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目的:探讨壁冠状动脉(MCA)于舒张中、晚期的显示规律,并分析壁冠状动脉于舒张中、晚期的狭窄程度与载心肌桥厚度以及动脉粥样硬化的发生等的相关关系。方法:对754例临床疑似冠心病患者进行冠状动脉CT成像,在独立工作站上进行多平面重组(MPR,包括CPR),观察冠状动脉与心肌的空间关系,确认完全性心肌桥。按照MB近、远端血管形态可分为两组:平滑弧形组和迂曲成角组。并按MB的厚度是否大于2 mm进行分组,在重组成像中测量壁冠状动脉的狭窄程度,并进行两组间t检验。按MCA近端有无斑块形成分为斑块组和无斑块组,对MCA狭窄程度分别作两组间独立样本t检验。对斑块组和非斑块组成角迂曲的发生概率作χ2检验。分析81 MCA患者静态心电图、心绞痛以及迂曲成角发生率与心肌桥厚度以及MCA近端有无斑块之间的相关性。结果:在总计754例受检者中发现完全性心肌桥81例。心肌桥较厚(>2 mm)时,舒张期MCA狭窄程度较走行正常者严重,两组间t检验结果有显著统计学差异(P<0.05)。斑块组舒张期MCA狭窄程度较无斑块组重,两组间t检验结果有显著统计学差异(P<0.05)。斑块组和非斑块组成角迂曲的发生概率作四格表χ2检验有显著统计学差异(P<0.05)。对81例受检者分析其静态心电图,迂曲成角组静态心电图ST-T段改变以及心绞痛发生的比率明显高于正常组(P<0.05)。结论:心肌桥可能与动脉粥样硬化病变的发展相关。舒张期MCA狭窄程度与MB厚度以及近端有无粥样硬化斑块有关,>2 mm组舒张期狭窄程度大于≤2 mm组,近端有斑块组舒张期狭窄程度大于无斑块组。MCA近端有斑块时,动脉粥样硬化更易发生成角迂曲,且迂曲成角组受检者静态心电图ST-T段改变以及心绞痛发生率均高于平滑弧形组。
OBJECTIVE: To investigate the pattern of middle and late stages of coronary artery wall (MCA) in diastole, and to analyze the correlation between the severity of diastolic middle and late coronary artery wall stenosis, the thickness of myocardial bridge and the occurrence of atherosclerosis. Methods: CT coronary angiography was performed in 754 patients with clinically suspected coronary artery disease. Multiplanar reconstruction (MPR, including CPR) was performed on an independent workstation. The spatial relationship between coronary artery and myocardium was observed to confirm the complete myocardial bridge. According to MB, distal vascular morphology can be divided into two groups: smooth arc group and tortuous angulation group. According to whether the thickness of MB was greater than 2 mm, the degree of stenosis of the wall coronary arteries was measured in the reconstructed images and the t-test was performed between the two groups. According to MCA proximal plaque formation is divided into plaque group and no plaque group, the degree of MCA stenosis were independent samples between the two groups t test. The plaque group and non-plaque formation tortuosity occurrence probability χ2 test. Analysis of 81 MCA patients with static electrocardiogram, angina and tortuous angulation and myocardial bridge thickness and the presence or absence of MCA proximal plaque correlation. Results: In a total of 754 subjects found in 81 cases of complete myocardial bridge. When the myocardial bridge was thicker (> 2 mm), the stenosis of diastolic MCA was more serious than that of the normal one. There was a significant difference between the two groups in t test (P <0.05). The degree of diastolic MCA stenosis in plaque group was significantly higher than that in non - plaque group, and there was a significant difference between the two groups in t test (P <0.05). Plaque group and non-plaque formation angle tortuosity probability for the four grid table χ2 test was significantly different (P <0.05). The static electrocardiogram was analyzed in 81 subjects, and the ratio of ST-T segment change and angina pectoris in tortuous angulation group was significantly higher than that in normal group (P <0.05). Conclusion: Myocardial bridge may be related to the development of atherosclerotic lesions. The degree of diastolic MCA stenosis was related to the thickness of MB and the presence or absence of atherosclerotic plaque in the proximal part. The diastolic stenosis of> 2 mm group was greater than that of ≤ 2 mm group. The degree of diastolic stenosis in the proximal plaque group was higher than that in the non - plaque group. Aortic atherosclerosis was more prone to angulation during plaque in the proximal MCA, and ST-T segment changes and angina pectoris were higher in the tortuous angulation group than in the smooth arc group.