| 能谱CT结合血清标志物在冠脉斑块特征分析中的研究 |
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| 引用本文： | 黄仁军,戴慧,李勇刚,郭亮,胡春洪,何志松.能谱CT结合血清标志物在冠脉斑块特征分析中的研究[J].CT理论与应用研究,2018,27(2):155-163. |
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| 作者姓名： | 黄仁军 戴慧 李勇刚 郭亮 胡春洪 何志松 |
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| 作者单位： | 苏州大学附属第一医院 a. 放射科;b. 心内科, 江苏 苏州 215006 |
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| 基金项目： | 江苏省卫生厅科研基金（Q201303）；国家自然科学基金（81171394；81201079）；江苏政府留学奖学金（JS-2014-197）。 |
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| 摘 要： | 目的:探讨能谱CT分析不同冠脉斑块成分的价值以及与不同血清学标志物水平之间的相关性，为能谱CT对斑块特征的诊断及鉴别诊断价值提供依据。方法:107名诊断为冠心病或急性发作性胸痛以及心前区不适的患者（男65例，女42例；平均年龄60岁），均行冠状动脉能谱CT扫描。将所有冠脉斑块根据CT值以及混合斑块中的钙化大小分为5组。用能谱分析软件分析冠脉斑块不同成分。斑块的易损性用血清标志物进行评估。血清标志物的浓度通过酶联免疫吸附法测定。结果:共发现有159个冠脉斑块，抽取了90例血样，除1组与5组以及2组与5组之间的FAT浓度以外，五组斑块之间的CT值以及能谱参数均有统计学差异（P<0.05）。冠脉斑块阳性者3种血清标志物浓度明显高于冠脉斑块阴性者（P<0.05）。2组与3组以及3组与5组之间的基质金属蛋白酶-9（matrix metalloproteinases，MMP-9）血清浓度具有明显差异（P<0.05）。血清MMP-9浓度与斑块CT值（r=-0.501，P<0.05）、有效原子序数（r=-0.372，P<0.05）、能谱曲线斜率（r=-0.378，P<0.05）、HAP浓度（r=-0.411，P<0.05）之间呈负相关关系，而与FAT浓度之间呈正性相关关系（r=0.34，P<0.05）。受试者工作特征曲线（Receiver operating characteristic curve，ROC）分析显示2组与5组之间的能谱曲线斜率、有效原子序数以及HAP浓度临界值分别为3.41，8.91，96.07。结论:宝石能谱CT在不同类型的冠状动脉粥样硬化斑块的鉴别中具有一定的价值；能谱CT的四种能谱参数与血清MMP-9浓度之间具有一定的相关性。
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| 关 键 词： | 宝石能谱成像 冠状动脉CT 能谱曲线 基物质分离 |
| 收稿时间： | 2017-11-03 |
Spectral Computer Tomography Combined with Serum Biomarkers in Coronary Plaque Characteristics Analysis |
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| Affiliation: | a). Department of Radiology, b). Department of Cardiovascular Medicine, the First Affiliated Hospital of Soochow University, Suzhou 215006, China |
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| Abstract: | Objective: To study the value of spectral CT in analyzing different coronary plaque components and their correlation with different serum levels of biomarker, and to provide a basis for the diagnosis value and differential diagnosis value of spectral CT. Methods: 107 consecutive patients diagnosed with coronary artery disease (CAD) or acute paroxysmal chest pain and discomfort in the anterior region of the heart (65 males and 42 females; mean age, 60 years) underwent coronary artery gemstone spectral imaging. Plaques were divided into 5 groups according to Multi-slice computed tomography (MSCT) criteria and the size of calcification in mixed plaques. Spectral attenuation curve (SAC), effective atomic number (EAN) and basic material decomposition:FAT and HAP technique were used to analyze the plaques. The vulnerability of plaques was evaluated by serum biomarkers including soluble OX40 ligand (sOX40 L), matrix metalloproteinases (MMP-9) and lipoprotein associated phospholipase A2 (Lp-PLA2). The concentrations of the serum biomarkers were detected by ELISA. Results: 159 coronary artery plaques were counted in total. 90 cases of blood samples (42 cases without coronary plaque, 48 cases with coronary plaque) were obtained. By measuring CT density, the plaques were classified as fibrosis group (group 1), soft plaque group (group 2) and pure calcification group (group 3). In addition, mixed plaques with non-spotty calcification group (group 4) and spotty calcification group (group 5) were also analyzed. There were statistically significant differences of CT density, SAC, EAN, HAP and FAT among the five groups (P<0.05), except the FAT value between group1 and group5 as well as between group 2 and group5. The concentrations of serum biomarkers were significantly higher in subjects with coronary atherosclerotic plaques than those in subjects without coronary plaques (P<0.05). There were significant differences of the MMP-9 concentrations between group 2 and group 3 as well as between group3 and group5 (P<0.05). Negative correlations were found as follow:MMP-9 concentration vs. CT density (r=-0.501, P<0.05), MMP-9 concentration vs. EAN (r=-0.372, P<0.05), MMP-9 concentration vs. SAC (r=-0.378, P<0.05) and MMP-9 concentration vs. HAP material density (r=-0.411, P<0.05). Positive correlation was found between serum MMP-9 concentration and FAT material density r=0.34, P<0.05). Receiver operating characteristic curve (ROC) showed cutoff value and area under the curve (AUC) of SAC and EAN and HAP material was 3.41 (AUC=0.633) and 8.91 AUC=0.652) and 96.07 (AUC=0.648) between group 2 and group 5. Conclusion: The results indicate that spectral CT might be promising in differentiating different kinds of atherosclerotic plaques. These four kinds of spectral CT parameters are associated with serum MMP-9 level. |
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