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  1. NTU Scholars
  2. 公共衛生學院
  3. 流行病學與預防醫學研究所
Please use this identifier to cite or link to this item: https://scholars.lib.ntu.edu.tw/handle/123456789/112595
DC FieldValueLanguage
dc.contributor賴美淑zh-TW
dc.contributorLai, Mei-Shuen
dc.contributor臺灣大學:預防醫學研究所zh-TW
dc.contributor.author郭嬿姝zh-TW
dc.contributor.authorKuo, Yen-Shuen
dc.creator郭嬿姝zh-TW
dc.creatorKuo, Yen-Shuen
dc.date2009en
dc.date.accessioned2010-06-02T02:53:00Z-
dc.date.accessioned2018-06-29T17:58:02Z-
dc.date.available2010-06-02T02:53:00Z-
dc.date.available2018-06-29T17:58:02Z-
dc.date.issued2009-
dc.identifier.otherU0001-1808200913231300en
dc.identifier.urihttp://ntur.lib.ntu.edu.tw//handle/246246/184868-
dc.description.abstract背景: 64多切面電腦斷層冠狀動脈血管攝影是近年來快速應用於診斷冠狀動脈疾病的非侵入性檢查,能同時提供冠狀動脈血管管腔和管壁之資訊。與心導管檢查及血管內超音波相比,証實該項檢查對於冠狀動脈之血管狹窄和管壁變化均具診斷價值。然而,64多切面電腦斷層冠狀動脈血管攝影用於評估冠狀動脈疾病的預後價值為何則尚待檢驗。的: 經由64多切面電腦斷層冠狀動脈血管攝影觀察到的冠狀動脈之動脈硬化嚴重度與發生冠狀動脈疾病之相關性探討,並和Framingham風險評估相比,以瞭解64多切面電腦斷層冠狀動脈血管攝影用於評估冠狀動脈疾病預後之價值。料與方法: 採回溯性世代研究設計,以2006年5月至2007年12月間於臺灣北部單一醫學中心接受64多切面電腦斷層冠狀動脈血管攝影檢查的受檢者共425人為研究樣本,在平圴22個月的追蹤期間內,對研究樣本的電腦斷層檢查冠狀動脈之動脈硬化嚴重度指標,與發生重大心臟事件(包括進一步接受冠狀動脈氣球擴張/支架置放、冠狀動脈繞道手術、不穩定心絞痛且需住院治療、心肌梗塞)或死亡之相關性以Cox proportional hazard regression analysis進行分析。以Receiver operating characteristic (ROC) curves分析和Area under ROC curves比較Framingham風險評估和電腦斷層動脈硬化嚴重度指標,藉以評估電腦斷層動脈硬化嚴重度指標的預測價值。果: 電腦斷層動脈硬化嚴重度較高者,發生重大心臟事件或死亡的風險比顯著高於嚴重度低者。控制干擾因子後,Modified Duke CAD Index [3-6分與0分相比]風險比為6.88 (95%信賴區間1.27-37.25),Segment Stenosis Score [> 5分與0分相比]風險比為6.11(1.08-34.57),Three-vessel Plaque Score [1分和0分相比]風險比為 5.81 (1.44-23.44)。和無動脈硬化者相比,兩條冠狀動脈疾病[血管狹窄≧50%]風險比為13.76 (2.14-88.51)、阻塞型冠狀動脈疾病[≧70%]風險比為6.08(1.06-34.81),單一條冠狀動脈疾病[≧70%]風險比為8.01 (1.33-48.23)。有中段血管狹窄[≧50%或≧70%]者,其風險比為9.84 (2.33-41.66)和6.73 (1.87-24.20)。有近或中段血管狹窄[≧50%或≧70%]者,其風險比各為13.40 (2.60-69.06)和8.83 (2.36-33.04)。依性別、年齡、臨床症狀和糖尿病分層,男性族群在Modified Duke CAD Index 3-6分、Three-vessel Plaque Score 1分、兩條冠狀動脈疾病[≧50%]、阻塞型冠狀動脈疾病[≧70%]及單一條冠狀動脈疾病[≧70%],有症狀族群在Modified Duke CAD Index 3-6分、Segment Stenosis Score > 5分、Three-vessel Plaque Score 1分、兩條冠狀動脈疾病[≧50%]、阻塞型冠狀動脈疾病[≧70%]及單一條冠狀動脈疾病[≧70%],無糖尿病族群在兩條冠狀動脈疾病[≧50%]的風險比,均顯著高於嚴重度低者。Framingham風險評估相比,64多切面電腦斷層冠狀動脈血管攝影提供更為精確的預後評估,電腦斷層冠狀動脈之動脈硬化嚴重度指標的表現均優於Framingham風險,其中以未分組或分組後的Segment Stenosis Score , Presence of obstructive CAD [≧50%或≧70%]和分組後的Modified Duke CAD Index為最佳預測指標,五種指標的敏感度均接近100%,特異度則介於81-89%之間。論: 本研究証明64多切面電腦斷層冠狀動脈血管攝影和發生冠狀動脈疾病之間有顯著相關,並証明與Framingham風險評估相比,64多切面電腦斷層冠狀動脈血管攝影對短中期預後評估更為精確。zh-TW
