应用冠脉血流显像技术评价高脂血症患者的冠脉血流储备

Noninvasive Estimate of Coronary Flow Reserve in Hypercholesterolemic Patients Using Coronary Flow Imaging

目的 应用冠脉血流显像技术结合潘生丁药物负荷试验对单纯高脂血症患者的冠脉血流储备（ＣＦＲ） 进行评价，探讨血脂对ＣＦＲ的影响。方法 研究对象分为单纯高脂血症组（Ａ 组，３０ 例） 和正常对照组（Ｂ 组，１５ 例），应用冠脉血流显像技术检测每位受试者静息时的冠脉血流频谱及静脉推注潘生丁（０－５６ｍｇ／ｋｇ） 后的冠脉血流频谱，分别用最大充血状态下与静息时的冠脉峰值血流速度（ＣＰＶ） 比值及速度时间积分（ＶＴＩ） ×心率（ＨＲ） 比值来计算ＣＦＲ。结果 静息时，两组的ＣＰＶ 及ＶＴＩ×ＨＲ 无明显差别（Ｐ＞ ０－０５）。潘生丁负荷后两组的冠脉血流速度均明显加快，但Ａ组的ＣＰＶ 及ＶＴＩ×ＨＲ 增加程度低于Ｂ 组。两组的ＣＦＲ 值有显著性差别，Ａ 组明显低于Ｂ 组（ Ｐ＜０－０１） 。相关性分析显示ＣＦＲ与ＴＣ、ＬＤＬＣ呈显著负相关（Ｐ＜ ０－０５） 。结论 应用冠脉血流显像新技术结合潘生丁药物负荷试验无创性检测ＣＦＲ，可以早期发现高脂血症患者的冠脉储备功能异常。

Objective This study was performed to investigate the coronary flow reserve (CFR) in hypercholesterolemic patients using coronary flow imaging combined with dipyridamole stress test. Methods In 30 asymptomatic middle aged hypercholesterolemic patients and 15 normal subjects,the coronary peak velocity (CPV) and coronary velocity time integral were measured at basal state and during dipyridamole induced hyperemia using coronary flow imaging.CFR was difined as the ratio of CPV or VTI×HR during maximum pharmacological vasodilation to CPV or VTI×HR at rest. Results The baseline CPV and VTI×HR were similar in the patients and the control subjects ( P>0.05) .A significant increase in CPV and VTI×HR were observed in both groups after dipyridamole infusion,but the increasing degree was lower in the patients.Consequently,CFR was lower in the patients than in the control subjects.Correlative analysis reveal significant negative correlation of CFR to total cholesterol ( r=-0.53,P<0.01) and low density lipoprotein ( r=-0.55,P<0.001 ). Conclusion Noninvasive coronary flow imaging combined with intravenous dipyridamole may allow early detection of preclinical abnormal CFR in asymptomatic hypercholesterolemic patients and may provide information for treatment and assessment of the cholesterol lowering therapy effects. [