肌桥所致心肌缺血机制与治疗

The study of the mechanism and therapy of myocardial ischemia caused by the coronary myocardial bridgeThe study of the mechanism and therapy of myocardial ischemia caused by the coronary myocardial bridge

目的研究冠状动脉心肌桥患者心肌缺血机制和治疗措施。方法回顾性分析390例左前降支冠状动脉心肌桥患者的临床特点。根据心脏收缩期桥段血管受压的轻重程度分为两组：A组235例，收缩期压迫〈50％；B组135例，收缩期压迫≥50％。对比两组患者心血管危险因素以及冠状动脉粥样硬化的发生率。结果390例左前降支冠状动脉肌桥近段血管动脉粥样硬化发生率为45．70％，远段血管动脉粥样硬化发生率为2．25％，两者差异有统计学意义（P〈0．05）。两组患者年龄、性别、高血压、高脂血症、家族史、吸烟史方面比较均无统计学意义（P〉0．05）。B组与A组相比，心肌桥近段血管动脉粥样硬化发生率明显增加，差异有统计学意义（P〈0．05）。结论①肌桥患者心肌缺血的主要机制是肌桥收缩时的挤压和肌桥近端动脉粥样硬化。②对靶血管进行再血管化是治疗心肌桥患者较为合理而有效的方法。

Objective To analyze the mechanism of myocardial ischemia and cure of myocardial bridge. Methods Out of 2500 patients who received coronary angiography, 390 patients were identified to have myocardial bridge on left anterior descending artery. The clinical manifestation, coronary angiogram and myocardium pathology were analyzed retrospectively. Two groups were constituted according to the percentage of systolic reduction of the epicardial coronary artery lumen： Group A, 〈50% （235 cases） and Group B, ≥50% （135 cases）. We also studied the correlation between the severity of the bridging and related cardiovascular risk factors, coronary atherosclerosis. Results The incidence of coronary atherosclerosis were 40.51% and 1.79% in proximal and distal segment of myocardial bridge with significant difference between the two groups （P〈0.05）. There was no significant difference between two groups in age, sex, hypertension, hyperlipidemia, family history, and smoking. The rate of diabetes meUitus was significantly higher in Group A than in Group B （P〈0.05）. The positive rate of coronary artery atheroselerosis on the proximal segment of myocardial bridge was higher significantly in Group B as compared with Group A （P〈0.05）. Conclusion （1）The mechanism of myocardial ischemia of myocardial bridge patients is related tb the compressing effect to the targeting coronary artery of the bridge muscle. （2）Myocardial bridge tends to accelerate the processes of atherosclerosis at the proximal segment of myocardial bridge. Revascularization is the more reasonable and effective way for the myocardial bridge patients.