52例冠状动脉心肌桥的临床分析

Clinical analysis of 52 patients with coronary myocardial bridge

目的探讨冠状动脉心肌桥的诊断及临床意义。方法回顾性分析1620例冠状动脉造影中检出的52例心肌桥病例的冠状动脉造影资料与临床特点,分析心肌桥与冠状动脉粥样硬化、心肌缺血及预后的关系。结果心肌桥检出率3.21%。肌桥前段血管动脉粥样硬化发生率为36.54%,远端血管动脉粥样硬化发生率为0,两者差异有统计学意义(P<0.05)。心肌桥Ⅱ、Ⅲ级狭窄组与Ⅰ级狭窄组相比,肌桥前段血管动脉粥样硬化发生率明显增加(58.62% vs 30.43%,P<0.05)。在孤立性心肌桥的患者中。肌桥Ⅱ、Ⅲ级狭窄组与Ⅰ级狭窄组相比较,平板运动试验阳性率、心绞痛发生率均明显增高(分别为66.68% vs 29.41%,P<0.05;60.00% vs 29.41%,P<0.05)。结论心肌桥有加促其前段血管发生粥样硬化病变的可能;心肌桥的狭窄程度越严重,引起心肌缺血越严重;对于有缺血症状的心肌桥患者应积极给予治疗。

Objective To evaluate the clinical diagnosis and significance of myocardial bridge. Methods The clinical manifestation and coronary angiography were retrospectively analyzed in 52 patients who were identified to have myocardial bridge. The relationship between myocardial bridge and coronary atherosclerosis, myocardial ischemia, prognosis were analyzed. Results The incidence of coronary myocardial bridge was 3.21%. The incidence of coronary atherosclerosis were 36.54% in proximal segment of myocardial bridge, and were 0 in distal segment of myocardial bridge patients, with significant difference between the groups （ P 〈 0.05 ）. The positive rate of coronary artery atherosclerosis was significantly different between the group of grade Ⅱ -Ⅲ stenosis and the group of grade Ⅰ stenosis（58.62 % vs 30.43% P 〈 0.05 ）. Among the patients with isolated myocardial bridge, the positive rate of the angina pectoris and the motor test were significantly different between the group of Ⅱ - Ⅲ grade systolic narrewing and the group of Ⅰ grade systolic narrowing （ 66.68% vs 29.41% P 〈 0.05 ;60.00% vs 29.41% P 〈 0.05 ）. Conclusion Myocardial bridge tends to promote or accelerate the atherosclerosis of proximal vessels;the more severe the extent of systolic diameter stenosis, the more severe the myocardial ischemia. The active treatment is necessary in ischemic cases.