急性冠状动脉综合征伴缺血性J波冠状动脉病变特点分析

Coronary characteristics of acute coronary syndrome with ischemic J wave

目的 探讨急性冠状动脉综合征（ACS）伴缺血性J波患者冠状动脉病变特点.方法 将60例动态心电图发现缺血性J波的ACS患者（缺血性J波组）和60例动态心电图没有发现缺血性J波的ACS患者（非缺血性J波组）行冠状动脉造影检查,依据Genisini评分积分法判断狭窄的程度,将冠状动脉积分分为0分,1~80分,81～160分三个等级 依据Ambrose分法将斑块形态分为Ⅰ、Ⅱ、Ⅲ型.观察ACS伴缺血性J波患者冠状动脉病变特点以及斑块特点.结果 2组患者冠状动脉狭窄程度（U=3.0686,P=0.0022）、冠状动脉斑块类型的分布（x2=16.0890,P=0.0003）,以及冠状动脉血管病变支教的分布差异有统计学意义（x2=12.1045,P=0.0024） 缺血性J渡与冠状动脉狭窄程度、冠状动脉斑块类型、冠状动脉病变支数均有相关性（r=0.44,0.34,0.31 P均〈0.05）.结论 ACS伴缺血性J波患者冠状动脉狭窄程度重,多支血管病变发病率高,存在不稳定斑块的概率高,缺血性J波可作为心肌缺血超急性期的缺血改变的预测指标.

Objective To understand the coronary characteristic of acute coronary syndrome patients with ischemic J wave. Methods Comparison was made between 60 acute coronary syndrome patients with ischemic J wave and 60 acute coronary syndrome patients without ischemic J wave. All patients were examined by Holter monitoring electrocardiogram and coronary arteriongraphy. To distinguish the stenosis degree was defined in three degree based on Genisini score of 0, 1-80, and 81-160. Plaque types were divided into Ⅰ,Ⅱ, Ⅲ by Ambrose classification,the coronary and plaque characteristics of acute coronary patients were observed with ischemic J wave. Results There were no significant difference of stenosis degree between the two groups （ U = 3. 0686, P = 0. 0022）, whereas there were significant difference of plaque types （x2 =16. 0890, P = 0. 0003） and coronary vessel numbers（x2 =12. 1045, P = 0. 0024）. The degree of stenosis, the plaque types, and number of stent in coronary vessel were positively correlated with ischemic J wave（r =0. 44,0. 34,0. 31 P 〈0. 05）. Conclusions The acute coronary syndrome with ischemic J wave patients is often not only accompanied with serious coronary stenosis and high incidence rate of multivessel disease,but also high probability of unstabilized plaque. Ischemic J wave can be a predictor of super-acute ischemic of myocardium.