冠状动脉微血管病患者的三支冠状动脉血流储备的差异

The difference of coronary flow reserve in three angiographically normal epicardial arteries in patients with coronary microvascular risk factors

目的 :观察冠状动脉 (冠脉 )造影正常而有冠脉微血管病基础者的三支冠脉血流储备 (Coronaryflowreserve ,CFR)之间是否有差异。方法 :临床上有不典型胸闷或胸痛的患者 4 5例 ,冠脉造影及左室射血分数正常 ,按有无冠脉微血管病基础分为甲、乙两组。甲组为冠脉微血管病组 ,共 2 9例 ,男 19例 ,女 10例 ,年龄 37～ 78(5 8±9.9)岁 ,其中心电图有左室肥厚或劳损表现的高血压患者 11例 ,糖尿病 3例 ,肥厚型心肌病 2例 ,长期吸烟者 10例 ,高血脂 8例 ;乙组为无冠脉微血管病组 ,共 16例 ,男 11例 ,女 5例 ,年龄 38～ 5 8(5 1± 8.6 )岁。冠脉造影过程中随机测定冠脉CFR值 (甲组 6 2支 ,左冠脉前降支 2 4支 ,冠脉左旋支 17支 ,右冠脉 2 1支 ;乙组 36支 ,左冠脉前降支13支 ,冠脉左旋支 8支 ,右冠脉 14支 )。结果 :甲组 6 2支冠脉的平均CFR为 2 .32± 0 .6 1,乙组 3.15± 0 .5 5 ,P <0 .0 1。甲组三支冠脉之间的CFR差异有统计学意义 ,P <0 .0 1;乙组三支冠脉的CFR差别无统计学意义P >0 .0 5。甲组前降支的CFR远低于右冠脉与回旋支 (2 .0 4± 0 .5 2∶2 .5 9± 0 .6 5 ,2 .39± 0 .5 5 ,均 P<0 .0 5 ) ;回旋支较右冠脉的CFR低 ,但差异无统计学意义 (2 .39± 0 .5 5∶2 .5 9± 0 .6 5 ,P >0 .0 5 )。结论 :冠脉微血?

Objective:To observe the difference in coronary flow reserve(CFR) among left anterior descending artery(LAD), left circumflex artery(LCx) and right coronary artery(RCA) in patients with coronary microvascular risk factors but normal angiographies.Methods:Twenty-nine patients (Group Ⅰ) were selected, including 19 males and 10 females with average ages of 58± 9.9. They at least had one coronary microvascular risk factor but normal angiograms (11 hypertension, 3 diabetics, 8 hypercholesterolemics, 2 hypertrophic cardiomyopathy, and 10 smokers) . 16 control subjects including 11 males and 5 females with average ages of 51± 8.6 (Group Ⅱ) were also studied. CFR of coronary arteries in all subjects were calculated randomly.Results:Average CFR in Group Ⅰ was significantly lower than that in Group Ⅱ ( 2.32± 0.61 vs 3.15± 0.55 P< 0.01). There was a difference in the CFR among LAD, LCx and RCA in Group Ⅰ (P< 0.01). And CFR in LAD was much lower than that in RCA and Lcx ( 2.04± 0.52 vs 2.59± 0.65, 2.39± 0.55,P< 0.05) in Group Ⅰ. But this didn't exist in Group Ⅱ (P> 0.05). However, there was no significant difference in CFR between LCx and RCA in Group Ⅰ ( 2.39± 0.55 vs 2.59± 0.65 P> 0.05).Conclusion:CFR in LAD is significantly lower than that in LCx and RCA in patients with coronary microvascular risk factors but normal coronary angiographies.