心肌桥-壁冠状动脉与心肌缺血的相关性研究

Correlation between myocardial bridge-mural coronary artery and myocardial ischemia

目的:探讨心肌桥-壁冠状动脉(MB-MCA)与心肌缺血的相关性。方法:回顾性分析因胸闷、胸痛就诊,经256层螺旋CT冠状动脉成像(CTCA)诊断为MB-MCA,且经临床相关检查排除冠心病、心肌病、瓣膜病、高血压心脏病及先天性心脏病等各种器质性心脏病,于1周内行负荷-静息核素心肌灌注显像(MPI)的82例(男45例,女37例)患者的影像资料,比较不完全MB组与完全MB组MCA收缩期狭窄率及MPI的差异,比较MPI正常组与异常组MB长度及MCA收缩期狭窄率的差异。结果:不完全MB组与完全MB组MCA收缩期狭窄率分别为(11.6±10.3)%与(30.5±12.2)%,差异有统计学意义(t=7.584,P=0.000);MPI异常分别为5例与19例,差异有统计学意义(χ~2=21.376,P=0.000)。MPI正常组与异常组MB长度分别为(14.4±3.8)mm与(15.1±4.7)mm,差异无统计学意义(t=0.909,P=0.366);MCA收缩期狭窄率分别为(13.8±10.4)%与(36.7±11.5)%,差异有统计学意义(t=10.238,P=0.000)。结论:MB-MCA与心肌缺血存在相关性。相比不完全MB,完全MB患者MCA收缩期狭窄程度更严重,更易出现心肌缺血,临床应给予高度重视。而MB长度对心肌供血无明显影响。

Objective：To evaluate the correlation between myocardial bridge-mural coronary artery（MB-MCA）and myocardial ischemia.Method：A total of 82 patients with MB-MCA undergoing 256-slice CTCA and MPI were collected and analyzed retrospectively.The systolic stenosis degree of MCA and MPI were compared between the incomplete and complete MB group.The MB length and the systolic stenosis degree of MCA were compared between the normal and abnormal MPI group.Result：There were statistically significant differences in the systolic stenosis degree of MCA and MPI between the incomplete and complete MB groups（t=7.584,P=0.000;χ~2=21.376,P=0.000）.There was no significant differences in the length of MB between the normal and abnormal MPI group（t=0.909,P=0.366）,whlie there was significant differences in the systolic stenosis degree of MCA（t=10.238,P=0.000）.Conclusion：MB-MCA is positively correlated with myocardial ischemia.Complete MB causes more severe systolic stenosis degree of MCA,and is easier to have more myocardial ischemia than incomplete MB.The length of MB does not influence myocardial perfusion.