冠状动脉钙化积分在冠心病临床价值中的 研究进展

Research Progress on the Clinical Value of Coronary Artery Calcium Score in Coronary Heart Disease

摘要: 冠状动脉钙化积分(Coronary Artery Calcium Score, CACS)作为反映冠状动脉粥样硬化负荷的重要影像学生YXNS标志物，在冠心病的早期识别、风险分层及预后评估中具有重要临床价值。本文系统梳理了CACS在冠心病临床价值方面的研究进展。技术层面，传统心电门控CT存在辐射剂量高、需专门扫描等局限，而非门控CT联合人工智能的应用使CACS可融入常规胸部CT筛查，显著提升了检查效率，但不同重建时相及算法的影响仍需标准化。本文评述了不同AI算法在钙化分割中的性能差异，并指出了当前研究在设计上的常见局限。机制层面，CACS不仅与传统危险因素(年龄、血脂、血糖等)显著正相关，还与炎症因子(hs-CRP、IL-6等)水平中度相关，揭示了钙化负荷与炎症状态的内在联系。预后层面，CACS是主要不良心血管事件的独立预测因子，但其预测价值在不同人群中呈现差异化特征：无症状老年人中CACS分级与风险密切相关；而青年患者中传统危险因素作用更为突出。本文新增了CACS临床应用的争议讨论。尽管研究取得显著进展，但仍存在方法学标准不统一、钙化形态与分布关注不足、特殊人群分层模型缺乏大规模验证等局限。未来研究需在标准化测量基础上，结合钙化形态学特征与多维度生物标志物，构建精细化风险预测模型，并加强特殊人群的前瞻性多中心验证。

Abstract: As an important imaging biomarker reflecting the burden of coronary atherosclerosis, the Coronary Artery Calcium Score (CACS) holds significant clinical value in the early identification, risk stratification, and prognosis assessment of coronary heart disease. This article systematically reviews the research progress on the clinical value of CACS in coronary heart disease. At the technical level, traditional electrocardiogram-gated CT has limitations such as high radiation dose and the need for dedicated scanning, whereas the application of non-gated CT combined with artificial intelligence enables the integration of CACS into routine chest CT screening, significantly improving examination efficiency; however, the impact of different reconstruction phases and algorithms requires standardization. This review evaluates the performance differences of various AI algorithms in calcium segmentation and identifies common design limitations in current studies. At the mechanistic level, CACS not only shows a significant positive correlation with traditional risk factors (such as age, blood lipids, and blood glucose) but also demonstrates a moderate correlation with inflammatory markers (such as hs-CRP and IL-6), revealing the intrinsic relationship between calcification burden and inflammatory status. Regarding prognostic prediction, CACS is an independent predictor of major adverse cardiovascular events, yet its predictive value exhibits differential characteristics across populations: in asymptomatic older adults, CACS grading is closely associated with risk, whereas in young patients, traditional risk factors play a more prominent role. This article additionally discusses controversies in the clinical application of CACS. Despite significant progress, limitations remain, including a lack of standardized methodological approaches, insufficient attention to calcification morphology and distribution, and the absence of largescale validation of risk stratification models in special populations. Future research should focus on standardized measurement, integrate calcification morphological features with multidimensional biomarkers to construct refined risk prediction models, and strengthen prospective, multicenter validation in special populations.