不同性别患者负荷心电图缺血改变与心肌血供及冠状动脉病变的关系
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摘要
目的:探讨腺苷负荷试验心电图(ECG)呈缺血性改变患者中,其性别间差异与冠状动脉病变及心肌血供受损之间的相互关系及临床意义。方法:回顾性分析2008年5月至2012年11月,本院疑诊冠心病行腺苷负荷/静息心肌灌注显像(MPI)的7 826例患者的资料,以腺苷负荷试验中ECG呈缺血改变的104例患者为研究对象,男性:女性为24:80,平均年龄(58.76±9.97)岁,其中62例患者在1个月内行冠状动脉造影检查(CAG)。结果:104例患者腺苷负荷试验ECG出现ST段水平或下斜型下移≥0.1mV,随后的MPI显示:阳性66例(男性18例),阴性38例(男性32例,P=0.181)。MPI阳性的患者中有33例(男性14例)同期施行了CAG,结果提示:仅1例女性患者冠状动脉呈粥样硬化性改变,但无明显狭窄性病变;另32例(97.0%)均有至少1支冠状动脉狭窄≥50%病变(男性100%,女性94.7%,P=0.576)。MPI阴性的患者中有29例(男性4例)行CAG,结果提示:男性2例(50%)、女性24例(96%)冠状动脉正常或病变<50%,余下2例男性(50%)和1例女性(4%)为3支冠状动脉窄性病变程度均≥50%(P=0.042)。结论:腺苷负荷ECG呈缺血性改变时,MPI阳性或阴性的发生率与性别无明显相关;冠状动脉有严重狭窄性病变且MPI阳性的发生率亦与性别无明显相关;但MPI阴性提示无心肌缺血,而存在严重冠状动脉狭窄性病变的男性明显高于女性。因此对此类男性患者进行临床诊断和评价时要特别慎重,必要时行冠状动脉造影检查。
Objective:Investigating the interrelation and clinical value between coronary artery stenosis and myocardial blood supply in different gender patients with ischemia change in adenosine stress electrocardialgram. Methods: Analyzing 7 826 patients data retrospectively with adenosine stress /rest myocardial perfusion imaging( MPI) imaging from May. 2008 to November. 2012 because of suspecting CAD including 104 patients with ischemia change in ECG during adenosine stress test. As the research objects,in these patients male /female= 24 /80,mean age( 58. 76 ± 9. 97),including 62 petients underwent coronary artery angiography( CAG) in one month. Results: The ST segment horizontally or inclined moved down ≥0. 1mv in adenosine stress test ECG comparing rest ECG in 104 patients,and the subsequent MPI showed: 66 positive( male /female = 18 /48),38negtive( male /female = 6 /32,P = 0. 181). 33 positive patients in MPI( male /female = 14 /19) undergone CAG with showing : there was no obvious coronary artery stenosis in only 1 female patient,and other 32( 97. 0%,32 /33) ones got more than one coronary artery stenosis with the extent ≥50%( male 14 /14 = 100%,female 18 /19= 94. 7%,P = 0. 576). 29 negtive patients( male /female = 4 /25) undergone CAG with showing : there was no obvious coronary artery stenosis in 2 male( 50%,2 /4) and 24 female patients( 96%,24 /25),other 2 male( 50%,2/4) and 1 female( 4%,1/25) patients got three-vessel coronary artery disease with the extent ≥50%( P =0.042). Conclusion: In the patients with ischemia change in adenosine stress electrocardialgram,there is no relevance in the incidence rate of positive and negative in MPI with gender,and so as the incidence rate between the positive in MPI and serious coronary artery stenosis. But in negative MPI patients,the incidence rate of serious coronary artery stenosis in the male is obviously higher than the female,which reminds us to take more care of such male patients for clinical diagnosis and evaluation,even taking CAG if necessary.
Objective:Investigating the interrelation and clinical value between coronary artery stenosis and myocardial blood supply in different gender patients with ischemia change in adenosine stress electrocardialgram. Methods: Analyzing 7 826 patients data retrospectively with adenosine stress /rest myocardial perfusion imaging( MPI) imaging from May. 2008 to November. 2012 because of suspecting CAD including 104 patients with ischemia change in ECG during adenosine stress test. As the research objects,in these patients male /female= 24 /80,mean age( 58. 76 ± 9. 97),including 62 petients underwent coronary artery angiography( CAG) in one month. Results: The ST segment horizontally or inclined moved down ≥0. 1mv in adenosine stress test ECG comparing rest ECG in 104 patients,and the subsequent MPI showed: 66 positive( male /female = 18 /48),38negtive( male /female = 6 /32,P = 0. 181). 33 positive patients in MPI( male /female = 14 /19) undergone CAG with showing : there was no obvious coronary artery stenosis in only 1 female patient,and other 32( 97. 0%,32 /33) ones got more than one coronary artery stenosis with the extent ≥50%( male 14 /14 = 100%,female 18 /19= 94. 7%,P = 0. 576). 29 negtive patients( male /female = 4 /25) undergone CAG with showing : there was no obvious coronary artery stenosis in 2 male( 50%,2 /4) and 24 female patients( 96%,24 /25),other 2 male( 50%,2/4) and 1 female( 4%,1/25) patients got three-vessel coronary artery disease with the extent ≥50%( P =0.042). Conclusion: In the patients with ischemia change in adenosine stress electrocardialgram,there is no relevance in the incidence rate of positive and negative in MPI with gender,and so as the incidence rate between the positive in MPI and serious coronary artery stenosis. But in negative MPI patients,the incidence rate of serious coronary artery stenosis in the male is obviously higher than the female,which reminds us to take more care of such male patients for clinical diagnosis and evaluation,even taking CAG if necessary.
