不同冠状动脉狭窄程度评估方法对无症状性脑梗死的预测价值

摘要

Objective To investigate the predictive value of different evaluation index of coronary artery stenosis to silent cerebral infarcts ( SCI). Methods Patients with coronary heart disease(CHD)undergone coronary angiography from June 2009 to February 2009 and brain CT or MRI around 1 year were continuously enrolled. Patients with overt cerebral infarcts were excluded. Gensini score was used to evaluate coronary ar-tery lesion severity. Results 50 patients were enrolled in this study,with the age of(62 ± 10)years old,including 31 men and 19 women,and 17 patients suffered from SCI. According to coronary artery occlusion counts,patients were divided into single coronary lesion group and multivessel lesion group(including double branch lesions,three branch lesions and left main coronary artery lesion),and the single/ double branch lesion group and three lesion group(including three branch lesions and left main coronary artery lesion). No matter how to group,there was no signifi-cant difference between the two groups in SCI incidence. When patients were divided into the Gensini score ﹤ 32 group and Gensini score ≥32 group,the incidence of SCI had no significant difference either. However,the incidence of SCI in the Gensini score ≥48 group was remarkably higher than Gensini score ﹤ 48 group( P ﹤ 0. 05). Conclusion Coronary artery lesion count was not an index to distinguish the high risk of SCI in CHD patients,however,coronary Gensini score ≥48(equaled to three coronary artery occlusion between 76℅ and 90℅ )was an important risk factor as a forecast of silent cerebral infarcts in CHD patients.%目的：探讨不同冠脉狭窄程度的评价指标对无症状性脑梗死的预测价值。方法连续入选于2009年6月至2010年2月行冠脉造影证实为冠心病，同时冠脉造影前后1年内行头颅 CT 或 MRI 的患者，排除症状性脑梗死的患者，采用 Gensini 评分评估冠状动脉病变程度。结果共入选50例病人，平均年龄62±10岁，其中男性31例，女性19例；无症状性脑梗死17例。根据冠状动脉病变支数将入组病人分为单支病变组和多支病变组（包括双支病变、三支病变和左主干病变），以及单双支病变组和三支病变组（包括三支病变和左主干病变），结果显示无论哪种分组方法，两组之间无症状性脑梗死发病率均无显著差异（ P ﹥0.05）。将病人分为 Gensini 评分﹤32和 Gensini 评分≥32两组，结果显示两组之间无症状脑梗死发病率无显著差异（ P ﹥0.05）。但是 Gensini 评分≥48组病人无症状性脑梗死发病率明显高于 Gensini 评分﹤48组，差异有显著性（ P ﹤0.05）。结论冠脉病变支数不能作为预测无症状性脑梗死高危患者的指标，冠脉 Gensini 评分≥48（相当于三支冠状动脉近段76℅~90℅狭窄程度）是冠心病患者中预测无症状性脑梗死高危患者的重要指标。