心肌桥Noble分级和发生位置与冠状动脉粥样硬化的关系  

Relationship between Noble grade and distribution of myocardial bridge and atherosclerosis

作　　者：杨栓锁[1] 汤磊[2] 陈晖[1] 仇兴标[1] 方唯一[1] 

机构地区：[1]上海交通大学胸科医院心内科,上海200030 [2]上海交通大学研究生院医学院分院,上海200025

出　　处：《上海交通大学学报（医学版）》2009年第8期967-970,974,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的探讨心肌桥Noble分级和发生位置与冠状动脉粥样硬化的关系。方法回顾性分析经冠状动脉造影检查出的192例心肌桥患者,结合临床症状以及心电图和心脏超声表现,分析心肌桥Noble分级和发生位置与冠状动脉粥样硬化的关系及药物治疗效果。结果心肌桥在冠状动脉造影的检出率为10.2%,最常发生在左前降支中段;Noble 3级患者均出现胸闷或胸痛症状,43.8%出现心电图缺血性ST-T改变,37.5%出现心脏超声室壁节段运动异常,Noble 1、2级患者不出现心电图缺血性ST-T改变和心脏超声室壁节段运动异常;心肌桥近端冠状动狭窄发生率显著高于壁冠状动脉及其远端冠状动脉(P<0.05);随着心肌桥分级的增高,心肌桥近端冠状动脉狭窄的发生率有增高的趋势(P<0.000 1);有症状的心肌桥患者β受体阻滞剂、钙离子拮抗剂、β受体阻滞剂联合钙离子拮抗剂使用率分别为80.0%、91.1%和62.2%,显著高于无症状者的11.4%、15.9%、4.5%(P<0.01)。结论冠状动脉心肌桥Noble 3级患者大多出现胸闷或胸痛症状;心肌桥近端较易发生冠状动脉粥样硬化;以β受体阻滞剂和钙离子拮抗剂治疗为主。Objective To study the relationship between Noble grade and distribution of myocardial bridge and atherosclerosis. Methods The clinical data of 192 patients with myocardial bridge diagnosed by coronary artery angiography were retrospectively analysed. The clinical symptoms, electrocardiographic and echocardiographic findings were analysed to explore the relationship between Noble grade and distribution of myocardial bridge and atherosclerosis, and the outcomes of medical treatment were also investigated. Results The positive rate of myocardial bridge detected by coronary artery angiography was 10.2%, which was usually observed in the middle part of left anterior descending coronary artery. All the patients with grade 3 of Noble grade experienced chest pain or palpitation, 43. 8% had ischemic ST-T changes on electrocardiogram, and 37.5% had abnormal segmental ventricular wall on echocardiography. However, patients with Noble grade 1 and 2 did not have ischemic ST-T changes on electrocardiogram or abnormal segmental ventricular wall on echocardiography. The prevalence of atherosclerosis in proximal coronary artery of myocardial bridge was significantly higher than those of mural coronary artery and distal coronary artery （P 〈 0.05）. Furthermore, the prevalence of atherosclerosis in proximal coronary artery had the tendency to increase with the grade of myocardial bridge （P 〈 0. 000 1）. For patients with myocardial bridge, those with presence of symptoms were more frequently treated with β-receptor blocker, calcium antagonist and β-receptor blocker ＋ calcium antagonist than those with absence of symptoms （80.0% vs 11.4%, 91.1% vs 15.9% and 62.2% vs 4.5%, respectively） （P 〈 0.01）. Conclusion The symptoms of chest pain or palpitation usually occurred in patients with grade 3 of myocardial bridge, while the proximal coronary artery of myocardial bridge is prone to atherosclerosis, and β-receptor blocker and calcium antagonist are predominant drugs in the treatment.

关 键 词：心肌桥 冠状动脉造影术 心电图 超声心动图 冠状动脉粥样硬化 

分 类 号：R541.1[医药卫生—心血管疾病]