无创性冠状动脉血流显像检测冠状动脉血流储备在冠状动脉造影正常患者中的临床应用研究  

The clinical research of the measurement of coronary flow reserve by noninvasive coronary flow imaging in patients with angiographically normal coronary arteries

作　　者：杨娅[1] 李治安[1] 王丽君[1] 

机构地区：[1]首都医科大学附属北京安贞医院超声影像科,北京100029

出　　处：《临床超声医学杂志》2006年第3期139-143,共5页Journal of Clinical Ultrasound in Medicine

基　　金：北京市自然科学基金资助项目(7042023)

摘　　要：目的本研究旨在通过冠状动脉血流显像(CFI)结合腺苷负荷试验,无创性检测有胸闷、胸痛等临床症状但冠状动脉造影正常患者的冠状动脉血流储备功能,探讨冠状动脉血流显像无创性检测冠状动脉血流储备的可行性,以及这组病人的冠状动脉血流储备功能变化。方法选择冠状动脉造影正常者34例,其中高血压和/或高脂血症患者19例,设为病例组;另15例为正常对照组。采用冠状动脉血流显像测量基础及最大充血反应状态下冠状动脉左前降支远段的血流速度,计算冠状动脉血流速度储备(CFVR,冠状动脉最大充血反应状态与基础状态下的平均舒张期血流速度之比),分析比较病例组与正常对照组冠状动脉血流测值。结果34例患者均成功测量了CFVR。病例组左前降支CFVR明显低于正常对照组(2.86±0.40 vs 3.30±0.28,P<0.05),基础状态和最大充血反应状态时冠状动脉血流参数两组间的差异无统计学意义。结论冠状动脉血流显像结合腺苷负荷试验是一项安全、可行测量CFVR的方法;冠状动脉造影正常,但伴有胸闷、胸痛等临床症状的患者,存在冠状动脉血流储备功能的减低;高血压和高血脂症是导致CFVR减低的原因之一。Objective To validate the feasibility of the measurement of coronary flow velocity reserve （CFVR） by noninvasive coronary flow imaging （CFI） and to evaluate the CFVR in patients who had chest pain and angiographically normal coronary arteries by this method. Methods CFVR was measured in the distal left anterior descending artery （LAD） in 34 subjects with angiographicaUy norreal coronary arteries, including 19 patients with chest pain and 15 normal control subjects by CFI at baseline and hyperemic conditions （intravenous administration of adenosine 140 μg· kg^-1·min^-1 ）. CFVR was defined as the ratio of hyperemie to basal mean diastolic velocity. Coronary flow velocity and CFVR were studied in 19 patients and compared to 15 normal subjects.Results CFVR was successfully measured in 34 subjects. In 19 patients, CFVR of LAD was lower than control subjects （ 2.79 ± 0.43 vs 3.30 ± 0.28, P 〈 0.05）. There was no significant difference of coronary flow velocity both at baseline and hyperemic conditions in patients and normal control subjects. Conclusion Noninvasive CFI combined with adenosine stress experiment provides a reliable measurement of CFVR in the distal left anterior descending artery. CFVR is impaired in patients with ehest pain and angiographically normal coronary arteries. Hypertension and hyperlipidemia are the reasons of the reduction of CFVR.

关 键 词：冠状动脉血流显像 冠状动脉血流储备 冠状动脉造影术 

分 类 号：R544.1[医药卫生—心血管疾病] R541.404[医药卫生—内科学]