冠状动脉左前降支心肌桥患者的临床特点分析

Clinical Features of Patients with Myocardial Bridge on the Left Anterior Descending Artery

目的探讨心肌桥患者及心肌桥合并冠状动脉狭窄和痉挛患者病变的临床特点。方法回顾性收集131例通过冠状动脉造影术发现心肌桥的患者,对其冠状动脉病变及临床资料进行分析。结果 131例患者中,男性多于女性,心肌桥多位于前降支中段。心肌桥合并冠状动脉狭窄47例,狭窄位于前降支近段34例(72.3%);心肌桥合并冠状动脉痉挛28例,痉挛位于前降支中段(心肌桥处)21例(75.0%)。心肌桥狭窄组中,吸烟、高血压、糖尿病患者高于单纯心肌桥组和心肌桥痉挛组(P<0.05),表明冠心病的危险因素可能存在心肌桥的这类特殊人群中。131例患者均有胸闷胸痛等不同程度类似冠心病的临床症状,而且Noble分级程度越高,症状越明显,同时合并冠状动脉狭窄或痉挛,则表现更典型。结论冠状动脉造影目前仍是心肌桥诊断的金标准,心肌桥可导致心肌缺血,引起心绞痛症状,症状与收缩期狭窄程度有关,亦与心肌桥合并冠状动脉狭窄和痉挛有关。治疗上主要以药物治疗为主。

Objective To investigate the clinical feature of coronary myocardial bridge,stenosis or artery spasm with coronary myocardial bridge. Methods To analyze the coronary artery lesion and clinical data of 131 patients with coronary myocardial bridge,who were diagnosed by coronary angiography. Results Of 131 cases,more men than women,the coronary myocardial bridge could be seen mostly in the middle of anterior descending branch. Stenosis with coronary myocardial bridge were in 47,at the left anterior descending arteries in 34（ 72. 3%）. Artery spasm with coronary myocardial bridge were in 28,at the middle of anterior descending branch in 21. Patients of stenosis with myocardial bridge,such as smoker,high blood pressure and diabetes,were more than in the simple myocardial bridge and artery spasm with coronary myocardial bridge（ P〈0. 05）. It indicated that the risk factors of coronary heart disease also exist in the special crowd of myocardial bridge. All of them had varying degrees of chest pain such as patients with coronary heart disease in clinic symptom,and the more upgraded the Noble grading,the more severe the symptom. It was more typical in coronary myocardial bridge complicated with stenosis or artery spasm. Conclusions Coronary arteriography has long been taken as the gold standard for diagnosis of coronary myocardial bridge. Myocardial bridge can lead to myocardial ischemia,cause symptoms such as angina pectoris. The symptom is related to the degree of systolic stenosis,the stenosis or artery spasm with coronary myocardial bridge. The main treatment of myocardial bridge is drug treatment.