左前降支长支起自右冠状动脉或右冠状窦的双前降支变异的CT血管成像解剖学特征分析  

CT angiography analysis of dual left anterior descending artery with origin of the long left anterior descending artery from right coronary sinus or right coronary artery

作　　者：刘晓龙 王小强[1] 孙占国[1] 邵凯 陈月芹[1] 李开华 王彦辉[1] 王培洁 Liu Xiaolong;Wang Xiaoqiang;Sun Zhanguo;Shao Kai;Chen Yueqin;Li Kaihua;Wang Yanhui;Wang Peijie(Department of Radiology,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院医学影像科,济宁272029

出　　处：《中华解剖与临床杂志》2023年第2期75-82,共8页Chinese Journal of Anatomy and Clinics

基　　金：济宁市重点研发计划项目(2021YXNS044,2022YXNS011);济宁医学院附属医院“苗圃”科研课题(MP-MS-2021-003)。

摘　　要：目的探讨左前降支(LAD)长支起自右冠状窦(RCS)/右冠状动脉(RCA)的双前降支变异的CT血管成像(CTA)影像解剖学特征及临床意义。方法横断面研究。纳入2015年1月—2022年1月在济宁医学院附属医院接受冠状动脉CTA(CCTA)检查的79617例患者中LAD长支起自RCS/RCA的双前降支变异的患者25例,其中男16例、女9例,年龄29~87(59.0±15.2)岁。根据LAD长支走行方式将患者分为肺动脉前型12例(pre-LAD组)和肺动脉下型13例(sub-LAD组)。另纳入30例CCTA检查无冠状动脉变异者作为对照组,其中男17例、女13例,年龄34~76(59.6±11.6)岁。观察指标:(1)测量和比较LAD短支及LAD长支全程长度、起始段管径的差异;比较pre-LAD组、sub-LAD组、对照组患者年龄、性别、LAD长度(全程、前室间沟前段)、管径(起始段、中段、远段)的差异。(2)比较pre-LAD组、sub-LAD组患者的LAD长支起源、对角支、间隔支及右圆锥支的差异。(3)评估pre-LAD组与sub-LAD组患者冠状动脉各分支有无斑块以及管腔有无狭窄,比较2组患者冠状动脉整体斑块发生率的差异,以及pre-LAD长支与sub-LAD长支、LAD长支与LAD短支斑块发生率的差异。结果LAD长支起自RCS/RCA变异的发生率为0.31‰(25/79617),其中0.20‰(16/79617)起自RCS、0.11‰(9/79617)起自距RCA开口10 mm范围内的RCA近段。(1)LAD长支、LAD短支的全程长度分别为(137.5±23.4)mm和(47.6±12.3)mm,差异有统计学意义(t=17.01,P<0.001);二者起始段管径的差异无统计学意义(P>0.05)。对照组、pre-LAD组、sub-LAD组患者的年龄及性别差异均无统计学意义(P值均>0.05);对照组LAD全程长度[(149.0±17.6)mm]大于sub-LAD组[(129.2±21.2)mm];pre-LAD组长支进入前室间沟前段长度[(90.8±15.7)mm]依次大于sub-LAD组[(48.1±8.4)mm]和对照组[(21.6±5.2)mm];对照组LAD起始段管径依次大于pre-LAD组和sub-LAD组;对照组LAD及pre-LAD组长支中段管径均大于sub-LAD组;对照组LAD及sub-LAD组长支远段Objective A study was conducted to investigate the CT angiography(CTA)anatomical features and clinical significance of the dual left anterior descending artery(LAD)anomaly with long LAD originating from the right coronary sinus(RCS)or right coronary artery(RCA).Methods A cross-sectional study was conducted.Data of 25 patients,namely,16 males and 9 females,aged 29-87 years old(mean,[59.0±15.2]years old)with dual LAD anomaly with long LAD originating from RCS or RCA,were retrospectively collected from among 79617 patients who underwent coronary CTA(CCTA)in the Affiliated Hospital of Jining Medical University from January 2015 to January 2022.According to the course of the long LAD,cases were divided into pre-pulmonic(pre-LAD groups,n=12)and sub-pulmonic(sub-LAD groups,n=13).Another 30 cases without coronary artery variants on CCTA examination were included as the control group.This control group included 17 males and 13 females,aged 34-76 years old(mean,[59.6±11.6]years old).Observation indexes were as follows:(1)to measure and compare the differences in the full length and the beginning segment diameter of the short and the long LADs and to compare the differences in age,sex,LAD length(full length and anterior segment of the anterior interventricular groove),and tube diameter(beginning,middle,and distal segments)in the pre-LAD,sub-LAD,and control groups;(2)The differences in long LAD origin,diagonal branch,septal branch,and right conal branch were compared between the pre-LAD and sub-LAD groups;and(3)to assess the presence of coronary plaque and luminal stenosis of pre-LAD and sub-LAD groups and to compare the differences in the overall coronary plaque incidence between patients in the two groups,the difference in plaque incidence between the pre-LAD and the sub-LAD,and between the long and the short LADs.Results The incidence of long LAD originating from the RCS/RCA variant was 0.31‰(25/79617),of which 0.20‰(16/79617)originated from the RCS,and 0.11‰(9/79617)originated from the proximal segment of RCA.(1)

关 键 词：冠状血管 左前降支 CT血管成像 解剖变异 容积再现 

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