摘要
目的探讨静息态下左前降支(LAD)单纯肌桥及其伴随的近端动脉粥样硬化对左室壁不同节段透壁心肌灌注指数(TPR)的影响。方法对1200例患者采用640层CT行冠状动脉CTA检查,对LAD心肌桥组121例及另外36例正常对照组行左心室壁TPR分析,对121例LAD心肌桥组根据肌桥厚度及是否伴有近端粥样硬化分为多个亚组。评价不同厚度肌桥、肌桥伴粥样硬化对于相应节段心肌TPR的影响。结果 121例LAD肌桥并发其近端粥样硬化者60例(49.6%)。肌桥组与对照组中间段前壁(t=2.299)、中间段间隔壁(t=2.591)、心尖段前壁(t=2.545)及心尖段间隔壁(t=2.157)TPR值差异具有统计学意义(P<0.05)。单纯深、浅肌桥组之间及其与对照组间所有节段TPR差异均无统计学意义。浅肌桥伴粥样硬化组与对照组比较,中间段前壁(t=-2.59)、中间段前间隔(t=-2.81)、心尖段前壁(t=-2.78)TPR差异有统计学意义(P<0.05);深肌桥伴粥样硬化组与正常对照组在基底部前间隔壁(t=-3.59)、中间段前壁(t=-3.08)、中间段前间隔(t=-3.49)、心尖段前壁(t=-3.01)及心尖段室间隔(t=-2.78)TPR差异存在统计学意义(P<0.05)。LAD肌桥前粥样硬化病例的中、重度狭窄组TPR下降明显,轻度狭窄组仅影响心肌前壁。另外深肌桥组与浅肌桥伴发其近端冠状动脉粥样硬化的差异无统计学意义(χ2=0.203)。结论单纯LAD肌桥对于心肌透壁灌注影响无明显临床意义;肌桥伴其近端动脉粥样硬化影响心肌灌注,主要是使前壁及心尖部心肌灌注下降,且中重度狭窄时对TPR影响更明显。
Objective To discuss the influence of myocardial bridge of left anterior descending artery（LAD） and the myocardial bridge accompanied with atherosclerosis coronary artery on the myocardial transmural perfusion ratio（TPR） of left ventricle in the rest state.Methods 1200 cases received coronary artery 640 slice CTA,36 normal cases as control group and 121 cases with myocardial bridge of LAD were analyzed by the myocardial perfusion software for evaluation of TPR retrospectively.121 cases with myocardial bridge of LAD were further divided into several subgroups according to thickness of myocardial bridge and with or without atherosclerosis.The difference of TPR of the relevant segments between different groups was analyzed.Results The incidence of atherosclerosis proximal to myocardial bridge of LAD was 49.6%（60/121）in 121 cases.There was difference with statistically significance（P0.05） between the myocardial bridge group and control group for the TPR of mid anterior（t=2.299）,mid anteroseptal（t=2.591）,apical anterior（t=2.545）,apical septal（t=2.157） segments.There was no significant difference between isolated myocardial bridge group and control group for TPR to any segment.There was no obvious difference between the TPR of shallow and thick myocardial bridge group and control group for all segments.Obvious difference was found between the TPR of mid anterior（t=-2.59）,mid anteroseptal（t=-2.81）,apical anterior segments（t=-2.78） of shallow myocardial bridge accompanying with atherosclerosis group and control group（P0.05）.There was significant difference of TPR between the thick myocardial bridge accompanying with atherosclerosis group and control group on the TPR of basal anteroseptal（t=-3.59）,mid anterior（t=-3.08）,mid anteroseptal（t=-3.49）,apical anterior（t=-3.01）,apical septal segments（t=-2.78）（P0.05）.The TPR of left ventricle of LAD myocardial bridge accompanying with medium severe atherosclerostic stenosis group decreased prominently.Whereas,only the TPR of anterior wall of left ventricle decreased for LAD myocardial bridge accompanying with mild atherosclerostic stenosis group.There was no obvious difference for the atherosclerosis in the coronary artery segment proximal to myocardial bridge between the shallow and thick myocardial bridge group（χ2=0.203）.Conclusion Isolated myocardial bridge of LAD on TPR of left ventricle has no obvious clinical significance.Myocardial bridge with atherosclerosis in the coronary artery segment proximal to myocardial bridge can influence the blood perfusion of left ventricle,especially the apical and anterior segments.The TPR of medium and severe stenosis groups decreases more obviously than that of mild stenosis group.
出处
《临床放射学杂志》
CSCD
北大核心
2013年第5期639-643,共5页
Journal of Clinical Radiology