引文
[1]张彦伟.冠心病患者危险因素202例分析.中西医结合心脑血管病杂志,2013,11:497-499.
[2]吕宁,李莉,李瑞杰.12导联动态心电图对冠心病的诊断价值.牡丹江医学院学报,2005,26:11-14.
[3]王蒨,王金城,米宏志,等.国产腺苷介入心肌断层显像诊断冠心病心肌缺血的价值.中华核医学杂志,2006,02:81-83.
[4]马东星,刘惠亮,吴晓霞,等.腺苷负荷心肌灌注显像在老年冠心病患者诊断中的价值.心肺血管病杂志,2010,S1:78-79.
[5]赵娜,宋丽萍.门控心肌灌注显像对冠状动脉粥样硬化性心脏病的诊断及评估价值.解放军医学院学报,2014,35:52-55.
[6]贺海荣,李培秀,王国军,等.心肌灌注显像与心电图对冠心病诊断的比较研究.实用诊断与治疗杂志,2008,22:292-293.
[7]陆军.平板运动试验与腺苷负荷心肌灌注显像对冠心病诊断效能的对比.四川医学,2013,34:1965-1966.
[8]朱传明,杨树贞,邱进.三磷酸腺苷二钠负荷心肌灌注显像在冠心病诊治中的临床应用.实用医技杂志,2013,20:594-596.
[9]王伟,吕风华,杨宾,等.核素心肌灌注显像对心脏X综合征的诊断价值.临床心血管病杂志,2008,24:554-555.
[10]Steven B,Anita M.Artifacts and pitfalls in myocardial perfusion imaging.J Nucl Med Technol,2006,34:193-211.
[11]蔡思宇,刘其昌,俞锋,等.冠状动脉造影与核素心肌灌注显像结果不一致16例分析.临床荟萃,2000,15:229-230.
[12]焦建,王蒨,米宏志,等.腺苷负荷心肌灌注显像正常女性中心电图呈缺血改变35例分析.心肺血管病杂志,2012,31:452-454.
[13]董宏伟,张绪国,施艳红.运动心电图的性别差异与冠状动脉造影的对比分析.中原医刊,2006,33:31.
[2]吕宁,李莉,李瑞杰.12导联动态心电图对冠心病的诊断价值.牡丹江医学院学报,2005,26:11-14.
[3]王蒨,王金城,米宏志,等.国产腺苷介入心肌断层显像诊断冠心病心肌缺血的价值.中华核医学杂志,2006,02:81-83.
[4]马东星,刘惠亮,吴晓霞,等.腺苷负荷心肌灌注显像在老年冠心病患者诊断中的价值.心肺血管病杂志,2010,S1:78-79.
[5]赵娜,宋丽萍.门控心肌灌注显像对冠状动脉粥样硬化性心脏病的诊断及评估价值.解放军医学院学报,2014,35:52-55.
[6]贺海荣,李培秀,王国军,等.心肌灌注显像与心电图对冠心病诊断的比较研究.实用诊断与治疗杂志,2008,22:292-293.
[7]陆军.平板运动试验与腺苷负荷心肌灌注显像对冠心病诊断效能的对比.四川医学,2013,34:1965-1966.
[8]朱传明,杨树贞,邱进.三磷酸腺苷二钠负荷心肌灌注显像在冠心病诊治中的临床应用.实用医技杂志,2013,20:594-596.
[9]王伟,吕风华,杨宾,等.核素心肌灌注显像对心脏X综合征的诊断价值.临床心血管病杂志,2008,24:554-555.
[10]Steven B,Anita M.Artifacts and pitfalls in myocardial perfusion imaging.J Nucl Med Technol,2006,34:193-211.
[11]蔡思宇,刘其昌,俞锋,等.冠状动脉造影与核素心肌灌注显像结果不一致16例分析.临床荟萃,2000,15:229-230.
[12]焦建,王蒨,米宏志,等.腺苷负荷心肌灌注显像正常女性中心电图呈缺血改变35例分析.心肺血管病杂志,2012,31:452-454.
[13]董宏伟,张绪国,施艳红.运动心电图的性别差异与冠状动脉造影的对比分析.中原医刊,2006,33:31.