静息态下左室壁透壁心肌灌注的640层CT研究

发布时间：2018-03-06 21:31

本文选题：肌桥　切入点：冠状动脉粥样硬化性心脏病　出处：《河北医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：第一部分静息态下冠状动脉狭窄对左室壁透壁心肌灌注影响的640层CT研究目的:确定静息态下心肌透壁指数（TPR）的正常值，，并探讨静息态下不同分支的冠状动脉狭窄与各冠状动脉分支的不同狭窄程度对左室壁不同节段透壁心肌灌注指数的影响。方法:采用Toshiba640层CT对274例患者行冠状动脉CTA及左心室室壁CTP检查。根据冠状动脉狭窄程度进行分组。观察正常组及不同程度冠状动脉狭窄组之间相应节段内TPR是否存在差异，以及冠脉狭窄程度与相应节段TPR的相关性。结果:前降支及左旋支病变对于左室壁心肌灌注影响较为明显，前降支狭窄主要影响中间段前壁（R=-0.288）、心尖段前壁（R=-0.263）及中间段间隔壁（R=-0.196），左旋支主要影响基底部前侧壁（R=-0.241）、基底部后侧壁（R=-0.279）及心尖段侧壁（R=-0.201），而右冠脉病变影响较小，主要影响中间段后壁（R=-0.195）；冠脉中、重度狭窄组对于左室壁心肌灌注影响程度较大（P＜0.05），轻度狭窄影响较小；左室前壁心肌灌注最易受到冠脉狭窄影响；在静息状态下前降支供血区域组、左旋支供血区域组及右冠脉供血区域组正常心肌和重度狭窄心肌平均TPR值分别为（1.14±0.09和1.07±0.13）、（1.13±0.11和1.06±0.14）、（1.15±0.14和1.10±0.12）。结论:不同冠状动脉分支狭窄分别影响不同节段心肌透壁灌注；冠状动脉狭窄与心肌透壁灌注指数之间有相关性。本研究提供了心肌透壁灌注指数静息态下的正常值。第二部分静息态下肌桥对左室壁透壁心肌灌注影响的640层CT研究目的：探讨静息态下单纯肌桥及其伴随的动脉粥样硬化对左室壁不同节段透壁心肌灌注指数的影响。方法：采用Toshiba640层CT对进行冠状动脉CTA检查，发现271例心肌桥，对其中121例资料完整者进行左心室壁心肌灌注指数（TPR）分析，根据肌桥厚度及是否伴有近端粥样硬化分组，正常对照组病例36例。通过不同组间比较评价不同厚度肌桥、肌桥伴粥样硬化对于相应节段心肌TPR的影响。结果：271例肌桥病例中并发肌桥近端粥样硬化病变者142例（52.3%），121例资料完整者中肌桥并发近端粥样硬化者60例（49.6%）；对121例心肌桥病例心肌灌注研究发现肌桥组与正常对照组基底部间隔壁、中间段前壁、中间段间隔壁、心尖段前壁及心尖段间隔壁TPR差异存在统计学意义（P＜0.05）；单纯浅肌桥组与正常对照组TPR无论在哪个节段差异均无统计学意义；单纯深肌桥组与正常对照组之间TPR所有节段差异均无统计学意义；单纯浅肌桥组与单纯深肌桥组TPR差异无统计学意义。浅肌桥伴粥样硬化组与正常组比较在中间段前壁、中间段前间隔、心尖段前壁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间隔壁、中间段前壁、中间段前间隔、心尖段前壁及心尖段室间隔TPR差异存在统计学意义（P＜0.05）。结论：肌桥可能促发或加速其近端血管的粥样硬化；单纯肌桥对于所支配节段的心肌透壁灌注影响无明显临床意义；肌桥对于心肌透壁灌注的影响主要是其近端的粥样硬化造成，且主要影响前壁及心尖部的心肌透壁灌注指数。
[Abstract]:The 640 layer CT study of the effects of resting coronary artery stenosis on left ventricular wall transmural perfusion in the first part of the resting state
Objective: to determine the normal value of myocardial permeability index (TPR) in resting state, and to explore the effect of different degrees of stenosis of coronary artery stenosis and coronary artery branches on transmyocardial myocardial perfusion index of different segments of left ventricular wall in resting state.
Methods: the Toshiba640 layer CT on 274 cases of patients with coronary artery CTA and left ventricular wall. CTP examination were grouped according to the severity of coronary artery stenosis. Observation of the normal group and the different degree of coronary artery stenosis group between the corresponding segment in TPR are different, and the correlation between the degree of coronary artery stenosis and the corresponding segment of TPR.
Results: the anterior descending and circumflex lesions in the left ventricular myocardial perfusion is obvious, anterior descending artery mainly affects the middle segment of anterior wall (R=-0.288), apical segment of anterior wall (R=-0.263) and the middle section of the room next door (R=-0.196), left circumflex mainly affected the basal lateral wall (R= -0.241), basal the rear side wall (R=-0.279) and apical lateral wall (R=-0.201), right coronary artery and less influence, mainly affects the middle segment of the posterior wall (R=-0.195); coronary artery, severe stenosis group for left ventricular myocardial perfusion a greater degree of influence (P < 0.05), mild narrow little effect; the left ventricular anterior wall myocardial perfusion the most vulnerable coronary artery stenosis; branch blood supply area groups decreased in the resting state, the left circumflex and right coronary blood supply area group and severe stenosis group of normal myocardial regional myocardial average TPR values were (1.14 + 0.09 and 1.07 + 0.13), (1.13 + 0.11 and 1.06 + 0.14 (1.15 + 0.14). And 1. 10 + 0.12).
