家族性高胆固醇血症患者的冠状动脉血流储备分析  

Assessment of coronary flow velocity reserve in patients with familial hypercholesterolemia

作　　者：杨娅[1] 李治安[1] 王艳红[1] 蔺洁[2] 王绿娅[2] 

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 [2]北京市心肺血管疾病研究所动脉粥样硬化研究室

出　　处：《中华超声影像学杂志》2007年第11期944-947,共4页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金（30470722）;北京市自然科学基金（7032012、7042023、7052021和7062010）;北京市科技新星项目（04827）;北京市留学人员科技活动择优资助项目

摘　　要：目的采用彩色多普勒冠状动脉血流显像测量家族性高胆固醇血症患者（FH）的冠状动脉血流,评价其冠状动脉血流储备（CFVR）功能。方法FH患者20例,血清总胆固醇（TC）为（14.52±3.52）mmol/L,低密度脂蛋白胆固醇（LDL-C）为（11.41±3.57）mmol/L。18例皮肤有黄色瘤。选取血脂、冠状动脉造影正常者10例作为对照组。利用彩色多普勒探测冠状动脉前降支（LAD）远端的血流,然后用脉冲多普勒探测静息状态LAD的血流频谱。经静脉注射140μg.kg-1.min-1腺苷,持续3min并记录血流频谱。结果经静脉注入腺苷后,FH组和对照组心率加快,血压减低,部分有副反应。FH患者LAD远端基础状态和最大充血反应状态舒张期平均血流速度均高于对照组,但差异无统计学意义。FH患者CFVR（2.30±0.85）较对照组（3.12±0.22）明显减低（P=0.005）,其中仅4例CFVR〉3.0,5例CFVR2.0～3.0,11例CFVR≤2.0。FH患者血清TC与CFVR呈负相关性,相关系数为-0.45。结论彩色多普勒冠状动脉血流显像是一项有效评价冠状动脉血流动力学的方法,FH患者的冠状动脉血流储备功能明显减低。Objective To evaluate the coronary flow velocity reserve（CFVR）of patients with familial hypercholesterolemia（FH）by transthoracic coronary flow imaging system.Methods A total of 20 patients（8 men and 12 women,age 5～33 years,mean age 16 years）with FH were enrolled;total serum cholesterol（TC）and serum low density lipoprotein cholesterol（LDL-C）were（14.52±3.52）mmol/L and（11.41±3.57）mmol/L respectively.Eighteen cases had cutaneous xanthomas.And 10 subjects with normal serum lipids and coronary artery angiogram were selected as control group.Coronary artery flow of distal left anterior descending coronary artery（LAD）was acquired with color Doppler flow imaging using Vivid 7 systems,then the flow velocity of LAD was measured with pulsed wave Doppler both at baseline and 3 minutes after intravenous adenosine infusion of 140 μg·kg-1·min-1.Results All of FH group and control group had increasing heart rate and decreasing blood pressure after intravenous adenosine infusion,some had side effects.Though mean diastolic velocity（MDV）of distal LAD in FH group was higher than control group both in baseline and maximal hyperemia,there was no statistical difference between two groups.CFVR of FH group was lower than control group significantly（2.30±0.85 vs 3.12±0.22,P=0.005）.CFVR was more than 3.0 only in 4 cases,CFVR was 2.0～3.0 in 5 cases and lower than 2.0 in 11 cases.And the TC and LDL-C of FH group were inversely correlated with CFVR（r=-0.45 and r=-0.40,respectively）.Conclusions Coronary flow imaging is an effective technique to measure coronary hemodynamics,the CFVR were decreased significantly in patients with FH.

关 键 词：超声心动描记术 高胆固醇血症 家族性 冠状血管 血液动力学现象 

分 类 号：R686[医药卫生—骨科学]