血管内超声检测成年国人左前降支外弹力膜直径的变化  

Changes of extra-elastic membrane diameter of normal left anterior descending branch in Chinese adults measured by intravascular ultrasound

作　　者：王泉 黄河 吉港 欧阳繁 吴名星 谭国骄 蔡杰 蔡鑫宇 颜燕 宋婧 WANG Quan;HUANG He;JI Gang;OUYANG Fan;WU Ming-xing;TAN Guo-jiao;CAI Jie;CAI Xin-yu;YAN Yan;SONG Jing(Department of Cardiology,Xiangtan Central Hospital,Xiangtan 411100,China)

机构地区：[1]湘潭市中心医院心血管内科,411100 [2]南华大学研究生院 [3]株洲市中心医院

出　　处：《中国介入心脏病学杂志》2022年第5期359-365,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的使用血管内超声(I V U S)测量并分析成年中国人正常左前降支(LAD)的外弹力膜(EEM)直径大小、渐变率,进一步加深对冠状动脉解剖的认识,为介入手术策略选择、手术器械研发等提供数据支持。方法 入选2017年1月1日至2021年6月1日在湘潭市中心医院心导管室经L A D行I V U S检查后确定检测长度至少为9 0m m且斑块负荷<20%的患者105例。将LAD从开口起每隔5mm进行测量,测量长度为开口至90mm处止。测量统计的数据包括血管EEM直径、渐变率及对角支与LAD的EEM关系。结果 (1)LAD的EEM直径从开口处(4.04±0.46)mm,逐渐减小至90mm处的(2.29±0.15)mm,LAD血管呈逐渐变细的趋势。(2)LAD的平均渐变率为2.95%(男3.12%,女2.86%),距开口10~25mm处和30~50mm处渐变率较大,在距开口50~90mm处渐变率较小。(3)男性EEM直径均大于女性,除80mm、85mm、90mm处以外,性别间EEM直径差异均有统计学意义(均P <0.05)。(4)非右冠优势型的LAD的EEM直径大于右冠优势型的EEM直径,但组间差异无统计学意义(均P>0.05)。(5)优势对角支组在5~25mm和30~50mm处分布较多。优势对角支前后5mm的LAD的EEM直径差异有统计学意义[(3.39±0.43)mm比(3.15±0.41)mm,P<0.001],非优势对角支前后5mm的LAD的EEM直径差异有统计学意义[(3.23±0.48)mm比(3.06±0.47)mm,P<0.001]。分出优势对角支处的LAD渐变率比分出非优势对角支处的LAD渐变率大(6.51%比4.48%,P<0.001),差异有统计学意义。结论在IVUS检测下获得我国成人正常LAD血管EEM直径和渐变率的数据,了解到LAD整体上呈逐渐变细的态势,LAD血管在近中段EEM直径变化幅度较大,远段EEM直径变化幅度较小,男性LAD的EEM直径大于女性,LAD的EEM直径变化幅度受对角支大小的影响。Objective To measure and analyze the diameter and the average decremented ratio of extra-elastic membrane(EEM)diameter of normal left anterior descending branch(LAD)in Chinese adults by intravascular ultrasound(IVUS),so as to deepen the understanding of coronary artery anatomy and to provide data support for interventional strategy selection and instrument development. Methods From January 1, 2017 to June 1, 2021, 105 patients with a minimum length of 90 mm and plaque load<20% underwent LAD IVUS examination in the cath lab of Xiangtan Central Hospital were selected. The LAD was measured from the beginning to the end of 90 mm by every 5 mm. The measured data included vascular EEM diameter, the average decremented ratio and EEM relationship between the diagonal branches and LAD. Results(1) the EEM diameter of anterior descending branch decreased gradually from(4.04±0.46)mm at the opening to(2.29±0.15)mm at the 90 mm.(2) The average decremented ratio of anterior descending branch was 2.95%(male 3.12%, female 2.86%). The average decremented ratio was larger at 10-25 mm and 30-50 mm away from the opening, and smaller at 50-90 mm away from the opening.(3) Male EEM diameters were all larger than female EEM diameters, except for 80 mm, 85 mm and 90 mm, the differences of gender EEM diameters were statistically significant(all P<0.05).(4) The EEM diameter of anterior descending vessels of non-right coronary dominance type was larger than that of right coronary dominance type, but there was no significant difference between groups(all P>0.05).(5) The dominant diagonal branch is more distributed at 5-25 mm and 30-50 mm of the LAD. The EEM diameter between the two part of of LAD, 5 mm before and after the opening of the dominant diagonal branch which was statistically significant[(3.39±0.43)mm vs.(3.15±0.41)mm,P<0.001],also,5 mm before and after the opening of the non-dominant diagonal branch which was statistically significant[(3.23±0.48)mm vs.(3.06±0.47)mm,P<0.001]. The average decremented ratio of the anterior desce

关 键 词：血管内超声 冠状动脉 外弹力膜直径 对角支 

分 类 号：R541[医药卫生—心血管疾病]