利用電腦斷層攝影研究無症狀受測者冠狀動脈鈣化斑在血管分佈上之特徵

Cardiac CT evaluation of vascular distribution of calcified coronary plaque in asymptomatic subjects

謝其書(Chi-Shu Hsieh)

指導教授 ： 張寶樹

高雄醫學大學/健康科學院/醫學影像暨放射科學系碩士在職專班/碩士(2015年)

摘要

以往預測冠狀動脈疾病(coronary artery disease,CAD)，參考的選項不外乎就是佛明罕風險分數(Framingham risk score)、心電圖、胸部X光片、心肌酵素、冠狀動脈血管攝影(侵入性檢查)等。動脈粥狀硬化(atherosclerosis)是CAD的指標性產物，利用電腦斷層攝影檢查心血管鈣化有絕佳的影像表現，且是一種非侵入性檢查，合理情況下操作簡單，適合用來評估受測者冠狀動脈的鈣化程度。Agatston分數計算冠狀動脈鈣化斑(coronary artery calcium, CAC)相當可靠。本研究以此基項，探討冠狀動脈鈣化斑在血管分佈上之特徵，與分佈區塊(Culprit location)是否與性別、抽菸、糖尿病有關聯性。
研究分析695位無心血管疾病受測者的CT影像，包含男性541位，女性154位。其中，有抽菸者410位，無抽菸者285位；有糖尿病者116位，無糖尿病者579位。以心臟冠狀動脈RCA、LAD、LM、LCX四條血管為主軸，分成近端(1、5、6、11)、中端(2、7、9、12)、遠端(3、4、8、10、13、14、15)共15個區段，進行鈣化斑塊ROI區圈選，以ANOVA統計分析平均值與中間值。
初步研究結果發現，695位受測者鈣化分佈型態近端與中端比率佔(83%)，遠端(17%)。分析近、中、遠端鈣化特徵發現，遠端有較低的鈣化密度呈現。男性與是否抽菸及是否有糖尿病鈣化比率仍以近端與中端居多，女性則無顯著差異(p>0.05)，三項共同點都是以LAD與RCA兩條血管鈣化斑塊分佈比例最高。在糖尿病方面，發現沒有糖尿病者，其鈣化斑塊分佈有顯著差異；而有糖尿病者則沒有顯著差異(p>0.05)，其鈣化斑塊分佈型態呈現分散(diffuse)。另一項差別顯示有糖尿病者在LCX與LM鈣化分佈相較於沒有糖尿病者有提高的現象。

關鍵字

動脈粥狀硬化 ； 冠狀動脈疾病 ； 亞加史東指數 ； 冠狀動脈鈣化斑

並列摘要

Framingham risk scores, EKG, chest X-ray, troponin and interventional coronary angiography are usually used to predict the coronary artery disease(CAD). Atherosclerosis may be the indicative of CAD. Computed tomography examination is a non-invasive method to estimate of examinee’s coronary artery calcification. Agatston calcium score is a useful tool to calculate a score based on the extent of coronary artery calcification detected by and unenhanced low-dose CT scan. This work is to study the vascular distribution of calcified coronary plaque and the association of gender, smoke addict, and diabetes mellitus with the culprit location.
There were 695 without cardiovascular disease examinee. In these examinee, male was 541 and female was 154, smoker was 410 and non-smoker was 285, and diabetes mellitus patient was 116, non-DM patient was 579, respectively.
According to the four main coronary artery, which is RCA, LAD, LM, and LCX, 15 segment’s ROI of calcium were demarcated. Among these segments, No. 1,5,6 and 11 segments were demarcated to the proximal end of vessels, No.2,7,9 and 12 were to the midde vessels, No.3,4,8,10,13,14 and 15 were to the distal end of vessels. An ANOVA was applied for statistical analysis.
The results show that there are 83% calcification distribution for the proximal and middle end of vessels, and only 17% calcification distribution for the distal end of vessels. To analyze the calcification features of the proximal, middle and distal end of vessels, the distant end of vessels has the lowest calcium density. For male examinee, the proximal and median end of vessels have the most calcium ratio. For female examinee, there is no significant difference(p>0.05) for calcium ratio. For sexual distinction, with/without smoke and with/without DM, the LAD and RCA get the higher distribution of calcification. For diabetes mellitus examinee, there is significant difference of the distribution of calcified plaque when examinee without diabetes mellitus. For examinee with diabetes mellitus, there is no significant difference(p >0.05), and the calcified plaque distribution shows diffuse. Another difference shows that the calcium distribution in LCX and LM is higher for the examinee with diabetes mellitus.

並列關鍵字

Atherosclerosis ； CAD ； Agatston score ； CAC

參考文獻

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