Nghiên cứu mối liên quan giữa mức độ vôi hóa động mạch vành trên MSCT với mức độ tổn thương động mạch vành theo thang điểm syntax

1 B GIO DC V O TO B Y T TRNG I HC Y H NI PHM ANH HNG NGHIÊN CứU MốI LIÊN QUAN GIữA MứC Độ VÔI HóA ĐộNG MạCH VàNH TRÊN MSCT VớI MứC Độ TổN THƯƠNG ĐộNG MạCH VàNH THEO THANG ĐIểM SYNTAX Chuyờn ngnh : Tim mch Mó s : 60720140 LUN VN THC S Y HC Ngi hng dn khoa hc: PGS.TS: NGUYN QUANG TUN H NI 2015 LI CM N Nhõn dp hon thnh lun tt nghip Thc s, tụi xin trõn thnh cm n Ban Giỏm hiu, Phũng o to Sau i hc, B mụn Tim mch, Ban Giỏm c Bnh vin Bch Mai, th cỏc bỏc s, iu dng Vin Tim mch Vit Nam ó giỳp v to mi iu kin thun li cho tụi quỏ trỡnh hc v nghiờn cu khoa hc Vi lũng kớnh trng v bit n sõu sc, tụi xin c trõn trng cm n GS.TS Doón Li Vin trng Vin Tim mch Vit Nam, Ch nhim B mụn Tim mch Ngi Thy ó tn tỡnh dy d, ch bo, giỳp v luụn to mi iu kin tt nht cho tụi quỏ trỡnh hc tp, lm vic v thc hin lun ny Tụi xin c by t lũng kớnh trng v bit n sõu sc ti GS.TS Nguyn Lõn Vit Ch tch Hi Tim mch Vit Nam Nguyờn Vin trng Vin Tim mch Vit Nam, Ngi ó giỳp tụi quỏ trỡnh hon thnh bn lun ny Tụi xin c by t lũng kớnh trng v bit n sõu sc ti PGS.TS Nguyn Quang Tun Ngi Thy ó hng dn v giỳp tụi rt nhiu nm hc Cao hc Tụi xin c gi li cm n ti PGS.TS inh Thu Hng, PGS.TS Trng Thanh Hng, PGS.TS.Phm Mnh Hựng, PGS.TS Nguyn Lõn Hiu, TS.Nguyn Ngc Quang, TS Phan ỡnh Phong, TS Phm Minh Tun ó giỳp v to mi iu kin thun li cho tụi hon thnh bn lun ny Tụi xin c gi li cm n ti th cỏn b cỏc phũng ban Vin tim mch: Phũng Hnh chớnh, Phũng Thụng tim, Phũng in tõm , Phũng d ỏn Tng huyt ỏp quc gia, Phũng iu tr C1 tụi hc C9 ó to mi iu kin cho Tụi mun c gi li cm n ti 111 bnh nhõn nghiờn cu ny v nhng bnh nhõn tụi ó iu tr thi gian hc cao hc, h chớnh ng lc cho tụi hc hnh Cui cựng, tụi xin c gi li cm n ti B, M, V v nhng ngi thõn gia ỡnh, cỏc bn hc viờn, ó khớch l v giỳp tụi thi gian hc v nghiờn cu va qua H Ni, ngy 03 thỏng 11 nm 2015 Phm Anh Hựng LI CAM OAN Tụi l Phm Anh Hựng, hc viờn cao hc XXII Trng i hc Y H Ni, Chuyờn ngnh Tim mch, xin cam oan: õy l lun bn thõn tụi trc tip thc hin di s hng dn ca thy PGS.TS Nguyn Quang Tun Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c s xỏc nhn v chp thun ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 03 thỏng 11 nm 2015 Phm Anh Hựng CC CH VIT TT ACC AHA AS AU BMI BN CAC CACS CAD MV DSCT EBCT MSCT MDCT FRS HCVC NMCT SS PCI : American college of cardiology Trng mụn tim mch M : American heart association Hip hi tim mch M : (Agatston score): im Agatston : (Agatston units): n v Agatston : (Body Mass Index): Ch s ca c th : Bnh nhõn : (Coronary Artery Calcium) Vụi hoỏ ng mch