本文選題：肌橋　切入點：冠狀動脈粥樣硬化性心臟病　出處：《河北醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分靜息態(tài)下冠狀動脈狹窄對左室壁透壁心肌灌注影響的640層CT研究 目的:確定靜息態(tài)下心肌透壁指數(shù)（TPR）的正常值，，并探討靜息態(tài)下不同分支的冠狀動脈狹窄與各冠狀動脈分支的不同狹窄程度對左室壁不同節(jié)段透壁心肌灌注指數(shù)的影響。 方法:采用Toshiba640層CT對274例患者行冠狀動脈CTA及左心室室壁CTP檢查。根據(jù)冠狀動脈狹窄程度進行分組。觀察正常組及不同程度冠狀動脈狹窄組之間相應(yīng)節(jié)段內(nèi)TPR是否存在差異，以及冠脈狹窄程度與相應(yīng)節(jié)段TPR的相關(guān)性。 結(jié)果:前降支及左旋支病變對于左室壁心肌灌注影響較為明顯，前降支狹窄主要影響中間段前壁（R=-0.288）、心尖段前壁（R=-0.263）及中間段間隔壁（R=-0.196），左旋支主要影響基底部前側(cè)壁（R=-0.241）、基底部后側(cè)壁（R=-0.279）及心尖段側(cè)壁（R=-0.201），而右冠脈病變影響較小，主要影響中間段后壁（R=-0.195）；冠脈中、重度狹窄組對于左室壁心肌灌注影響程度較大（P＜0.05），輕度狹窄影響較小；左室前壁心肌灌注最易受到冠脈狹窄影響；在靜息狀態(tài)下前降支供血區(qū)域組、左旋支供血區(qū)域組及右冠脈供血區(qū)域組正常心肌和重度狹窄心肌平均TPR值分別為（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）。 結(jié)論:不同冠狀動脈分支狹窄分別影響不同節(jié)段心肌透壁灌注；冠狀動脈狹窄與心肌透壁灌注指數(shù)之間有相關(guān)性。本研究提供了心肌透壁灌注指數(shù)靜息態(tài)下的正常值。 第二部分靜息態(tài)下肌橋?qū)ψ笫冶谕副谛募」嘧⒂绊懙?40層CT研究 目的：探討靜息態(tài)下單純肌橋及其伴隨的動脈粥樣硬化對左室壁不同節(jié)段透壁心肌灌注指數(shù)的影響。 方法：采用Toshiba640層CT對進行冠狀動脈CTA檢查，發(fā)現(xiàn)271例心肌橋，對其中121例資料完整者進行左心室壁心肌灌注指數(shù)（TPR）分析，根據(jù)肌橋厚度及是否伴有近端粥樣硬化分組，正常對照組病例36例。通過不同組間比較評價不同厚度肌橋、肌橋伴粥樣硬化對于相應(yīng)節(jié)段心肌TPR的影響。 結(jié)果：271例肌橋病例中并發(fā)肌橋近端粥樣硬化病變者142例（52.3%），121例資料完整者中肌橋并發(fā)近端粥樣硬化者60例（49.6%）；對121例心肌橋病例心肌灌注研究發(fā)現(xiàn)肌橋組與正常對照組基底部間隔壁、中間段前壁、中間段間隔壁、心尖段前壁及心尖段間隔壁TPR差異存在統(tǒng)計學(xué)意義（P＜0.05）；單純淺肌橋組與正常對照組TPR無論在哪個節(jié)段差異均無統(tǒng)計學(xué)意義；單純深肌橋組與正常對照組之間TPR所有節(jié)段差異均無統(tǒng)計學(xué)意義；單純淺肌橋組與單純深肌橋組TPR差異無統(tǒng)計學(xué)意義。淺肌橋伴粥樣硬化組與正常組比較在中間段前壁、中間段前間隔、心尖段前壁TPR差異有統(tǒng)計學(xué)意義（P＜0.05）；深肌橋伴粥樣硬化組與正常對照組在基底部間隔壁、中間段前壁、中間段前間隔、心尖段前壁及心尖段室間隔TPR差異存在統(tǒng)計學(xué)意義（P＜0.05）。 結(jié)論：肌橋可能促發(fā)或加速其近端血管的粥樣硬化；單純肌橋?qū)τ谒涔?jié)段的心肌透壁灌注影響無明顯臨床意義；肌橋?qū)τ谛募⊥副诠嘧⒌挠绊懼饕瞧浣说闹鄻佑不斐�，且主要影響前壁及心尖部的心肌透壁灌注指�?shù)。
[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.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R816.2

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