壁冠状动脉心肌桥与冠状动脉粥样硬化关系的临床研究  

The relationship between myocardial bridge in mural coronary artery segment and coronary atherosclerosis

作　　者：丁世军[1] 黄榕翀[1] 贾崇富[2] 钟雷[1] 安攀[2] 王兆谦[2] 朱皓[1] 武宝林[1] 周旭晨[1] 

机构地区：[1]大连医科大学附属第一医院心内科,116011 [2]大连医科大学附属第一医院心脏检查中心

出　　处：《中华心血管病杂志》2016年第10期873-878,共6页Chinese Journal of Cardiology

摘　　要：目的 应用64排双源螺旋CT冠状动脉成像技术分析心肌桥的发生率、心肌桥解剖性质以及心肌桥特征与动脉粥样硬化的关系.方法 研究为前瞻性非随机对照研究.连续入选2012年1月至2013年6月于大连医科大学附属第一医院三部心内科住院,因疑诊冠心病需行64排双源螺旋CT冠状动脉扫描检查的患者1 132例.记录入选患者的临床特征,包括性别、年龄、高血压病史、糖尿病病史、吸烟史、血清总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）水平等.心肌桥患者同时记录心肌桥长度、厚度、收缩期和舒张期压迫程度.采用Spearman检验、单因素回归分析、多因素logistic回归分析和线性回归分析分析心肌桥患者临床特征、心肌桥特征与冠状动脉粥样硬化之间的关系.结果 1 132例患者中发现心肌桥者330例,其中329例心肌桥位于壁冠状动脉,以左前降支中段为主,心肌桥平均长度20.1 m（3.3 -95.5 mm）,平均厚度2.13 mm（0.24- 12.40 mm）,表浅型心肌桥189（57.4％）,纵深型140例（42.6％）.单因素回归分析显示心肌桥是冠状动脉粥样硬化的保护性因素（OR =0.361,P=0.000）.相比心肌桥远端,心肌桥近端血管更易发生动脉粥样硬化（P=0.000）.多因素logistic回归分析结果显示,对于存在心肌桥的患者,年龄、高血压和桥-壁冠状动脉舒张期压迫程度是心肌桥近端动脉粥样硬化的危险因素（OR值分别为1.064、2.186、1.049,P值分别为0.000、0.002、0.000）.心肌桥厚度和桥-壁冠状动脉收缩期、舒张期压迫程度具有相关性（OR值分别为4.227、3.398,P值分别为0.000、0.001）.结论 壁冠状动脉心肌桥发生率29％,其近端更易发生动脉粥样硬化,且心肌桥厚度和舒张期压迫程度与动脉粥样硬化有关.Objective The myocardial bridging （MB） prevalence,anatomic characteristics of MB,and the relationship between characteristics of MB in mural coronary artery segment and coronary atherosclerosis were analyzed.Methods In this perspective nonrandomized controlled study,a total of 1 132 patients who admitted to our hospital for suspected or known coronary artery disease from January 2012 to June 2013 were enrolled.All patients underwent dual-source 64-slice spiral CT coronary angiography.The general patient characteristics including gender,age,history of hypertension,diabetes,hyperlipidemia and smoking,serum level of total cholesterol （TC） and LDL-C were recorded.The length,depth and the degree of compression of myocardial bridge in systolic or diastolic phase were also analyzed in patients with MB.The relationship between MB and coronary atherosclerosis,the characteristics of MB and coronary atherosclerosis were analyzed by Spearman correlation analysis,univariate logistic regression analysis,variate logistic regression analysis and linear regression analysis.Results Myocardial bridging was detected in 330 out of 1 132 patients,and MB was mostly located in the mural coronary artery （329/330） and at the mid-distal segment of the left anterior descending artery （LAD）.Average MB length was 20.1 mm （3.3-95.5 mm） and the average depth was 2.13 mm （0.24-12.40 mm）.There were 140 patients with intramyocardial MB （42.6%） and 189 patients with superficial MB （57.4%）.Myocardial bridging was an independent protective factor of coronary atherosclerosis （OR =0.361,P =0.000） and the proximal segment of MB was more susceptible to atherosclerosis compared to the distal segment of MB （P =0.000）.Multivariate analysis revealed that age,hypertension and the degree of compression of myocardial bridge in diastolic phase were independent factors related to the atherosclerosis （odds ratio：1.064,2.186 and 1.049 respectively,P value：0.000,0.002 and 0.000）.The depth of MB was significantly correl

关 键 词：冠状动脉疾病 心肌桥 体层摄影术 螺旋计算机 

分 类 号：R543[医药卫生—心血管疾病]