vnh : Coronary Artery Calcium Score im vụi hoỏ ca ng mch vnh : (Coronary artery disease): Bnh ng mch vnh : ng mch vnh : Dual-source computed tomography Chp ct lp vi tớnh ngun nng lng : Electron beam computed tomography Chp ct lp vi tớnh chựm in t : Multislice computed tomography Chp ct lp a dóy : Multiple detector computed tomography Chp ct lp a ngun phỏt : Framingham risk score Thang im nguy c Framingham : Hi chng vnh cp : Nhi mỏu c tim : SYNTAX score (im SYNTAX) : Percutaneous coronary intervention Can thip ng mch vnh qua da MC LC T VN CHNG 1: TNG QUAN TI LIU 14 1.1 Tỡnh hỡnh mc bnh tim mch trờn th gii v Vit Nam 14 1.1.1 Tỡnh hỡnh mc hi chng vnh cp trờn th gii 14 1.1.2 Vit Nam 14 1.2 c im gii phu, chc nng ng mch vnh 14 1.2.1 Gii phu MV 14 1.2.2 MV trỏi 15 1.2.3 MV phi 16 1.3 Cỏc yu t nguy c tim mch 16 1.3.1 nh ngha 16 1.3.2 Cỏc yu t nguy c thng gp ca bnh tim mch 17 1.3.3 Thang im nguy c Framingham d bỏo nguy c bnh mch vnh 21 1.4 Phõn loi v chn oỏn bnh ng mch vnh 22 1.4.1 Phõn loi bnh ng mch vnh 22 1.4.2 au tht ngc n nh 23 1.4.3 Nhi mỏu c tim khụng cú ST chờnh lờn v au tht ngc khụng n nh 27 1.4.4 Nhi mỏu c tim cú ST chờnh lờn 30 1.4.5 nh ngha nhi mỏu c tim 30 nh ngha ton cu ln th III v nhi mỏu c tim 30 1.5 Chp ct lp vi tớnh a dóy ng mch vnh 32 1.6 ỏnh giỏ mc tn thng MV theo thang im SYNTAX trờn phim chp mch 42 1.6.1 Cỏc phõn loi tn ti trc cú thang im SYNTAX 43 1.6.2 Thang im SYNTAX 44 CHNG 2: I TNG V PHNG PHP NGHIấN CU 49 2.1 i tng nghiờn cu 49 2.1.1 Tiờu chun chn i tng 49 2.1.2 Tiờu chun loi tr 49 2.1.3 Phng phỏp chon c mu nghiờn cu 49 2.2 Phng phỏp nghiờn cu 50 2.2.1 a im nghiờn cu 50 2.2.2 Thit k nghiờn cu 50 2.2.3 Cỏc bc tin hnh nghiờn cu 50 CHNG 3: KT QU NGHIấN CU 55 3.1 c im chung ca i tng nghiờn cu 55 3.1.1 Kt qu v c im i tng nghiờn cu 55 3.1.2 So sỏnh c im ca hai nhúm nghiờn cu 56 3.2 Kt qu v tỡm hiu mt s yu t liờn quan n mc vụi hoỏ ng mch vnh trờn phim chp ct lp a dóy 57 3.2.1 nhúm bnh nhõn nghiờn cu chung 57 3.2.2 nhúm bnh nhõn hi chng vnh cp 58 3.2.3 nhúm bnh nhõn au ngc n nh 59 3.3 Kt qu v mi liờn quan gia mc vụi hoỏ ng mch vnh trờn phim chp ct lp a dóy vi mc tn thng ng mch vnh theo thang im SYNTAX trờn phim chp mch 60 3.3.1 Mi liờn quan gia mc vụi hoỏ ng mch vnh v thang im SYNTAX 60 3.3.2 Mi liờn quan gia im Agatston v s ng mch vnh b tn thng 67 3.3.3 Mi liờn quan gia im Agatston v c im hỡnh thỏi tn thng theo im SYNTAX 70 CHNG 4: BN LUN 76 4.1 Bn lun v mt s yu t liờn quan n mc vụi hoỏ ng mch vnh trờn phim chp ct lp a dóy 76 4.1.1 c im chung ca i tng nghiờn cu 76 4.1.2 Tỡm hiu mt s yu t liờn quan n mc vụi hoỏ ng mch vnh trờn phim chp ct lp a dóy 82 4.2 