血管内超声评价运动试验阳性、冠状动脉造影正常患者的冠状动脉病变  

Evaluation of Coronary Artery Disease with Positive Exercise Test and Normal Coronary Angiography Using Intravascular Ultrasound

作　　者：魏静[1] 张明哲[2] 纪红[2] 刘传木[2] 

机构地区：[1]滨州医学院附属医院烟台分院心内科,山东烟台264100 [2]东营胜利油田中心医院心内科,山东东营257068

出　　处：《中国医学影像学杂志》2013年第7期530-533,共4页Chinese Journal of Medical Imaging

摘　　要：目的采用血管内超声(IVUS)评价运动试验(EET)阳性、冠状动脉造影(CAG)正常的拟诊为冠心病患者的冠状动脉病变。资料与方法 98例患者拟诊为冠心病,其中32例EET阳性、CAG正常,66例基本正常,全部患者均行IVUS检查。根据是否绝经将45例女性患者分为A1组(绝经前及绝经期,28例)和B1组(绝经后,17例);53例男性患者分为A2组(无危险因素,20例)和B2组(合并危险因素,33例)。分析心电图负荷试验阳性导联表现与冠状动脉病变程度的关系。结果①IVUS发现血管完全正常7例(7.1%),轻、中度病变68例(69.4%),冠心病23例(23.5%);EET阳性、CAG正常的32例患者IVUS结果显示粥样硬化斑块26处,其中不稳定斑块1处;EET阳性及CAG轻、中度病变不稳定斑块3例。②轻、中度冠状动脉病变患者存在1～2个危险因子60例(91.2%),冠心病患者存在典型心绞痛17例(73.9%);A1组发现冠心病0例,B1组发现冠心病6例(35.3%);A2组发现冠心病2例(10.0%),B2组发现冠心病15例(45.5%),A1组冠心病发病率显著低于B1组(χ2=2.936,P<0.05);A2组冠心病发病率显著低于B2组(χ2=1.986,P<0.05)。③心电图负荷试验阳性导联表现为Ⅱ、Ⅲ、avF及V4～6存在不同程度的血管病变68例(68/91,74.7%),表现为Ⅱ、Ⅲ、avFST-T改变存在冠状动脉病变的可能性小。结论 IVUS诊断冠状动脉病变优于CAG,IVUS可以进一步了解冠状动脉狭窄程度、斑块性质和特征;对于EET阳性而CAG正常或基本正常的患者,对冠状动脉病变程度的诊断应结合危险因子进行综合判断。Purpose To evaluate the coronary artery disease of coronary heart disease （CHD） patients with positive exercise test （EET） and normal coronary angiography （CAG） using intravascular ultrasound （IVUS）. Materials and Methods IVUS was performed in 98 patients with probable CHD, including 32 patients with positive exercise test and normal coronary angiography, 66 patients with normal exercise test and coronary angiography. Forty-five females were classified into two groups based on menstruation： group A 1 （premenopause and menopause, n=28） and group B1 （postmenopause, n=17）. Fifty-three males were classified into two groups based on cardiovascular risk factors： group A2 （no risk thctors, n=20） and group B2 （accompanied with risk factors, n=33）. The relationship between the positive lead of the electrocardiographic stress test and the extent of coronary artery lesions was analyzed. Results ①Coronary artery was normal in 7 cases （7.1%）, mild and moderate change in 68 cases （69.4%）, diagnosed as CHD in 23 cases （23.5%） using IVUS. Thirty-three cases with positive exercise test and normal coronary angiography showed 26 atherosclerotic plaques （1 instable plaque） using IVUS. Three cases showed positive EET and mild and moderate coronary artery change by CAG. ②Sixty cases （91.2%） with mild and moderate coronary artery change were revealed 1 to 2 risk factors. CHD with angina pectoris was demonstrated in 17 cases （73.9%）. CHD in AI group （0 cases） was obviously lower than that in BI group （6 case, 35.3%） （χ2=2.936, P〈0.05）, and A2 group （2 cases, 10.0%） significantly lower than B2 group （15 cases, 45.5%） （χ=1.986, P〈0.05）. ③Sixty-eight cases with positive Ⅱ, Ⅲ, avF and V4-6, lead by the electrocardiographic stress test showed different extent vascular lesions, and the possibility of CHD was smaller in the cases with ST-T changes on Ⅱ, Ⅲ, avF lead. Conclusion IVUS shows an advantage over coronary angiography in the diagnosi

关 键 词：超声检查 介入性 运动试验 冠状血管造影术 冠心病 

分 类 号：R543.3[医药卫生—心血管疾病] R445.1[医药卫生—内科学]