中文摘要：

目的 利用无创计算机断层扫描（CT）获得冠状动脉（冠脉）斑块影像,通过血液动力学模型计算其流体力学参数,初步分析不同斑块构成和狭窄程度时其流体力学参数的特征.方法 回顾性纳入2016年3至9月在解放军总医院心内科同时接受冠脉CT血管成像（CTA）和有创冠脉血流储备分数（FFR）检查的冠心病患者26例.在CT冠脉影像的基础上通过血液动力学模型计算管壁切应力（WSS）和轴向斑块应力（APS）,运用CT定量分析软件测量斑块负荷和成分体积,并评估不同解剖狭窄程度和功能狭窄程度斑块的无创流体力学参数.结果 研究共纳入31处图像质量清晰的冠脉斑块病变,其中低WSS（＜1Pa）斑块占35.5％（11/31）,负向APS斑块占25.8％ （8/31）.低WSS斑块总体积为（78.5±48.6） mm3,对应斑块负荷为（69.1±12.1）％,而高WSS斑块总体积为（60.5±57.3） mm3,对应斑块负荷为（57.5±14.0）％,二者斑块负荷差异有统计学意义（P =0.028）.而细化到具体斑块各成分体积,二者钙化斑块、纤维斑块和脂质核心斑块相对百分比差异均无统计学意义.正向APS斑块总体积为（79.7±69.1） mm3,对应斑块负荷为（68.7±13.7）％,而负向APS斑块总体积为（61.7±24.9） mm3,对应斑块负荷为（68.9±10.4）％,二者斑块负荷差异无统计学意义（P＞0.05）.而细化到具体斑块各成分体积,正向APS斑块脂质核心斑块相对百分比[（25.1±18.1）％]高于负向APS斑块[（10.8±12.7）％],P=0.049.冠脉非重度狭窄斑块的WSS为（9.6±8.8） Pa明显低于重度狭窄的斑块[（16.7±6.1）Pa],P=0.018.冠脉非重度狭窄斑块的APS为（1 073.7±657.1） Pa明显低于重度狭窄的斑块（1 731.8±713.5） Pa,P=0.013.功能性缺血斑块的WSS为（13.3±8.7） Pa,非功能性缺血斑块的WSS为（12.2±11.0） Pa,二者差异未见统计学意义（P＞0.05）.而功能性缺血斑块的APS为（1 698.8±652.6） Pa明显高?

英文摘要：

Objective To characterize the hemodynamic force towards coronary plaque based on noninvasive coronary computed tomographic angiography and to investigate its relationship with plaque features and stenosis severity by computational fluid dynamics.Methods Twenty-six patients underwent invasive fractional flow reserve measurement following coronary computed tomography angiography examination from March to September 2016 were retrospectively included.Computational fluid dynamics was applied and wall shear stress （WSS） and axial plaque stress （APS）,which extracted the axial component of hemodynamic stress acting on stenotic lesions,were calculated based on the results of noninvasive coronary computed tomographic angiography.Plaque analysis was performed to elucidate plaque features and relative plaque burden.The fluid dynamics distributions in lesions with different stenosis severity were investigated.Results Thirty-one coronary plaques with satisfactory imaging quality were analyzed,there were 11 （35.5%） dominant low WSS （〈 1 Pa） lesion and 20 high WSS lesion （64.5%）,8（25.8%） net retrograde APS lesion and 23 （74.2%） anterograde lesion.Plaque volume was （78.5 ± 48.6） mm3 and plaque burden was （69.1 ± 12.1） % in the low WSS group,which was （60.5 ± 57.3） mm3,and （57.5 ±14.0）%,respectively in the high WSS group,the plaque burden was significantly higher in the low WSS group than in the high WSS group （P =0.028）,while the percentage of calcified plaque,fibrotic plaque and lipid core volume were similar between the two groups （P 〉0.05）.Plaque volume was （79.7 ±69.1） mm3 and plaque burden was （68.7 ± 13.7）% in the group with anterograde-dominant APS plaque,which was（61.7 ± 24.9） mm3,and （68.9 ± 10.4） %,respectively in the net retrograde APS lesion group （P 〉 0.05）.Percentage of lipid core area was significantly higher in the anterograde lesion group than in the retrograde lesion group （（25.1 ± 18.1） % vs.（10.8 ± 12.7） %,P =0.04