2026 年第 9 期 第 21 卷

基于心肌声学造影的非阻塞性冠心病预后风险研究

Prognostic risk study of non-obstructive coronary atherosclerotic heart disease based on myocardial contrast echocardiography

作者：杜桂彬杨淑君郑雪许新新潘晓洁

英文作者：Du Guibin Yang Shujun Zheng Xue Xu Xinxin Pan Xiaojie

单位：河北中石油中心医院超声医学科，廊坊065000

英文单位：Department of Ultrasound Medicine Hebei Petro China Central Hospital Langfang 065000 China

关键词：非阻塞性冠心病；心肌声学造影；主要不良心脑血管事件；预测价值

英文关键词：Non-obstructivecoronaryatheroscleroticheartdisease;Myocardialcontrastechocardiography;Majoradversecardiovascularandcerebrovascularevents;Predictivevalue

• 摘要：

• 目的 基于心肌声学造影探讨非阻塞性冠心病（冠状动脉粥样硬化性心脏病）患者的预后风险。方法 选取2024年1—10月在河北中石油中心医院治疗的非阻塞性冠心病患者100例，治疗后随访12个月，比较发生（发生组，24例）和未发生（未发生组，76例）主要不良心脑血管事件（MACCE）患者的临床资料、治疗48 h后实验室指标、心肌声学造影参数差异，采用Logistic回归分析模型、列线图模型和受试者工作特征（ROC）曲线分析非阻塞性冠心病患者预后风险。结果 发生组和未发生组患者年龄、体重指数、吸烟史、饮酒史、基础疾病及用药情况方面差异均无统计学意义（均P＞0.05）。2组患者治疗48 h后总胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）等指标比较差异均无统计学意义（均P＞0.05）。发生组患者治疗48 h后心肌声学造影参数平台期峰值强度（Α）、曲线斜率（β）、心肌血流量（Α·β）和左心室射血分数（LVEF）低于未发生组患者，而灌注计分指数（PSI）高于未发生组患者（均P＜0.05）。Logistic回归分析结果显示，Α、β、PSI和LVEF是患者治疗后发生MACCE的影响因素（均P＜0.05），据此构建列线图模型，其预测MACCE的ROC曲线下面积为0.948（95%置信区间：0.901～0.994），敏感度和特异度分别为85.00%和92.50%。结论 非阻塞性冠心病患者预后受心肌声学造影参数Α、β、PSI和LVEF的影响，构建基于心肌声学造影参数Α、β、PSI和LVEF的列线图模型预测治疗后MACCE发生有较好的应用价值。

• Objective To investigate the prognostic risk of patients with non-obstructive coronary atherosclerotic heart disease based on myocardial contrast echocardiography. Methods A total of 100 patients diagnosed with non-obstructive coronary atherosclerotic heart disease treated in Hebei Petro China Central Hospital from January to October 2024 were enrolled and followed up for 12 months after treatment. Clinical data, laboratory indicators at 48 h post-treatment and myocardial contrast echocardiography parameters were compared between patients with major adverse cardiovascular and cerebrovascular events (MACCE, event group, 24 cases) and those without MACCE (non-event group, 76 cases). Logistic regression model, nomogram model and receiver operating characteristic (ROC) curve were adopted to analyze the prognostic risk of patients with non-obstructive coronary atherosclerotic heart disease. Results There were no statistically significant intergroup differences in age, body mass index, smoking history, drinking history, underlying diseases and medication status between the event group and non-event group (all P＞0.05). No significant differences were observed in total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and other laboratory indicators at 48 h post-treatment between the two groups (all P＞0.05). The myocardial contrast echocardiography parameters including plateau peak intensity (A), curve slope (β), myocardial blood flow (A·β) and left ventricular ejection fraction (LVEF) at 48 h post-treatment in the event group were lower than those in the non-event group, while the perfusion score index (PSI) was higher (all P＜0.05). Logistic regression analysis revealed that A, β, PSI and LVEF were influencing factors for post-treatment MACCE (all P＜0.05). A nomogram model was established accordingly, whose area under the ROC curve for predicting MACCE was 0.948 (95% confidence interval: 0.901-0.994), with a sensitivity of 85.00% and a specificity of 92.50%. Conclusion The prognosis of patients with non-obstructive coronary atherosclerotic heart disease is affected by myocardial contrast echocardiography parameters A, β, PSI and LVEF. The nomogram model constructed based on the above four parameters presents favorable application value in predicting post-treatment MACCE.