上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (8): 967-.

• 论著（临床研究） • 上一篇    下一篇

心肌桥Noble分级和发生位置与冠状动脉粥样硬化的关系

杨栓锁1, 汤 磊2, 陈 晖1, 仇兴标1, 方唯一1   

  1. 上海交通大学 1. 胸科医院心内科, 上海200030；2. 研究生院医学院分院, 上海 200025
  • 出版日期:2009-08-25 发布日期:2009-09-27
  • 通讯作者: 方唯一, 电子信箱: fwychest@163.com。
  • 作者简介:杨栓锁（1968—）, 男, 副主任医师, 博士, 硕士生导师；电子信箱: yangss@medmail.com.cn。

Relationship between Noble grade and distribution of myocardial bridge and atherosclerosis

YANG Shuan-suo1, TANG Lei2, CHEN Hui1, QIU Xing-biao1, FANG Wei-yi1   

  1. 1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China|2. School of Medical Graduate, Shanghai Jiaotong University, Shanghai 200025, China
  • Online:2009-08-25 Published:2009-09-27

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摘要：

目的 探讨心肌桥Noble分级和发生位置与冠状动脉粥样硬化的关系。 方法 回顾性分析经冠状动脉造影检查出的192例心肌桥患者，结合临床症状以及心电图和心脏超声表现，分析心肌桥Noble分级和发生位置与冠状动脉粥样硬化的关系及药物治疗效果。 结果 心肌桥在冠状动脉造影的检出率为10.2%，最常发生在左前降支中段；Noble 3级患者均出现胸闷或胸痛症状，43.8%出现心电图缺血性ST-T改变，37.5%出现心脏超声室壁节段运动异常，Noble 1、2级患者不出现心电图缺血性ST-T改变和心脏超声室壁节段运动异常；心肌桥近端冠状动狭窄发生率显著高于壁冠状动脉及其远端冠状动脉（P<0.05）；随着心肌桥分级的增高，心肌桥近端冠状动脉狭窄的发生率有增高的趋势（P<0.000 1）；有症状的心肌桥患者β受体阻滞剂、钙离子拮抗剂、β受体阻滞剂联合钙离子拮抗剂使用率分别为80.0%、91.1%和62.2%，显著高于无症状者的11.4%、15.9%、4.5%（P<0.01）。 结论 冠状动脉心肌桥Noble 3级患者大多出现胸闷或胸痛症状；心肌桥近端较易发生冠状动脉粥样硬化；以β受体阻滞剂和钙离子拮抗剂治疗为主。

关键词: 心肌桥, 冠状动脉造影术, 心电图, 超声心动图, 冠状动脉粥样硬化

Abstract:

Objective To study the relationship between Noble grade and distribution of myocardial bridge and atherosclerosis. Methods The clinical data of 192 patients with myocardial bridge diagnosed by coronary artery angiography were retrospectively analysed. The clinical symptoms, electrocardiographic and echocardiographic findings were analysed to explore the relationship between Noble grade and distribution of myocardial bridge and atherosclerosis, and the outcomes of medical treatment were also investigated. Results The positive rate of myocardial bridge detected by coronary artery angiography was 10.2%, which was usually observed in the middle part of left anterior descending coronary artery. All the patients with grade 3 of Noble grade experienced chest pain or palpitation, 43.8% had ischemic ST-T changes on electrocardiogram, and 37.5% had abnormal segmental ventricular wall on echocardiography. However, patients with Noble grade 1 and 2 did not have ischemic ST-T changes on electrocardiogram or abnormal segmental ventricular wall on echocardiography. The prevalence of atherosclerosis in proximal coronary artery of myocardial bridge was significantly higher than those of mural coronary artery and distal coronary artery (P<0.05）. Furthermore, the prevalence of atherosclerosis in proximal coronary artery had the tendency to increase with the grade of myocardial bridge (P<0.0001). For patients with myocardial bridge, those with presence of symptoms were more frequently treated with β-receptor blocker, calcium antagonist and β-receptor blocker+calcium antagonist than those with absence of symptoms (80.0% vs 11.4%, 91.1% vs 15.9% and 62.2% vs 4.5%, respectively) (P<0.01）. Conclusion The symptoms of chest pain or palpitation usually occurred in patients with grade 3 of myocardial bridge, while the proximal coronary artery of myocardial bridge is prone to atherosclerosis, and β-receptor blocker and calcium antagonist are predominant drugs in the treatment.

Key words: myocardial bridge, coronary artery angiography, electrocardiogram, echocardiography, atherosclerosis

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