心肌桥-壁冠状动脉的形态学特征与冠状动脉近段粥样硬化病变的关系

Relationship between morphological characteristics of myocardial bridge mural coronary artery and atherosclerotic lesions of proximal coronary artery

目的通过128层螺旋CT冠状动脉成像技术评价心肌桥-壁冠状动脉(MBMCA)的形态学特征,并分析其与冠状动脉近段粥样硬化病变的关系。方法选取2015年3月~2017年3月于北京市仁和医院收治的单纯MBMCA不伴有动脉粥样硬化患者79例记为对照组,另取同期收治的心肌桥近端冠状动脉伴粥样硬化患者79例作为观察组。两组均接受128层螺旋CT冠状动脉成像技术检查。比较两组患者年龄、性别、心率等基本临床资料,各项冠状动脉检测指标(心肌桥厚度、壁冠状动脉长度、壁冠状动脉两端平滑、壁冠状动脉近端成角、壁冠状动脉远端成角、壁冠状动脉两端成角)水平,并通过多因素Logistic回归分析MBMCA与冠状动脉近段粥样硬化病变的关系。结果观察组年龄明显高于对照组(P<0.05);而性别、心率、病程、高血压与糖尿病情况比较,差异均无统计学意义(P均>0.05)。观察组壁冠状动脉长度、壁冠状动脉两端平滑患者比例均分别明显低于对照组,而壁冠状动脉远端成角、壁冠状动脉两端成角患者比例均分别明显高于对照组(P均<0.05)。经多因素Logistic回归分析可得:年龄(OR=1.421,P=0.037)、壁冠状动脉远端成角(OR=2.147,P=0.042)以及壁冠状动脉两端成角(OR=2.579,P=0.002)均是影响壁近端冠状动脉粥样硬化的独立危险因素,而壁冠状动脉两端平滑是保护性因素(OR=2.736,P=0.012)。结论采用128层螺旋CT冠状动脉成像技术可有效评价MBMCA形态学特征和冠状动脉近段粥样硬化病变情况,且两者存在密切相关,值得临床重点关注。

Objective To evaluate the morphological characteristics of myocardial bridge mural coronary artery（MBMCA） by 128 slice spiral CT coronary angiography, and to analyze the relationship between atherosclerotic lesion of proximal coronary artery. Methods From March 2015 - March 2017, 79 pure MBMCA patients without atherosclerosis were selected as control group, another 79 proximal coronary myocardial bridge patients with atherosclerosis were selected as observation group. Patients in both groups were examined with 128-slice spiral CT coronary angiography. Basic clinical data such as age, gender, and heart rate, the coronary artery detection indexes（thickness and length of mural coronary artery myocardial bridge and smooth mural coronary artery on both ends, wall proximal coronary artery angulation, distal coronary artery wall into the angle of mural coronary artery, the angulation） levels, and through the multi-factor Logistic regression analysis MBMCA and coronary artery in the relationship between atherosclerotic lesions were compared. Results The age of observation group was significantly higher than that of the control group（P〈0.05）. There was no statistically significant difference in gender, heart rate, course of disease, hypertension and diabetes（P〉0.05）. The smooth mural coronary artery wall length, coronary artery ends number accounted rate of observation group were significantly lower than those of control group. And mural coronary artery distal coronary artery wall angle, angle of the total number of people on both ends of observation group were significantly higher than those of control group, the difference was statistically significant（P〈0.05）. After multivariable logistic regression analysis available： age（OR=1.421, P=1.421）, distal coronary artery wall Angle（OR=2.147, P=2.147） and coronary artery wall Angle on both ends（OR=2.579, P=2.579） were independent risk factors of the wall of the proximal coronary atherosclerosis, and the smooth mural coronary artery on both ends were protective factors（OR=2.736, P=2.736）. Conclusion 128 slice spiral CT coronary angiography can effectively evaluate the myocardial bridge wall coronary artery morphological characteristics and coronary atherosclerotic lesions in the proximal segment, and they are closely related, which is worth for attention.