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目的：探讨冠状动脉CT血管成像（CCTA）获得的血流储备分数（CT-FFR）对冠状动脉临界病变预后的评估价值。方法：回顾性纳入行CCTA检查并诊断为冠状动脉临界病变的冠状动脉硬化性心脏病（冠心病）患者289例。将CCTA原始DICOM数据导入脉影CT-FFR模块行后处理，得到CT-FFR值。记录患者临床基线资料，记录随访期间内主要心血管不良事件（MACE）的发生情况。根据CT-FFR值分为CT-FFR≤0.8组177例和CT-FFR>0.8组112例；以是否发生MACE分为MACE组60例和无MACE组229例；比较各组的基线资料。采用Cox回归分析筛选MACE发生的独立危险因素，建立风险预测模型，绘制时间依赖ROC曲线评价预测模型的预测效能。结果：CT-FFR≤0.8组MACE发生率高于CT-FFR>0.8组（P<0.05）。MACE组糖尿病史、多支病变、CT-FFR≤0.8占比均显著高于无MACE组（均P<0.05）。多因素Cox回归分析表明，CT-FFR≤0.8、糖尿病史、多支病变是冠状动脉临界病变患者发生MACE的独立危险因素（均P<0.05），用于建立Cox风险预测模型。时间依赖ROC曲线显示，预测模型整体AUC较高，在第8、16个月时模型的敏感度为1.000，特异度在不同时间点上相对较低。结论：糖尿病史、多支病变、CT-FFR≤0.8是冠状动脉临界病变患者发生MACE的独立危险因素，有助于识别发生MACE风险较高的患者。三者联合建立的预测模型对冠状动脉临界病变的预后具有良好的预测价值，可进一步提升对MACE的预测能力，实现对冠状动脉临界病变的精准分层，改善患者预后。
Abstract：Objective:To investigate the prognostic value of coronary CT angiography(CCTA) fractional flow reserve(FFR) to the prognosis of patients with coronary heart disease(CHD) who had moderate coronary artery stenosis. Methods:A total of 289 CHD patients were retrospectively included,all of them underwent CCTA examination and were diagnosed with moderate coronary artery stenosis. The original DICOM data from CCTA images were imported into the Maiying CT-FFR module for post-processing to obtain the CT-FFR values. Clinical baseline data and the mortality and major adverse cardiovascular events(MACE) from discharge until the follow-up period were recorded. Initially,the patients were divided into two groups,the group of CT-FFR >0.8(112 cases) and the group of CT-FFR ≤ 0.8(177 cases). Additionally,the patients were divided into two groups according to occurrence of MACE,the MACE group(60 cases) and the non-MACE group(229 cases). The clinical baseline data between groups were compared,and Cox regression analysis was employed to identify the independent risk factors for MACE. A risk prediction model was established,and the ROC curve was applied to evaluate the predictive ability of the model. Results:The incidence rate of MACE in the group of CT-FFR ≤ 0.8 during the follow-up period was significantly higher than that in the group of CT-FFR > 0.8(P<0.05). The history of diabetes,the incidence of multi-vessel disease and the proportion of patients with CT-FFR ≤ 0.8 in the MACE group were significantly greater than those in the non-MACE group(all P<0.05). Multivariate Cox regression analysis indicated that CT-FFR ≤ 0.8,the history of diabetes and multi-vessel disease were the independent risk factors for MACE,and were used to construct the Cox predictive model. The time-dependent ROC curve showed that the overall AUC of the predictive model was relatively high,with the model's sensitivity approaching 1.000 at the 8 th and 16 th months,while the specificities were relatively low at different time points. Conclusions:History of diabetes,multi-vessel disease,and CT-FFR ≤ 0.8 are identified as independent risk factors for MACE in CHD patients with moderate coronary artery stenosis,which can assist in identifying patients at higher risk for MACE. The combined prediction model incorporating these three factors demonstrates good prognostic value for CHD patients with moderate coronary artery stenosis,enhancing MACE prediction capabilities,facilitating accurate stratification of CHD patients,and ultimately reducing myocardial risks and improving patient outcomes.
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基本信息:
中图分类号:R541.4;R816.2
引用信息:
[1]刘涛,孙勇.冠状动脉CT血管成像血流储备分数对冠状动脉临界病变的预后评估价值[J].中国中西医结合影像学杂志,2026,24(01):64-69.
基金信息:
国家自然科学基金项目（8207070681）
2026-01-21
2026-01-21