冠状动脉造影及冠心病相关危险因素分析

Coronary angiograpby and the relatively risky factor analysis of coronary atherosclerotic heart disease

目的分析242例冠状动脉造影(CAG)形态特点及冠心病相关危险因素,为冠心病诊断、治疗及预防提供依据。方法用回顾性调查方法分析CAG病例年龄、性别、发病情况、冠状动脉(冠脉)病变特点及可能发病易患因素。结果242例中冠脉异常164例(占68%),包括:冠心病151例(62·40%)、心肌桥14例(5·79%)、冠脉畸形4例(1·65%),正常冠脉78例(32%)。151例冠心病共有271支冠脉受累(平均每例1·8支),病变血管依次为左前降支115支、右冠77支、左回旋支74支、左主干5支;冠心病心电图正常13例(8·61%),ST-T改变100例(66·23%),仅心律失常(房早、室早、房颤、传导阻滞等)38例(25·17%);心肌桥平均年龄60·36岁±13·40岁,男女差别不大,较少合并高血压病、糖尿病;心悸胸闷待诊68例中冠心病20例(29·41%),心律失常待诊33例中冠心病15例(45·45%);冠心病合并急慢性炎症83例(慢性炎症69例、急性炎症14例),占冠心病总数54·97%,合并慢性炎症种类越多则冠心病患病率越高,但合并慢性炎症检出率(61·06%)与未合并慢性炎症冠心病检出率(62·79%)无明显区别,而合并急性炎症19例中检出冠心病14例(73·68%),检出率较高。结论冠心病最常累及左前降支,其次是右冠、左回旋支和左主干。临床症状结合心电图ST-T改变及心律失常可检出大多数冠心病,CAG有助区分冠心病、冠脉畸形及心肌桥。慢性炎症可能与冠心病发生有关,尤其合并多种慢性炎症时,合并急性炎症病例易诱发急性冠脉事件发生,提示及时处理急慢性炎症可减少冠脉疾病及急性冠脉事件发生。

Objective To analyse the characterstic shape on 242 cases coronary angiography and the relatively risky factor of the coronary atherosclerotic heart disease （CAHD） , in order to provide bases for the diagnosis, therapy and prevention of CAHD. Methods To analyse age,sex,the occurring condition of disease,the coronary pathological characteristic and the vulnerable factor through the retrospective survey. Results There were 164 cases with abnormal coronary,including 151 cases were CAHD （62.40%）, 14 cases myocardial bridge （5.79%） and 4 cases coronary deformity （ 1.65% ） ,normal coronary artery was 78 cases（ 32% ）. 271 coronary arteries were involved in 151 cases with CAHD（ average 1.8 branch every patiene）,the involved vessels included LAD 115 RA 77, LCX 74 and LM 5 respeetively. The ECG was normal in 13 cases （ 8. 61% ） , 100 cases （66.23%） with ST-T change and 38 cases （ 25. 17 % ） with the only arrhythmia （atrial or ventricular extrasystole,atrial fibrillation, block ）. In the patients with myocardial bridge, the average age was （60. 36 ± 13. 40 years old） and little difference in sex.hypertension and diabetes were less commonly seen in them, There were 20 patients（ 29. 41% ） with CAHD in 68 cases of palpitation and chest depress who needed to diagnose and among 33 cases of arrhythmia 15 cases（45.45% ） were CAHD. 83 cases of CAHD,in association with acute or choric inflammation （choric inflammation 69 cases and acute inflammation 14 cases） ,were 54. 97%. Ahhongh the patients of CAHD tended to combine multiple inflammation,they were no difference between the detectable rate of chronic inflammation （61.06%） or without chronic inflammation（62.79% ）. However there were high detectable ratio in the patient with the acute inflammation （finding 14 cases in 19 cases,account for 73.68% ）. Conclusion The LAD was the easiest to be involved and the involved coronary artery in turn was RA, LCX and LM. The most CAHD minght be found through clinical symptoms, ECG ST-T change and arrhythmia. CAG could help to distinguish CAHD, coronary deformity or myocardial bridge. The chronic inflammation might be correlation with CAHD, especially with multiplicate chronic inflammation. It has showed that the acute coronary event conld be induced by acute inflammation or by treatment of the acute inflammation which was delayed.