Bn lun v mi liờn quan gia mc vụi hoỏ ng mch vnh trờn phim chp ct lp a dóy vi mc tn thng ng mch vnh theo thang im SYNTAX trờn phim chp mch 87 4.2.1 Mi liờn quan gia mc vụi hoỏ ng mch vnh trờn phim chp ct lp a dóy vi mc tn thng ng mch vnh theo thang im SYNTAX trờn phim chp mch 87 4.2.2 Mi liờn quan gia im Agatston v s lng mch vnh b hp 90 4.2.3 Mi liờn quan gia im Agatston v c im hỡnh thỏi tn thng theo im SYNTAX 91 KT LUN 93 TI LIU THAM KHO PH LC DANH MC BNG Bng 1.1 Bng 1.2 Bng 1.3 Bng 1.4 Bng 1.5 Bng 3.1 Bng 3.2 Bng 3.3 Bng 3.4 Bng 3.5 Bng 3.6 Bng 3.7 Bng 3.8 Bng 3.9 Bng 3.10 Bng 3.11 Bng 3.12 Bng 3.13 Bng 3.14 Bng 3.15 Phõn au tht ngc theo CCS 24 Nhng d liu giỳp d oỏn nguy c cao b bnh MV trờn in tõm gng sc 26 nh lng mc vụi húa MV theo thang im Agatston 38 Ph lc hng dn s dng im vụi húa mch vnh 38 H s tn thng theo tớnh cht 47 c im chung ca i tng nghiờn cu 55 c im nghiờn cu ca nhúm 56 Mụ hỡnh hi quy tuyn tớnh v mi liờn quan gia im Agatston vi mt s yu t nguy c nhúm bnh nhõn nghiờn cu chung 57 Mụ hỡnh hi quy tuyn tớnh v mi liờn quan gia im Agatston vi mt s yu t nguy c nhúm bnh nhõn HCVC 58 Mụ hỡnh hi quy tuyn tớnh v mi liờn quan gia im Agatston vi mt s yu t nguy c tim mch nhúm bnh nhõn Nễ 59 T l bnh nhõn theo cỏc nhúm im Agatston 60 So sỏnh im SYNTAX cỏc nhúm im Agatston nhúm bnh nhõn ngiờn cu chung 61 So sỏnh im SYNTAX cỏc nhúm im Agatston nhúm bnh nhõn hi chng vnh cp 63 So sỏnh im SYNTAX cỏc nhúm im Agatston nhúm bnh nhõn au ngc n nh 64 Mi liờn quan gia tng im Agatston v im SYNTAX theo tng hỡnh thỏi tn thng nhúm bnh nhõn nghiờn cu chung 70 Mi tng quan a bin gia im Agatston vi cỏc c im tn thng MV 71 Mi liờn quan gia tng im Agatston v im SYNTAX theo tng hỡnh thỏi tn thng nhúm bnh nhõn hi chng vnh cp 72 Mi tng quan a bin gia im Agatston vi 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Ngi ta chia tn thng ch chia nhỏnh thnh cỏc dng khỏc nhau, ng vi mt dng tn thng cú h s c thự riờng: A, B, C = E, F, G, H = - Ngoi ra, gúc c to bi on xa ca mch chớnh v nhỏnh ph nu < 70% thỡ cng c cng thờm im ... khác, mức độ vôi hoá động mạch vành với mức độ tổn thương động mạch vành Xuất phát từ lý tiến hành nghiên cứu đề tài Nghiên cứu mối liên quan mức độ vôi hóa động mạch vành MSCT với mức độ tổn thương. .. Kết mối liên quan mức độ vôi hoá động mạch vành phim chụp cắt lớp đa dãy với mức độ tổn thương động mạch vành theo thang điểm SYNTAX phim chụp mạch 60 3.3.1 Mối liên quan mức độ vôi hoá động. .. mạch 87 4.2.1 Mối liên quan mức độ vôi hoá động mạch vành phim chụp cắt lớp đa dãy với mức độ tổn thương động mạch vành theo thang điểm SYNTAX phim chụp mạch 87 4.2.2 Mối liên quan điểm