintz GS, Pichard AD, Popma JJ, et al. Preliminary experience with adjunct directional coronary atherectomy after high-speed rotational atherectomy in the treatment of calcific coronary artery disease. Am J Cardiol, 1993,71:799-804.
- 9 Betrand ME, Bauters C, Lablanche JM. Percutaneous coronary rotational angioplasty with rotablator. In Ref, 7:659-667.
- 10 Gussenhoven EJ, Essed CE, Lancee CT, et al . Arterial wall characteristics determined by intravascular ultrasound imaging: an in vitro study. J Am Coll Cardiol, 1989,14:947-952.
- 11 Richardson PD, Davies MJ, Born GVR. Influence of plaque configuration and stress distribution on fissuring of coronary atherosclerotic plaques. Lancet, 1989, 2:941-944.
- 12 Demer LL. Effect of calcification on in vivo mechanical response of rabbit arteries to balloon dilation. Circulation, 1991,83:2083-2093.
- 13 Tanenbaum SR, Kondos GT, Veselik KE, et al. Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. Am J Cardiol, 1989,63:870-872.
- 14 Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium uaing ultrafast computed tomography. J Am Coll Cardiol, 1990,15:827-832.
- 15 Mintz GS, Douek P, Pichard AD, et al. Target lesion calcification in coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol, 1992,20:1149-1155.
- 16 Gianrossi R, Detrano R, Colombo A, et al. Cardiac fluoroscopy for the diagnosis of coronary artery disease: a meta analytic review. Am Heart J, 1990,120:1179-1188.
- 17 Gertz SD, Malekzadeh S, Dollar AL, et al . Compositions of atherosclerotic plaques in the four major epicardial coro- nary arteries in patients greater than or equal to 90 years of age. Am J Cardiol, 1991,67:1228-1233.
- 18 Waller BF, Roberts WC. Cardiovascular disease in the very elderly. Analysis of 40 necropsy patients aged 90 years or over. Am J Cardiol, 1983, 51:403-421.
- 19 Dinsmore RE, Lees RJ. Vascular calcification in type II and IV hyperlipoproteinemia: radiographic appearance and clinical significance. Am J Roentgenol, 1995,144:895-899.
- 20 Mintz GS, Popma JJ, Pichard AD, et al. Patterns of calcification in coronary artery disease. Circulation, 1995,91:1959-1965.