糖尿病患者前降支心肌桥与桥前血管冠状动脉粥样硬化的相关性

目的探讨糖尿病患者前降支心肌桥与心肌桥前血管冠状动脉粥样硬化的相关性，以确定前降支心肌桥是否为心肌桥前
段冠状动脉粥样硬化发生的一个独立危险因素。方法回顾性分析2011年3月~2012年12月间拟诊为冠心病的患者的ＣＴ冠
状动脉血管成像资料（只记录前降支有无心肌桥及桥前血管有无狭窄大于50%冠脉粥样硬化）及临床资料。首先对糖尿病受试
者按照有无心肌桥进行分组，比较心肌桥前段和无心肌桥组的对等段血管冠状动脉粥样硬化有无差别以及差别是否具有统计
学意义。然后对所有心肌桥受试者按照有无糖尿病进行分组，比较两组间心肌桥前段冠状动脉粥样硬化有无差别以及差别是
否具有统计学意义。最后应用Logistic回归模型分别分析糖尿病及非糖尿病患者前降支心肌桥及桥前血管冠状动脉粥样硬化
病变的关系。结果糖尿病患者2345例，其中1373例心肌桥中，827例桥前段冠脉存在动脉粥样狭窄，972例无心肌桥，与心肌
桥组桥前血管对等部位血管中254例存在动脉粥样狭窄，差别具有统计学意义（P<0.05）。Logistic回归模型结果显示经最终校
正后，糖尿病及非糖尿病患者桥前血管发生动脉粥样硬化病变的Odds Ratio值分别为3.91、2.69（P<0.05）。结论糖尿病患者心
肌桥桥前段更易发生粥样硬化狭窄，心肌桥均为桥前血管发生狭窄大于50%的冠状动脉粥样硬化病变的独立危险因素，与非糖
尿病组相比，糖尿病组的心肌桥致桥前血管发生狭窄大于50%的冠状动脉粥样硬化病变的危险性更高。

Association of myocardial bridge in the left anterior descending coronary with coronaryatherosclerosis proximal to the bridge site in diabetic patients

Objecitve To investigate whether myocardial bridging (MB) is an independent risk factor for coronary
atherosclerosis proximal to the bridge site in the left anterior descending coronary artery (LAD) in diabetic patients. Methods
From March 2011 to December 2012, 9862 patients with suspected coronary disease underwent coronary computed
tomography angiography (CCTA) using a dual-source CT scanner. The baseline clinical characteristics (age, gender, smoking
history, presence of hypertension, dyslipidemia, diabetes mellitus, family history of heart attack and body mass index) and the
results of CCTA were reviewed. Two radiologists evaluated the MB and coronary atherosclerosis stenosis (CAS) over 50% in
the LAD and made a diagnosis by consensus. Significant independent risk factors for CAS were investigated by logistic
regression analysis. Results Of the 2345 patients identified to have diabetes mellitus, 1373 had MB, among whom 827 had
coronary atherosclerosis proximal to the bridge site; 972 of the diabetic patients were free of MB, among whom 254 had
coronary atherosclerosis at the equivalent site. None of the patients had CAS in the tunneled segment. After adjusted for
clinical data, logistic regression analysis showed that MB in the LAD was significantly correlated with coronary atherosclerosis
in the proximal LAD in diabetic patient (OR=3.91) and non-diabetic patients (OR=2.69) (P<0.05). Conclusion In diabetic
patients, atherosclerosis occurred frequently in the segment proximal to MB in the LAD, and MB in the mid-LAD is an
independent risk factor for CAS in the proximal LAD.