管腔内密度衰减梯度评估合并心肌桥前降支与冠状动脉粥样硬化关系的研究  

Evaluating the relationship between myocardial bridge of the left anterior descending branch and atherosclerosis of coronary artery using transluminal attenuation gradient on CT

作　　者：刘翔宇 所世腾[1] 秦文彬 周炜[1] 沈佳璐 严佳军 张欣伟 姚晨旭 路青[1] Liu Xiangyu;Suo Shiteng;Qin Wenbin;Zhou Wei;Shen Jialu;Yan Jiajun;Zhang Xinwei;Yao Chenxu;Lu Qing(Department of Radiology,Affiliated Renji Hospital of Shanghai Jiaotong University,School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院放射科,200127

出　　处：《中华放射学杂志》2019年第6期453-458,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81271638,81371622);上海市科委浦江人才计划(15PJ1405200).

摘　　要：目的探讨管腔内对比度衰减梯度(TAG)评估合并心肌桥前降支与冠状动脉粥样硬化斑块形成的关系。方法回顾性分析2017年6月至2018年3月上海交通大学医学院附属仁济医院行冠状动脉CTA检查结果为前降支心肌桥的198例患者资料。患者均采用320排探测器CT行冠状动脉CTA检查。根据CTA上心肌桥表现将患者分为深埋型、浅表型心肌桥组,根据是否合并冠状动脉粥样硬化斑块,分为孤立性心肌桥组及心肌桥合并冠状动脉粥样硬化斑块组,记录肌桥厚度、肌桥长度、肌桥所在冠状动脉斑块体积、桥前TAG值、桥后TAG值及两者的K比值。采用独立样本t检验(正态分布)或Mann-WhitneyU检验(偏态分布)比较不同组间计量资料数据的差异,采用χ2检验比较不同组间计数资料的差异。采用Pearson相关性检验分析桥前TAG值、桥后TAG值、K比值、肌桥厚度、长度与斑块体积的相关性,并采用二元logistic回归分析上述指标对斑块发生的影响程度。采用ROC分析主要影响指标与斑块形成的关系。结果孤立性心肌桥99例,心肌桥合并冠状动脉粥样硬化斑块99例;心肌桥类型为浅表型27例,深埋型171例;粥样硬化斑块均发生于桥前,斑块平均体积(91.6±83.0)mm3。孤立性心肌桥组和心肌桥合并冠状动脉粥样硬化斑块组患者的性别构成、年龄、身高、体重和体重指数差异均无统计学意义(P均>0.05)。孤立性心肌桥组和心肌桥合并冠状动脉粥样硬化斑块组患者的桥前TAG值差异有统计学意义(P<0.05),而桥后TAG值和K比值差异无统计学意义(P均>0.05);浅表组与深埋组患者的桥前TAG值、桥后TAG值及K值差异均无统计学意义(P均>0.05)。斑块体积和桥前TAG值、桥后TAG值及K比值间存在弱负相关(r值分别为-0.205、-0.316、-0.339,P值均<0.05)。桥前TAG值显著影响斑块形成(P=0.014),优势比为0.884(95%可信区间为0.801~0.976),而其他因素与斑块形成�Objective To evaluate the relationship between concurrent myocardial bridge at anterior descending branch and the formation of coronary atherosclerosis plaques by using transluminal attenuation gradient (TAG). MethodsA total of 198 patients underwent coronary CTA in Renji Hospital of Shanghai Jiaotong University School of Medcine from June 2017 to March 2018 and the results showed the anterior descending myocardial bridge. The data were retrospectively analyzed. All patients completed the coronary CTA with 320-row detector CT. According to the manifestations of myocardial bridge on CTA,the patients were divided into deep and superficial myocardial bridge groups. According to whether the patients were complicated with coronary atherosclerotic plaques,they were divided into isolated myocardial bridge group and myocardial bridge with coronary atherosclerotic plaque group. The thickness and length of myocardial bridge,the volume of coronary atherosclerotic plaques at the site of myocardial bridge,the pre-bridge and post-bridge TAG values,and the K ratio were recorded. Independent sample t test (normal distribution) or Mann-Whitney U test (skewed distribution) was used to compare the difference of measurement data among different groups.χ2 test was used to compare the difference of enumeration data among different groups. Pearson correlation test was used to analyze the correlation among pre-bridge and post-bridge TAG values,K ratio,thickness and length of myocardial bridge and plaque volume. The influence of above indexes on plaque occurrence was analyzed by binary logistic regression analysis. The relationship between main influence indexes and plaque formation was analyzed by receiver operating characteristic curve (ROC). ResultsNinety nine patients had isolated myocardial bridge,99 with myocardial bridge and coronary atherosclerotic plaques,27 with superficial myocardial bridge and 171 with deep myocardial bridge. All atherosclerotic plaques occurred in pre-bridge and the mean volume of plaques was (91.6±83.0)mm

关 键 词：冠状血管 体层摄影术 X线计算机 管腔内对比度衰减梯度 心肌桥 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]