多层螺旋 CT 评价心肌桥及其与动脉粥样硬化的关系?

目的：探讨壁冠状动脉（MCA）于舒张中、晚期的显示规律，并分析壁冠状动脉于舒张中、晚期的狭窄程度与载心肌桥厚度以及动脉粥样硬化的发生等的相关关系。方法：对754例临床疑似冠心病患者进行冠状动脉 CT 成像，在独立工作站上进行多平面重组（MPR，包括 CPR），观察冠状动脉与心肌的空间关系，确认完全性心肌桥。按照 MB 近、远端血管形态可分为两组：平滑弧形组和迂曲成角组。并按 MB 的厚度是否大于2 mm 进行分组，在重组成像中测量壁冠状动脉的狭窄程度，并进行两组间 t 检验。按 MCA 近端有无斑块形成分为斑块组和无斑块组，对 MCA狭窄程度分别作两组间独立样本 t 检验。对斑块组和非斑块组成角迂曲的发生概率作χ2检验。分析81 MCA 患者静态心电图、心绞痛以及迂曲成角发生率与心肌桥厚度以及 MCA 近端有无斑块之间的相关性。结果：在总计754例受检者中发现完全性心肌桥81例。心肌桥较厚（>2 mm）时，舒张期 MCA 狭窄程度较走行正常者严重，两组间 t 检验结果有显著统计学差异（P <0.05）。斑块组舒张期 MCA 狭窄程度较无斑块组重，两组间 t 检验结果有显著统计学差异（P <0.05）。斑块组和非斑块组成角迂曲的发生概率作四格表χ2检验有显著统计学差异（P <0.05）。对81例受检者分析其静态心电图，迂曲成角组静态心电图 ST-T 段改变以及心绞痛发生的比率明显高于正常组（P <0.05）。结论：心肌桥可能与动脉粥样硬化病变的发展相关。舒张期 MCA 狭窄程度与 MB 厚度以及近端有无粥样硬化斑块有关，>2 mm 组舒张期狭窄程度大于≤2 mm 组，近端有斑块组舒张期狭窄程度大于无斑块组。MCA 近端有斑块时，动脉粥样硬化更易发生成角迂曲，且迂曲成角组受检者静态心电图 ST-T 段改变以及心绞痛发生率均高于平滑弧形组。

MSCT Evaluation of Myocardial Bridge and Its Relationship with Atherosclerosis

Objective: To explore the mural coronary artery in diastole late, according to law, and analyze the mural coronary artery in the middle of the early diastole, the degree of stenosis and MB coronary artery overall form as well as the correlation between the occurrence of atherosclerosis. Materials and methods:754 cases of clinical suspected coronary heart disease (CHD) patients with coronary artery CT imaging, the independent workstation multilane reconstruction (MPR, CPR) blood vessels and myocardial spatial relationships, confirm the completeness of the myocardial bridge, in the judgment and the morphology of mural coronary artery: observation on the MPR like coronary take line all the way, and grouping, measuring wall in the reorganization of intracavitary imaging of coronary artery stenosis degree, and t test between the two groups. According to MCA proximal presence of plaque formation is divided into patches and plaques group, the mural coronary artery stenosis degree respectively independent sample t test between the two groups. The plaque group and the probability of occurrence of plaque composition Angle give four table chi-square test. Results: In a total of 754 subjects found in 81 cases of complete myocardial bridge. According to the MB thickness, can be divided into two groups: > 2 mm group and ≤ 2 mm group. t test results between the two groups have statistically significant differences (P < 0.05). The MB coronary artery course circuity, direction normal diastolic MCA stenosis degree is serious. Plaque and plaque group t test results between the two groups have statistically significant differences (P < 0.05). Plaque group and the Angle of circuitous probability table chi-square four grids has statistically significant difference (P < 0.05). Patients in 81 cases of ECG, analysis of its static circuity-angulation group electrocardiogram ST-T period of change and the rate of angina pectoris occurred was obviously higher than that of normal group. Conclusion: The myocardial bridge could cause the development of atherosclerotic lesions. Diastolic MCA stenosis degree and load MB proximal coronary artery overall direction and presence of atherosclerotic plaques, circuity-angulation diastolic stenosis degree is greater than the normal group. Proximal have plaque diastolic more narrow than no plaque group. MCA proximal plaques, as a result of atherosclerosis, are more likely to happen as Angle circuity. Circuity angulation group client static ECG ST-T segment changes as well as the incidence of angina pectoris were higher than that of smooth arc group.