老年患者心肌桥近端冠状动脉粥样硬化相关因子及临床特点分析

Analysis of related factors and clinical features of coronary artery atherosclerosis proximal to myocardial bridge in elderly patients

目的评价老年患者心肌桥（MB）近端冠状动脉粥样硬化病变临床相关因子及临床特点。方法连续人选2004年5月至2009年5月我院首次冠状动脉造影发现MB-壁冠状动脉（MB-MCA）的患者共603例。收集患者临床资料和冠状动脉造影资料，分为60～86岁组及28--59岁组，运用多因素分析方法研究与MB近端冠状动脉粥样硬化病变密切相关的临床因子，并对临床特点进行比较。结果60～86岁组MB-MCA患者中，具有典型胸痛、急性冠状动脉综合征（ACS）、高血压史患者多（y。值分别为8．61、41．12、24．97，均P〈0．01）；高血压、糖尿病患病病程长（t值分别为5．25、2．57，P％0．01和P〈o．05），MB近端冠状动脉粥样硬化病变比例高且程度重，多位于血管分叉处，非MB-MCA血管病变程度重且支数多，MB-MCA收缩期狭窄率高（P〈O．01或P〈0．05）。28～59岁组MB-MCA患者既往、当前吸烟多和有高血压、糖尿病、冠心病家族史的患者多及血清三酰甘油高（P％0．01或P％0．05）。多因素分析结果提示，按标准化回归系数（J8）由大到小排列，60～86岁组与桥前首发病变相关的因素包括非MB-MCA冠状动脉中最严重狭窄病变的狭窄率（非桥最病）、MB近端首发冠状动脉粥样硬化病变是否位于血管分叉（首病分叉）、男性、MB-MCA收缩期狭窄率（肌桥收缩）、糖尿病、血脂异常（口值分别为：0．397、0．273、0．201、0．140、0．120、0．109，均P〈0．05）。与桥前最重病变相关因素包括非桥最病、MB近端最重冠状动脉粥样硬化病变是否位于血管分叉（最病分叉）、男性、糖尿病、肌桥收缩（｜9值分别为0．455、0．246、0．148、0．110、0．109，P％0．01或P％0．05）。结论老年MB患者存在更多冠心病危险因素的聚集，更高冠心病发生率，非MH_MCA病变情况、血管分叉、男性、MB-MCA收缩期狭窄率、糖尿病、血脂异常可能与其MB近端冠状动脉动脉粥样硬化的发生密切相关。

Objective To evaluate the related factors and clinical features of coronary artery atherosclerosis proximal to myocardial bridging （MB） in elderly patients. Methods 603 patients with MB-mural coronary artery （MB-MCA） detected by angiography at the first time in our hospital were enrolled. Clinical and angiographic data of them were collected. Patients were divided into the elderly group （n=229, aged 60-86 years） and young group （n=374, aged 28-59 years）. The related factors for coronary artery atherosclerosis proximal to MB were analyzed by multivariate analysis. Clinical features were compared between the two groups. Results The proportion of patients with typical chest pain, acute coronary syndrome （ACS）, hypertension was higher in the elderly group than in the young group （X2 =8.61, 41.12, 24.97 respectively, all P〈O. 01）. The courses of hypertension and diabetes were longer in the elderly group than in the young group （t 5.25 and 2.57, P〈O. 01 or 0.05）. The proportion of atherosclerotic lesions proximal to MB was higher and the degree of atherosclerosis was more serious, lesions were mainly located in vascular bifurcate place, the degree of atherosclerosis in non-MB-MCA was more serious, the number of the coronary non-MB-MCA arteries was much more, and systolic narrow rate was higher in MB-MCA （P^0.01 or 0.05）. The proportion of previous and current smokers were higher, the proportions of patients with family histories of hypertension, diabetes and coronary heart disease were higher, and serum triglyceride level was higher in the young group than in the elderly group （P^0.01 or 0.05）. Multivariate regression analysis suggested that the related factors for first coronary artery atherosclerosis proximal to MB sequenced by 13 value were narrow rate of non-MB-MCA with the most severe degree of narrow, vascular bifurcation lesions, male, systolic narrow rate of MB-MCA and diabetes and dyslipidemia in the elderly group according to 13 value （13value：0. 397, 0.273, 0.201, 0. 140, 0.120 and 0.109, respectively, all P% 0.05）. The related factors for the severe degree of coronary artery atherosclerosis proximal to MB sequenced by Beta value were non-MB-MCA, vascular bifurcation lesions, male, diabetes and systolic narrow rate of MB-MCA （p value：0. 455, 0. 246, 0. 148, 0. 110 and 0. 109, respectively, P%0.01 or 0.05）. Conclusions There are more risk factors for coronary artery disease and a higher incidence of coronary heart disease in elderly patients with MB-MCA. Lesions of non-MB mural coronary artery, vascular bifurcation lesions, male, systolic narrow rate of MB-MCA, diabetes and dyslipidemia may be closely related with coronary artery atherosclerosis proximal to MB.