冠状动脉左前降支心肌桥合并粥样硬化的危险因素分析

Risk factor analysis of the atherosclerosis incidence in patients with left anterior descending artery with myocardial bridging

目的:了解心肌桥合并冠状动脉粥样硬化的危险因素。方法:对186名冠状动脉左前降支心肌桥的临床资料进行回顾性分析,采用多元回归分析模型探讨心肌桥合并冠状动脉粥样硬化的危险因素。结果:合并糖尿病(OR=3.92,P<0.05)、吸烟(OR=2.91,P<0.05)、总胆固醇异常(OR=3.99,P<0.05)和低密度脂蛋白异常(OR=9.95,P<0.05)是心肌桥合并冠状动脉粥样硬化的独立危险因素。不同水平的Noble分级与合并糖尿病(NobleⅡ级×糖尿病异常:OR=10.38,P<0.05)、总胆固醇异常(NobleⅢ级×总胆固醇异常:OR=8.83,P<0.05)及低密度脂蛋白异常的交互作用(NobleⅠ级×低密度脂蛋白异常:OR=4.01,P<0.01;NobleⅡ级×低密度脂蛋白异常,OR=11.62,P<0.05;NobleⅢ级×低密度脂蛋白异常OR=30.56,P<0.05)与心肌桥合并冠状动脉粥样硬化显著相关。结论:心肌桥患者的Noble分级在冠状动脉粥样硬化的形成过程中起着重要的调制修饰作用,临床治疗实践中应重视心肌桥这一先天解剖异常现象。

Objective： To assess the risk factors of atherosclerosis inci- dence in patients with left anterior descending artery associated with myocardial bridging （ MB ）. Methods ： The clinical data were retrospectively analyzed in total 186 patients with left anterior descending coronary artery associated with MB. Muhinomial logistic regression was performed to examine the risk factors of left anterior descending coronary artery associated with MB and atherosclerosis incidence. Results ： The independent risk factors for atberosclerosis incidence in patients of anomalous left anterior descending coronary artery with MB were associated with complicated diabetes mellitus （DM） （ OR = 3. 92, P 〈 0. 05 ）, cigarette smoking （ OR = 2.91, P 〈 0.05 ）, elevated total cholesterol （ eTC ） level （ OR = 3.99, P 〈 0.05 ） and elevated low density lipid cholesterol （eLDL-C）level OR = 9.95, （P 〈 0.05 ）. The incidence of atherosclerosis from anomalous left anterior descending coronary artery with MB was significantly involved in interactive effects between different levels of Noble scoring and DM （ No- ble II × DM ： β = 2.34, P 〈 0. 05, OR = 10.38 ） , eTC （ Noble III x eTC ： OR = 8. 831, P 〈 0.05 ）, eLDL-C （ Noble I × eLDL-C ： OR = 4. 01, P 〈 0.05 ; Noble II × eLDL-C ： OR = 11.62, P 〈 0.05 ; Noble II × eLDL-C ： OR = 30.56, P 〈 0.05 ）. Conclusion ： The findings suggest that Noble grading is indicative of atherosclerosis incidence in patients with modulation effect of the different levels of Noble grade for the occurrence of coronary artery angiography in the patients with anomalous left anterior descending coronary artery with MB ,thus the coronary anomaly shall call the attention for the physicians in diagnosis and treatment of such patients.