负荷心肌超声造影测定冠状动脉血流储备的临床应用  

Clinical application of stress myocardial contrast echocardiography in the determination of coronary flow reserve

作　　者：刘佳楠 孙宇佳 安换换 方小梅 陈丽娜[1] 相菲 韩薇[1] LIU Jia-nan;SUN Yu-jia;AN Huan-huan;FANG Xiao-mei;CHEN Li-nan;XIANG Fei;HAN Wei(The First Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第--医院,黑龙江哈尔滨150000

出　　处：《中国临床医学影像杂志》2020年第3期180-183,187,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨负荷心肌超声造影测定冠状动脉血流储备(Coronary flow reserve,CFR)的无创方法,并将其应用于评价冠状动脉微循环功能障碍(Coronary microcirculation dysfunction,CMD)。方法:人选161例因胸痛住院的非阻塞性冠状动脉疾病患者,所有患者均进行三磷酸腺苷负荷心肌造影,用QLab定量分析静息和负荷后平台期信号强度(A)和信号强度增加率(β)。心肌血流量(Myocardial blood flow,MBF)用A×β表示,CFR=MBF负荷/MBF静息。CMD定义为CFR<2.0。用Logistie多元回归分析筛选CMD的影响因素。结果:在非阻塞性胸痛患者中CMD发生率为51.6%;与冠状动脉微循环功能正常者相比,CMD中糖尿病高脂血症和E/e'>15比例明显增加,Logistic多元回归分析显示,E/e'>15是CMD发生的独立危险因素。结论:负荷心肌超声造影是测定CFR的有效无创方法;在非阻塞性胸痛患者中CMD发病率高,且与左室舒张末压升高有关。Objective:To explore a non-invasive method for the determination of coronary flow reserve(CFR)by stress myocardial contrast echocardiography(MCE)and its application in evaluating coronary microcireulation dysfunction(CMD).Methods:A total of 161 patients with non-obstructive coronary artery disease hospitalized due to chest pain were enrolled.All patients underwent adenosine triphosphate(ATP)stress MCE,and QLab was used to quantitatively analyze the myocardial plateau signal intensity(A)and signal intensity exchange rate(B)at rest and post--stress.Myocardial blood flow(MBF)is ex-pressed as Axβ,and CFR equals stress MBF divided by rest MBF.CMD is defined as CFR<2.0.Multivariate Logistic regres-sion analysis was used to screen the influencing factors of CMD.Results:The inceidence of CMD in patients with non-ob-structive chest pain was 51.6%.Compared with the normal group,the incidence of diabetes,hyperlipidemia and the proportion of E/e'>15 in CMD was significantly increased.Multivariate Logistic regression analysis showed that E/e'>15 was an indepen-dent risk factor for CMD.Conclusion:MCE is an effective noninvasive method for the determination of CFR.The incidence of CMD in patients with non-obstructive chest pain was 51.6%.It was also associated with inereased left ventricular end-di-astolic pressure.

关 键 词：冠状动脉疾病 超声心动描记术 

分 类 号：R543.3[医药卫生—心血管疾病] R540.45[医药卫生—内科学]