dc.description.abstractBackground: The diagnostic accuracy of 64-multislice coronary computed tomography angiography (CCTA) regarding obstructive coronary artery disease has been demonstrated in previous studies compared with invasive coronary angiography and intravascular ultrasound. However, the prognostic performance remains to be further examined.bjectives: The study is aimed to assess the association between 64-multislice CCTA and occurrence of major cardiac events or death, and to evaluate the prognostic value of 64-multislice computed tomography coronary angiography compared with the Framingham risk score.aterials and Methods: The study retrospectively enrolled 425 patients who had undergone 64-multislice CCTA at single hospital in Northern Taiwan between May 2006 and December 2007. The severity of coronary atherosclerosis was determined by different CCTA indicators and the occurrence of severe cardiac events (revascularization after 90 days, unstable angina requiring hospitalization, myocardial infarct) or death were observed for mean follow up time of 22 months. The association between severity of coronary atherosclerosis on CCTA and the occurrence of severe cardiac events or death was analyzed using Cox proportional hazard regression model before and after adjustment. The prognostive value of 64-multislice CCTA was evaluated and compared with Framingham risk score using receiver operating characteristic (ROC) curves and area under ROC curves analysis.esults: Increased hazard ratios were observed in cases with more advanced coronary atherosclerosis detected by computed tomography. After adjustment, the hazard ratios were 6.88 (95% confidence interval 1.27-37.25) for modified Duke CAD index 3-6, 6.11 (1.08-34.57) for segment stenosis score > 5, and 5.81 (1.44-23.44) for three-vessel plaque score 1. The hazard ratios were 13.76 (214-88.51) for two-vessel obstructive CAD [≧50% stenosis], 6.08 (1.06-34.81) for obstructive CAD [≧70%], and 8.01 (1.33-48.23) for one-vessel obstructive CAD [≧70%]. Regarding stenosis in proximal and middle segment arteries, the hazard ratios for middle or either proximal or middle segment stenosis [≧50%,≧70%] were 9.84 (2.33-41.66), 13.40 (2.60-69.06), and 6.73 (1.87-24.20) and 8.83 (2.36-33.04), respectively. Further stratification by sex, age, presence of symptoms or diabetes showed significant increase in hazard ratios in the followings: modified Duke CAD index 3-6, three-vessel plaque score 1, two-vessel CAD [≧50%], obstructive CAD [≧70%] and single-vessel CAD [≧70%] in male subgroup; Modified Duke CAD index 3-6, segment stenosis score > 5, three-vessel plaque score 1, two-vessel CAD [≧50%], obstructive CAD [≧70%] and single-vessel CAD [≧70%] in symptomatic subgroup; two-vessel CAD [≧50%] in non-diabetic subgroup.ixty-four multislice CCTA significantly outperformed the Framingham risk score in predicting severe cardiac events and death. Among the CCTA indicators for severity of coronary atherosclerosis, segment stenosis score [either 0-48 or classified into 0, 1-5 and > 