冠脉心肌桥患者流行病学特征及其冠脉血管压迫程度与疗效的关系

The epidemiologic feature of the patients with coronary myocardial bridge and relation of the therapeutic effect combined with the oppressed degree of coronary

目的：探索冠脉心肌桥发病流行病学特征,并根据冠脉血管压迫程度观察美托洛尔和地尔硫卓对临床心功能改善情况.方法：通过冠脉造影检查以确诊冠脉心肌桥;并根据冠脉心肌桥压迫血管程度将单纯性左前降支冠脉心肌桥分为〈70%组和≥70%组,在各组随机应用地尔硫卓、美托洛尔.按照美国纽约心脏病学会（New York heart association,NYHA）,将临床心功能积分：0级=0、Ⅰ级=1、Ⅱ级=2、Ⅲ级=3、Ⅳ级=4.观察美托洛尔和地尔硫卓对各组临床心功能积分的影响.结果：851患者例冠状动脉造影检查,发现142例为冠脉心肌桥病例,比例达17%;其中男性69名,占48.6%,年龄（54±10.96）岁;女性73名,占51.4%,年龄（58±7.42）岁;男性病例年龄明显小于女性患者（P=0.012）;在单纯左前降支冠脉心肌桥患者中,61例男性患者平均年龄（53.8±10.7）岁明显小于62例女性患者的平均年龄（57.4±7.35岁）（P=0.032）;男性患者血管压迫程度（69±15.4）%,明显重于女性患者的60.7±17.6%（P=0.0063）.在两组中观察到美托洛尔、地尔硫卓对冠脉心肌桥患者均有明显改善临床心功能积分的作用（均P〈0.01）,两者之间没有明显的差异,但在≥70%组治疗中,美托洛尔在改善临床心功能积分方面要好于地尔硫卓（P=0.0039）.结论：冠脉心肌桥患者,男性发病明显早于女性,且男性冠脉心肌桥对冠脉血管压迫程度重于女性患者;美托洛尔和地尔硫卓对冠脉心肌桥患者的临床心功能均有改善作用;但在≥70%组,可考虑优先选用美托洛尔进行治疗.

Objectives： To assess the epidemiologic feature of coronary myocardial bridge and to observe the therapeutic effect on the patients with coronary myocardial bridge according to oppressed degree of coronary. Methods： The final diagnosis of coronary myocardial bridge were done by coronary arteriongraphy. Metoprolol or dilthiazem was choosed randomly in the two groups （〈70%group and ≥70%group）, which the patients with coronary myocardial bridge were divided into according to the oppressed degree of coronary, and to observe the therapeutic effect of metoprolol or dilthiazem on the clinical heart function of the patients with coronary myocardial bridge. The clinical heart function was graded according to New York heart association（NYH A） of America. The integrals of clinical heart function were specified ： 0grade = 0, I grade = 1, II grade=2, III grade = 3, IV grade = 4. Results ： The ratio of the 114 patients with coronary myocardial bridge was 17% in the 851 patients examined by coronary arteriongraphy： 69 men, mean age 54 5-10.96 years;73 women, mean age 585-7.42 years. The age of men with coronary myocardial bridge was significantly less than the one of women（P =0. 012）. In the patients with the myocardial bridge of simple left anterior descending coronary artery, there were 61 men with mean age 53.8：t_ 10. 7years, 62 women with mean age 57.4±7.35years（P=0. 032）. The oppressed degree of coronary in men was 69±15.4M, which was more than in women（60.7±17.6%, P=0. 0063 ）. Metoprolol and dilthiazem both improved the clinical heart function integral in patients with myocardial bridge of simple left anterior descending coronary artery, and the therapeutic effect of metoprolol on clinical heart function integral prior to dilthiazem＇s in ≥70% group（P=0. 0039）. Conclusions： In patients with coronary myocardial bridge, mean age of men was less than one of women, but the oppressed degree of coronary in men was more than in women. Metoprolol and dilthiazem both improved the clinical heart function integral in patients with myocardial bridge of simple left anterior descending coronary artery. In ≥70% group, it was best to choose metoprolol.