不同性别患者负荷心电图缺血改变与心肌血供及冠状动脉病变的关系  

The relationship between myocardial blood supply and coronary artery stenosis in different gender patients with ischemia change in stress electrocardialgram

作　　者：焦建[1] 王蒨[1] 米宏志[1] 董薇[1] 陆遥[1] 柏江[1] 张烨虹[1] 李珺奇[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所核医学科,100029

出　　处：《心肺血管病杂志》2014年第5期695-698,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都医学发展科研基金(20073089);首都医科大学附属北京安贞医院院长科技发展基金(2010C01)

摘　　要：目的:探讨腺苷负荷试验心电图(ECG)呈缺血性改变患者中,其性别间差异与冠状动脉病变及心肌血供受损之间的相互关系及临床意义。方法:回顾性分析2008年5月至2012年11月,本院疑诊冠心病行腺苷负荷/静息心肌灌注显像(MPI)的7 826例患者的资料,以腺苷负荷试验中ECG呈缺血改变的104例患者为研究对象,男性:女性为24:80,平均年龄(58.76±9.97)岁,其中62例患者在1个月内行冠状动脉造影检查(CAG)。结果:104例患者腺苷负荷试验ECG出现ST段水平或下斜型下移≥0.1mV,随后的MPI显示:阳性66例(男性18例),阴性38例(男性32例,P=0.181)。MPI阳性的患者中有33例(男性14例)同期施行了CAG,结果提示:仅1例女性患者冠状动脉呈粥样硬化性改变,但无明显狭窄性病变;另32例(97.0%)均有至少1支冠状动脉狭窄≥50%病变(男性100%,女性94.7%,P=0.576)。MPI阴性的患者中有29例(男性4例)行CAG,结果提示:男性2例(50%)、女性24例(96%)冠状动脉正常或病变<50%,余下2例男性(50%)和1例女性(4%)为3支冠状动脉窄性病变程度均≥50%(P=0.042)。结论:腺苷负荷ECG呈缺血性改变时,MPI阳性或阴性的发生率与性别无明显相关;冠状动脉有严重狭窄性病变且MPI阳性的发生率亦与性别无明显相关;但MPI阴性提示无心肌缺血,而存在严重冠状动脉狭窄性病变的男性明显高于女性。因此对此类男性患者进行临床诊断和评价时要特别慎重,必要时行冠状动脉造影检查。Objective：Investigating the interrelation and clinical value between coronary artery stenosis and myocardial blood supply in different gender patients with ischemia change in adenosine stress electrocardialgram. Methods： Analyzing 7 826 patients data retrospectively with adenosine stress /rest myocardial perfusion imaging（ MPI） imaging from May. 2008 to November. 2012 because of suspecting CAD including 104 patients with ischemia change in ECG during adenosine stress test. As the research objects,in these patients male /female= 24 /80,mean age（ 58. 76 ± 9. 97）,including 62 petients underwent coronary artery angiography（ CAG） in one month. Results： The ST segment horizontally or inclined moved down ≥0. 1mv in adenosine stress test ECG comparing rest ECG in 104 patients,and the subsequent MPI showed： 66 positive（ male /female = 18 /48）,38negtive（ male /female = 6 /32,P = 0. 181）. 33 positive patients in MPI（ male /female = 14 /19） undergone CAG with showing ： there was no obvious coronary artery stenosis in only 1 female patient,and other 32（ 97. 0%,32 /33） ones got more than one coronary artery stenosis with the extent ≥50%（ male 14 /14 = 100%,female 18 /19= 94. 7%,P = 0. 576）. 29 negtive patients（ male /female = 4 /25） undergone CAG with showing ： there was no obvious coronary artery stenosis in 2 male（ 50%,2 /4） and 24 female patients（ 96%,24 /25）,other 2 male（ 50%,2/4） and 1 female（ 4%,1/25） patients got three-vessel coronary artery disease with the extent ≥50%（ P =0.042）. Conclusion： In the patients with ischemia change in adenosine stress electrocardialgram,there is no relevance in the incidence rate of positive and negative in MPI with gender,and so as the incidence rate between the positive in MPI and serious coronary artery stenosis. But in negative MPI patients,the incidence rate of serious coronary artery stenosis in the male is obviously higher than the female,which reminds us to take more care of such male patients for clinica

关 键 词：腺苷负荷试验 心肌灌注显像 冠状动脉造影 心电图 

分 类 号：R54[医药卫生—心血管疾病]