5], presence of obstructive CAD [≧50% or ≧70%] and modified Duke CAD index [classified into 0, 1-2, 3-6] were among the best performing indicators with sensitivity approaching 100% and specificity between 81-89%.onclusions: The study demonstrated the positive association between severity of coronary atherosclerosis detected by 64-multislice CCTA and occurrence of severe cardiac events or death, and the outperforming prognostic value of 64-multislice CCTA compared with Framingham risk score.en
dc.description.tableofcontents中文摘要 II文摘要 IV目錄 X目錄 XIV一章 前言 1 第一節 研究背景 1 第二節 研究動機 2二章 文獻回顧 3 第一節 電腦斷層冠狀動脈血管攝影與發生冠狀動脈疾病之相關性研究 3 第二節 電腦斷層冠狀動脈血管攝影與Framingham風險評估之相關研究 5 第三節 研究內容和目的 6 第四節 研究假說 7三章 材料與方法 14 第一節 研究設計 14 第二節 研究樣本選取 14 第三節 研究架構 15 第四節 研究之影像檢查流程和影像後處理 16 第五節 研究變項定義與測量 17 第六節 資料處理與統計分析 22四章 結果 29 第一節 研究樣本的基本資料、電腦斷層冠狀動脈之動脈硬化嚴重度指標與發生重大心臟事件或死亡的描述性分析 29 第二節 研究樣本的電腦斷層冠狀動脈動脈硬化嚴重度指標於分組後發生重大心臟事件或死亡之分布 51 第三節 研究樣本的電腦斷層冠狀動脈動脈硬化嚴重度指標於分組後與發生重大心臟事件或死亡之相關強度分析 54 第四節 研究樣本的Framingham風險之描述性分析 84 第五節 研究樣本的Framingham風險於分組後之基本資料與電腦斷層冠狀動脈動脈硬化嚴重度指標的分布 84 第六節 研究樣本的Framingham風險與重大心臟事件或死亡之分布 85 第七節 研究樣本的Framingham風險與發生重大心臟事件或死亡之相關強度分析 86 第八節 研究樣本的電腦斷層冠狀動脈動脈硬化嚴重度指標與Framingham風險之Receiver Operating Characteristic (ROC) curves和Area Under ROC curves分析 86五章 討論 104 第一節 冠狀動脈疾病與64多切面電腦斷層冠狀動脈血管攝影之關係 104 第二節 64多切面電腦斷層冠狀動脈血管攝影和發生重大心臟事件或死亡的相關性探討 106 第三節 64多切面電腦斷層冠狀動脈血管攝影的預後價值探討 108 第四節 與其他電腦斷層冠狀動脈血管攝影預後研究之比較 110 第五節 研究限制 111六章 結論 113考文獻 114目錄1~表3 Literature Review of the Prognostic Studies Regarding Coronary Computed Tomography Agiography (CCTA) 8~134 研究變項之概念型和操作型定義 27,285-1 研究樣本之基本資料分布 365-2,5-3 研究樣本之電腦斷層冠狀動脈動脈硬化嚴重度指標 37,385-4 近段和中段血管之斑塊特性與發生重大心臟事件或死亡之關係 395-5 研究樣本發生重大心臟事件或死亡之分布情形 405-6 研究樣本依Agatston Calcium Score分組之基本資料分布情形 415-7 研究樣本依Modified Duke CAD Index分組之基本資料分布情形 425-8 研究樣本依Segment Stenosis Score分組之基本資料分布情形 435-9 研究樣本依Segment Involvement Score分組之基本資料分布情形 445-10 研究樣本依Three-vessel Plaque Score分組之基本資料分布情形 455-11, 5-12 研究樣本依Presence of Obstructive CAD(≧50%)分組之基本資料分布情形 46,475-13, 5-14 研究樣本依Presence of Obstructive CAD(≧70%)分組之基本資料分布情形 48,495-15 研究樣本依發生重大心臟事件和死亡與否分組之基本資料分布 506 電腦斷層之冠狀動脈硬化嚴重度指標於分組後的累積發生率和風險比 63,647 電腦斷層之冠狀動脈動脈硬化嚴重度指標單變項Cox Proportional Hazard Regression分析 658-1 近和中段血管斑塊位置之Cox Proportional Hazard Regression分析 668-2 近和中段血管斑塊成分之Cox Proportional Hazard Regression分析 678-3 近和中段血管斑塊合併血管狹窄之Cox Proportional Hazard Regression分析 689 研究樣本基本資料之單變項Cox Proportional Hazard Regression分析 6910-1, 10-2 電腦斷層冠狀動脈之動脈硬化嚴重度指標多變項 Cox Proportional Hazard Regression分析 70,7111-1, 11-2 電腦斷層冠狀動脈之動脈硬化嚴重度指標之多變項Cox Proportional Hazard Regression分析–以性別分層 72,7312-1, 12-2 電腦斷層冠狀動脈之動脈硬化嚴重度指標之多變項Cox Proportional Hazard Regression分析–以年齡分層 74,7513-1, 13-2 電腦斷層冠狀動脈之動脈硬化嚴重度指標之多變項Cox Proportional Hazard Regression分析–以臨床症狀分層 76,7714-1, 14-2 電腦斷層冠狀動脈之動脈硬化嚴重度指標之多變項Cox Proportional Hazard Regression分析–以糖尿病分層 