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目的：通过对冠心病患者行64排螺旋 CT 检查和同型半胱氨酸（Hcy）水平检测，探讨其对冠状动脉斑块稳定性的预测价值。方法选择拟诊为冠心病的患者83例为研究对象，所有患者均行冠状动脉 CT 和冠状动脉造影检查，冠状动脉 CT 未见粥样硬化者纳入对照组，其余患者根据冠状动脉造影结果及病史分为急性冠状动脉综合症组，稳定型心绞痛组，再根据冠状动脉 CT 检查结果，分为易损斑块组，混合斑块组、稳定斑块组，所有患者均行血清Hcy 检测。结果易损斑块在 ACS 组的分布高于 SAP 组（P ﹤0.05），稳定斑块在 SAP 组的分布高于 ACS 组（P ﹤0.05）。ACS 组和 SAP 组 Hcy 水平均高于对照组（ P ﹤0.05），ACS 组 Hcy 水平高于 SAP 组（P ﹤0.05）。易损斑块组、混合斑块组、稳定斑块组 Hcy 水平均高于对照组（P ﹤0.05），且易损斑块组 Hcy 水平﹥混合斑块组﹥稳定斑块组，差异均有统计学意义（P ﹤0.05）。结论 Hcy 结合冠状动脉 CT 对冠状动脉斑块的不稳定性有预测价值。“,”Objective Doubtful or diagnosed coronary heart disease patients were conducted with 64-multislice spiral computed tomography,at the same time,homocysteine(Hcy)were determined. To investigate the value of 64-MSCT combined with Hcy for estimating the stability of coronary artery plaques of patients with coronary heart disease. Methods 83 in-hospital doubtful or diagnosed coronary heart disease patients admitted to our hospital were enrolled. All patients conducted with CT tomography and coronary angiography( CAG),the result of CT tomography of who were negative,were divided into control group,According to the results of CAG and medical history,the others were divided into acute coronary syndrome( ACS) group,stable angina pectoris(SAP)group. According to the results of coronary artery plaques detected by MSCT,both ACS and SAP groups were further divided into vulnerable plaque group,mixed plaque group and stable plaque group. The levels of serum homocysteine(Hcy)were measured. Results The distribution of vulnerable plaques in ACS group was higher than that in SAP group(P ﹤ 0. 05),while that of stable plaques lower than in SAP group(P ﹤ 0. 05). The levels of homocysteine in SAP and ACS group were higher than those in control group(P ﹤ 0. 05),and there was significant difference betwween SAP and ACS groups(P ﹤ 0. 05). The levels of homocysteine in every plaque group were all obviously higher than those in the control group(P ﹤ 0. 05),and those in vulnerable and mixed plaque group were also higher than those in stable plaque group(P ﹤0. 05). The levels of homocysteine in vulnerable plaque group were higher than those in mixed plaque group(P ﹤0. 05). Conclu-sion The detection of 64-MSCT combined with homocysteine(Hcy)had predictive value of unstable coronary artery plaques.