心肌桥的研究现状

Research status of myocardial bridge

心肌桥是最常见的先天性冠状动脉变异,尸检发病率为42.0%,多见于女性患者(74.5%),主要累及左前降支(77.2%)。心肌桥可能与各种并发症相关,如心绞痛、急性心肌梗死等,甚至在儿童早期导致较严重的临床症状,目前认为可能的致病机制包括心肌缺血、冠脉痉挛及冠状动脉粥样硬化。然而近期有研究认为心肌桥的存在可能对患者起到潜在的保护作用,并推测可能是由于心肌桥附近的脂肪组织和其他结缔组织组成"冠状动脉脂肪垫",其对抗收缩期对血管的压迫,同时心肌桥收缩,刺激抗凝剂和生长因子释放,保护壁冠状动脉,从而达到抵抗动脉粥样硬化的作用。心肌桥为胚胎时期发育异常造成,因此在临床中无法预防,目前治疗方法主要有药物、手术或介入治疗。介入治疗存在争议,推荐手术治疗,但缺乏统一的标准,对深度>2 mm,长度>25 mm,心肌桥压迫持续至舒张期尚不能完全恢复的患者,建议进行冠脉搭桥手术。在极少数情况下,心肌桥可能需要紧急治疗,甚至需要在儿童早期进行外科干预。本文就心肌桥的生理病理、检查方法、治疗等研究现状进行综述。

Myocardial bridge is the most common congenital coronary artery anomaly,the morbidity of autopsy was 42%,more in female patients(74.5%),mainly involves the left anterior descending branch(77.2%).The presence of myocardial bridge may be associated with various complications,such as angina pectoris,acute myocardial infarction,and even lead to severe clinical symptoms in early childhood.The possible damage mechanisms of myocardial bridge include myocardial ischemia,coronary spasm and coronary atherosclerosis.However,recent studies have considered the existence of the myocardial bridge may play a potential protective effect on the patients,and speculated that may be due to myocardial bridge near the adipose tissue and other connective tissue,form"coronary artery fat pad",helps blood vessels fight systolic bundle compression,myocardial bridge contraction stimulating anticoagulant and growth factor release,protection of mural coronary artery atherosclerosis.Myocardial bridge is caused by abnormal development of embryo,so it cannot be prevented in clinic.At present,there are mainly drug,surgery or interventional therapy.Interventional therapy is controversial,and surgical treatment is recommended,but there is no unified standard.For patients with depth>2 mm,length>25 mm and myocardial bridge compression persisting until diastolic phase cannot fully recover,coronary artery bypass surgery is recommended.In rare cases,emergency treatment may be needed,and even surgical intervention in early childhood is needed.This article reviews the research status of physiology,pathology,examination methods and treatment of myocardial bridge.