78,7915 研究樣本的Framingham風險分數和Framingham 10年風險分層 8916 研究樣本依Framingham 10年風險分層之基本資料分布 9017 各項電腦斷層之冠狀動脈動脈硬化嚴重度指標與Framingham 10年風險分層之相關性分析 9118 研究樣本依Framingham風險分數及10年風險分層,其發生重大心臟事件或死亡之分布 9219 研究樣本之Framingham風險分數和Framingham 10年風險分層之單變項Cox Proportional Hazard Regression分析 9320-1 Area Under ROC Curves of Framingham risk score, Framingham 10-year Risk Stratification and the CCTA indicators of Severity of Coronary Atherosclerosis 9620-2 Pairwise Comparison of Area Under ROC Curves amongramingham Risk Score, Framingham 10-year Risk Stratification and the CCTA Indicators of Severity of Coronary Atherosclerosis 97目錄 1 研究樣本選取流程 252 研究架構圖 263-1 Kaplan-Meier Survival Analysis of Agatston Calcium Score 803-2 Kaplan-Meier Survival Analysis of Modified Duke CAD Index 803-3 Kaplan-Meier Survival Analysis of Segment Stenosis Score 813-4 Kaplan-Meier Survival Analysis of Segment Involvement Score 813-5 Kaplan-Meier Survival Analysis of Three-vessel Plaque Score 823-6 Kaplan-Meier Survival Analysis of Presence of obstructive CAD (≧50%) 823-7 Kaplan-Meier Survival Analysis of Presence of obstructive CAD (≧70%) 834-1 Kaplan-Meier Survival Analysis of Framingham 10-year Risk Stratification 944-2 Kaplan-Meier Survival Analysis of Framingham 10-year Risk Stratification in Women 944-3 Kaplan-Meier Survival Analysis of Framingham 10-year Risk Stratification in Men 955-1 Receiver-Operating Characteristic Curve of Framingham Risk Score 985-2 Receiver-Operating Characteristic Curve of Framingham 10-year Risk Stratification 985-3, 5-4 Receiver-Operating Characteristic Curves of Segment Stenosis Score and Framingham 10-year Risk Stratification 995-5, 5-6 Receiver-Operating Characteristic Curves of Presence of Obstructive CAD (≧70%) and Framingham 10-year Risk Stratification 1005-7, 5-8 Receiver-Operating Characteristic Curves of Modified Duke CAD Index and Framingham 10-year Risk Stratification 1015-9, 5-10 Receiver-Operating Characteristic Curves of Segment Stenosis Score and Framingham 10-year Risk Stratification 1025-11, 5-12 Receiver-Operating Characteristic Curves of Presence of Obstructive CAD (≧50%) and Framingham 10-year Risk Stratification 103en
dc.formatapplication/pdfen
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dc.format.mimetypeapplication/pdf-
dc.languagezh-TWen
dc.language.isoen_US-
dc.subject電腦斷層zh-TW
dc.subject冠狀動脈血管攝影zh-TW
dc.subject冠狀動脈疾病zh-TW
dc.subject預後研究zh-TW
dc.subjectcomputed tomographyen
dc.subjectCT angiographyen
dc.subjectcoronary angiographyen
dc.subjectcoronary artery diseaseen
dc.subjectprognosisen
dc.title六十四多切面電腦斷層冠狀動脈血管攝影與發生冠狀動脈疾病之相關性探討zh-TW
dc.titleAssociation between 64-multislice Coronary Computed Tomography Angiography and Occurrence of Coronary Artery Diseaseen
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