Conclusion: different branches of coronary artery stenosis affect the permeability of different segments of myocardium. There is a correlation between coronary artery stenosis and myocardial permeability index. This study provides the normal value of myocardial wall perfusion index resting state.
Second part CT study on the effect of muscle bridge in resting state on left ventricular wall transmural perfusion in 640 layers
Objective: To investigate the effect of simple muscle bridge and associated atherosclerosis in resting state on myocardial perfusion index of different segments of left ventricular wall.
Methods: the Toshiba640 layer CT on coronary artery CTA examination found 271 cases of myocardial bridge, left ventricular wall myocardial perfusion index in 121 cases with complete data analysis (TPR), according to the thickness and is associated with myocardial bridge proximal atherosclerosis group, normal control group 36 cases. Through the comparative evaluation between different groups the different thickness of muscle bridge, with atherosclerotic effects of muscle bridge for the corresponding segment of myocardial TPR.
Results: 142 cases of 271 cases of muscular bridge cases were complicated with myocardial bridge proximal atherosclerotic lesions (52.3%), 60 cases of myocardial bridge and 121 cases with complete data were complicated with proximal atherosclerosis (49.6%); to study the cases of myocardial perfusion in 121 patients with myocardial bridge muscle bridge group and normal control group the basal septal wall the middle section of the anterior, middle, apical segment next door, the difference before next door to the TPR wall and apical segment between statistical significance (P < 0.05); simple superficial muscle bridge group and normal control group TPR in which segments had no statistically significant difference between the pure; deep muscle bridge group and normal control group, all TPR segmental differences were not statistically significant; no statistically significant simple superficial muscle bridge group and simple TPR group. The difference of deep muscle bridge shallow muscle bridge with atherosclerosis group compared with normal group in the middle section of the front wall, the middle section before the interval, the apical segment of anterior wall TPR was statistically significant (P < 0.05); Shenzhen There were significant differences in TPR between the muscle bridge and atherosclerotic group and the normal control group in the basal septal wall, the anterior middle segment, the anterior septal segment, the apical anterior wall and the apical segment of the interventricular septum (P < 0.05).
Conclusion: the myocardial bridge may promote or accelerate the proximal vascular atherosclerosis; simple myocardial bridge for control segmental myocardial transmural perfusion effect without obvious clinical significance; muscle bridge effect on myocardial transmural perfusion is mainly caused by atherosclerosis of the proximal end, and the main effect of the front wall and apex. Transmural myocardial perfusion index.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.2

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