CAJ | 학술논문

目的评价老年患者心肌桥(MB)近端冠状动脉粥样硬化病变临床相关因子及临床特点. 方法连续入选2004年5月至2009年5月我院首次冠状动脉造影发现MB-壁冠状动脉(MB-MCA)的患者共603例.收集患者临床资料和冠状动脉造影资料,分为60～86岁组及28～59岁组,运用多因素分析方法研究与MB近端冠状动脉粥样硬化病变密切相关的临床因子,并对临床特点进行比较. 结果 60～86岁组MB-MCA患者中,具有典型胸痛、急性冠状动脉综合征(ACS)、高血压史患者多(x2值分别为8.61、41.12、24.97,均P＜0.01);高血压、糖尿病患病病程长(t值分别为5.25、2.57,P＜0.01和P＜0.05),MB近端冠状动脉粥样硬化病变比例高且程度重,多位于血管分叉处,非MB-MCA血管病变程度重且支数多,MB-MCA收缩期狭窄率高(P＜0.01或P＜0.05).28～59岁组MB-MCA患者既往、当前吸烟多和有高血压、糖尿病、冠心病家族史的患者多及血清三酰甘油高(P＜0.01或P＜0.05).多因素分析结果提示,按标准化回归系数(β)由大到小排列,60～86岁组与桥前首发病变相关的因素包括非MB-MCA冠状动脉中最严重狭窄病变的狭窄率(非桥最病)、MB近端首发冠状动脉粥样硬化病变是否位于血管分叉(首病分叉)、男性、MB-MCA收缩期狭窄率(肌桥收缩)、糖尿病、血脂异常(β值分别为:0.397、0.273、0.201、0.140、0.120、0.109,均P＜0.05).与桥前最重病变相关因素包括非桥最病、MB近端最重冠状动脉粥样硬化病变是否位于血管分叉(最病分叉)、男性、糖尿病、肌桥收缩(β值分别为0.455、0.246、0.148、0.110、0.109,P＜0.01或P＜0.05). 结论老年MB患者存在更多冠心病危险因素的聚集,更高冠心病发生率,非MB-MCA病变情况、血管分叉、男性、MB-MCA收缩期狭窄率、糖尿病、血脂异常可能与其MB近端冠状动脉动脉粥样硬化的发生密切相关.
목적 평개노년환자심기교(MB)근단관상동맥죽양경화병변림상상관인자급림상특점. 방법 련속입선2004년5월지2009년5월아원수차관상동맥조영발현MB-벽관상동맥(MB-MCA)적환자공603례.수집환자림상자료화관상동맥조영자료,분위60～86세조급28～59세조,운용다인소분석방법연구여MB근단관상동맥죽양경화병변밀절상관적림상인자,병대림상특점진행비교. 결과 60～86세조MB-MCA환자중,구유전형흉통、급성관상동맥종합정(ACS)、고혈압사환자다(x2치분별위8.61、41.12、24.97,균P＜0.01);고혈압、당뇨병환병병정장(t치분별위5.25、2.57,P＜0.01화P＜0.05),MB근단관상동맥죽양경화병변비례고차정도중,다위우혈관분차처,비MB-MCA혈관병변정도중차지수다,MB-MCA수축기협착솔고(P＜0.01혹P＜0.05).28～59세조MB-MCA환자기왕、당전흡연다화유고혈압、당뇨병、관심병가족사적환자다급혈청삼선감유고(P＜0.01혹P＜0.05).다인소분석결과제시,안표준화회귀계수(β)유대도소배렬,60～86세조여교전수발병변상관적인소포괄비MB-MCA관상동맥중최엄중협착병변적협착솔(비교최병)、MB근단수발관상동맥죽양경화병변시부위우혈관분차(수병분차)、남성、MB-MCA수축기협착솔(기교수축)、당뇨병、혈지이상(β치분별위:0.397、0.273、0.201、0.140、0.120、0.109,균P＜0.05).여교전최중병변상관인소포괄비교최병、MB근단최중관상동맥죽양경화병변시부위우혈관분차(최병분차)、남성、당뇨병、기교수축(β치분별위0.455、0.246、0.148、0.110、0.109,P＜0.01혹P＜0.05). 결론 노년MB환자존재경다관심병위험인소적취집,경고관심병발생솔,비MB-MCA병변정황、혈관분차、남성、MB-MCA수축기협착솔、당뇨병、혈지이상가능여기MB근단관상동맥동맥죽양경화적발생밀절상관.
Objective To evaluate the related factors and clinical features of coronary artery atherosclerosis proximal to myocardial bridging (MB) in elderly patients.Methods 603 patients with MB-mural coronary artery (MB-MCA) detected by angiography at the first time in our hospital were enrolled.Clinical and angiographic data of them were collected.Patients were divided into the elderly group (n＝229,aged 60 86 years) and young group (n=374,aged 28-59 years).The related factors for coronary artery atherosclerosis proximal to MB were analyzed by multivariate analysis.Clinical features were compared between the two groups.Results The proportion of patients with typical chest pain,acutc coronary syndrome (ACS),hypertension was higher in the elderly group than in the young group (x2 =8.61,41.12,24.97 respectively,all P＜0.01).The courses of hypertension and diabetes were longer in the elderly group than in the young group (t=5.25 and 2.57,P＜0.01 or 0.05).The proportion of atherosclerotic lesions proximal to MB was higher and the degree of atherosclerosis was more serious,lesions were mainly located in vascular bifurcate place,the degree of atherosclerosis in non-MB-MCA was more serious,the number of the coronary non-MB-MCA arteries was much more,and systolic narrow rate was higher in MB-MCA (P＜0.01 or 0.05).The proportion of previous and current smokers were higher,the proportions of patients with family histories of hypertension,diabetes and coronary heart disease were higher,and serum triglyceride level was higher in the young group than in the elderly group (P＜0.01 or 0.05).Multivariate regression analysis suggested that the related factors for first coronary artery atherosclerosis proximal to MB sequenced by β value were narrow rate of non-MB-MCA with the most severe degree of narrow,vascular bifurcation lesions,male,systolic narrow rate of MB-MCA and diabetes and dyslipidemia in the elderly group according to β value (βvalue:0.397,0.273,0.201,0.140,0.120 and 0.109,respectively,all P＜ 0.05).The related factors for the severe degree of coronary artery atherosclerosis proximal to MB sequenced by Beta value were non-MB-MCA,vascular bifurcation lesions,male,diabetes and systolic narrow rate of MB-MCA (β value:0.455,0.246,0.148,0.110 and 0.109,respectively,P＜0.01 or 0.05).Conclusions There are more risk factors for coronary artery disease and a higher incidence of coronary heart disease in elderly patients with MB-MCA.Lesions of non-MB mural coronary artery,vascular bifurcation lesions,male,systolic narrow rate of MB-MCA,diabetes and dyslipidemia may be closely related with coronary artery atherosclerosis proximal to MB.