心肌桥临床诊疗分析

Analysis of the clinical diagnosis and treatment of myocardial bridge

目的探讨心肌桥(myocardial bridge,MB)的临床诊疗策略。方法应用双源CT(double source CT,DSCT)对有心绞痛及类似症状的可疑冠心病患者行冠状动脉血管成像,其中部分病人同时行选择性冠脉造影(selective coronary arteriography,SCA)。按年龄分3组,分析MB的检出率、MB壁冠状动脉粥样硬化斑块的发生率、壁冠状动脉粥样硬化斑块的性质及各年龄组的差别。结果478例患者行DSCT检查,检出MB 96例,检出率20.1%。共检出MB 107个,合并粥样硬化斑块59个,其中近段粥样硬化斑块48个(81.4%)。59例患者行SCA检查,检出MB 5例,检出率8.5%。青年组、中年组与老年组比较MB近段冠脉斑块性质明显不同,差异有统计学意义(P<0.01)。结论DSCT对MB及其近段冠脉病变的诊断有较高敏感性。MB近段冠脉粥样斑块的发生与年龄增长相关。青年组、中年组与老年组比较MB近段冠脉粥样硬化斑块性质有所不同。

Objective To explore the strategy of clinical diagnosis and treatment of myocardial bridge （ MB ）.Methods Patients with angina or similar symptoms underwent coronary angiography by using double source CT（ DSCT）, and some patients among them underwent traditional selective coronary arteriography （SCA） simultaneously. All patients were divided into three groups according to age. The detection rate of MB, coronary atherosclerosis incidence in intramural coronary artery and the character of plaque of the three groups were analyzed. Results There were 96 （20. 1% ） patients who were found to have MB by using DSCT. The total number of MB cases was 107, and 59 of them had coronary atherosclerosis plaques, among which 48 （81.4%） located proximally. There were 59 patients undergoing traditional SCA simultaneously, and 5 （8.5%） were found to have MB. Conclusions DSCT has superior sensitivity in diagnosing MB and proximal coronary diseases. The incidence of proximal coronary atherosclerosis is associated with aging. The properties of proximal coronary plagues in younger,middle age-groups and older age-groups are different.