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目的探讨经冠状动脉超声心肌声学造影(myocardial contrast echocardiography,MCE)评价非完全闭塞性冠状动脉的狭窄程度与心肌灌注水平二者关系时,定性与定量分析方法的特点。方法35例住院患者行选择性冠状动脉造影,检测冠状动脉病变程度;经冠状动脉注射造影剂行实时MCE,采用记分的方式对结果进行视觉定性分析,并由定量分析得到以下参数造影剂峰值密度(A)、曲线下面积(area under the curve,AUC)、峰值时间(time to peak intensity,TP);利用统计学方法对相应心肌节段的组织灌注情况进行分析。结果35例患者冠状动脉造影正常6例(17%),其余29例(83%)至少有1支血管狭窄≥50%;MCE检测210个心肌节段中有167个(79.6%)获得较满意图像,定性分析从中发现异常心肌灌注节段17个(12.2%),均来自病变组;而定量分析显示,与正常组比较,轻度狭窄组无明显变化,中度狭窄组AUC明显降低(P<0.05),重度狭窄组A、AUC和TP值均产生显著变化(P<0.05)。结论MCE定性分析能直观检测病变血管所对应心肌的异常灌注状况,而定量分析能更好的反映病变血管与心肌灌注水平的关系。
Objective To investigate the characteristics of qualitative and quantitative methods for assessing the relationship between the degree of myocardial stenosis and the degree of stenosis of coronary artery by using coronary contrast echocardiography (MCE). Methods 35 cases of hospitalized patients underwent selective coronary angiography to detect the degree of coronary artery lesions; the injection of contrast agent through the coronary artery real-time MCE, the results were visually and qualitatively analyzed by scoring, and quantitative analysis of the following parameters contrast agent peak densities (A), area under the curve (AUC) and time to peak intensity (TP). The tissue perfusion of corresponding myocardial segments was analyzed by statistical method. Results Of the 35 patients, 6 (17%) had normal coronary angiography and the remaining 29 (83%) had at least 1 vessel stenosis ≥50%. MCE was found to be satisfactory in 210 myocardial segments (79.6%) According to the image and qualitative analysis, 17 (12.2%) of the abnormal myocardial perfusion segments were found in the lesion group. Quantitative analysis showed no significant change in mild stenosis group compared with the normal group <0.05). The A, AUC and TP values of severe stenosis group had significant changes (P <0.05). Conclusions MCE qualitative analysis can directly detect abnormal perfusion of myocardium corresponding to diseased vessels, and quantitative analysis can better reflect the relationship between diseased vessels and myocardial perfusion.