【摘要】：目的:冠狀動脈扭曲可以造成冠狀動脈血流動力學的改變,扭曲的嚴重程度被認為與其造成的血流動力學影響具有相關性,提出對冠狀動脈的扭曲程度進行準確的測量評價的新方法可以為明確冠狀動脈扭曲的所造成的影響提供有利條件。方法:連續錄入2014年7月188例臨床擬診“冠心病”且均接受256排冠狀動脈CTA檢查患者圖像及相關臨床資料。觀測記錄患者臨床數據及實驗室檢查結果。CTA血管圖像經后處理后,提取心外膜下三支主要冠狀動脈血管中軸,獲取其在三維空間中的坐標,并對扭曲系數進行量化測量。分析扭曲系數與其他臨床觀測指標的相關性。建模檢驗:通過對冠狀動脈左前降支的扭曲建模,模型扭曲角度與扭曲系數呈線性相關,相關系數R2=0.999。檢驗證明該方法對扭曲評價的效果良好。結果: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;吸煙史陽性患者57例;有飲酒史陽性患者22例;診斷為冠狀動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TC3DLAD為0.0906±0.0800;左回旋支扭曲系數平均值TC3DLCX為0.2368±0.2379,右冠狀動脈扭曲系數平均值TC3DRCA為0.4242±0.3043。左前降支非扭曲組冠狀動脈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,冠狀動脈CTA檢查提示發生狹窄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%)。右冠狀動脈非扭曲組中CTA檢查提示發生狹窄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%)。三支冠狀動的脈扭曲組中狹窄發生率均高于對照組。在臨床資料對比中,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。三支冠狀動脈的扭曲組平均年齡顯著高于非扭曲組(P0.05)。結論:此方法能對冠狀動脈在三維空間的扭曲程度進行準確的定量化分析,且結果不受造影投射面、人為測量誤差及血管長度的影響。本次研究中右冠狀動脈的扭曲系數均值最大,冠狀動脈扭曲人群中冠狀動脈狹窄發生率較高,提示冠狀動脈扭曲可能與冠狀動脈狹窄發生相關。年齡因素也可能與冠狀動脈扭曲的發生呈正相關。
[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.
【學位授予單位】：第三軍醫大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R541.4

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