| Objective： In recent years, with people’s living standard rise, thecardiovascular disease increased year by year.With the development ofinterventional techniques, a lot of clinical patients have been saved, but manystudies found that after coronary angioplasty and coronary artery bypasssurgery,25%patients still did not achieve organizational level of myocardialreperfusion.Which makes people pay their attention to myocardialmicrocirculation. The myocardial microcirculation detection technologyincluds corrected TIMI frame count (CTFC), myocardial blush grade(MBG),TIMI myocardial perfusion grade (TMPG), nuclide detection contrastenhancement of nuclear magnetic resonance imaging (MRI), myocardialacoustic imaging(MCE), coronary doppler blood flow measurement.We usethe myocardial acoustic imaging to evaluate myocardial microcirculation.It is well known that coronary heart disease have a lot of risk factors. Ifthe renal artery endothelial damage,the urine trace albumin will appear.It canindicate the changes of renal blood vessels and capillaries pathological, and itis an early manifestation of systemic vascular lesions. In recent years, studieshave shown that increased urine trace albumin is an independent risk factor forcoronary heart disease, we can prevent and control the risk factors to preventand treat the coronary heart disease (CHD).We can put forward hypothesis:is there any relationship betweenmyocardial microcirculation and urine trace albumin?And if they haverelationship,what’s the correlation coefficient.In this research,we discuss thevalue of microalbuminuria in myocardial microcirculation disorder.Methods： Select40patients treated by percutaneous coronaryangiography in the first hospital of shijiazhuang during November2012toNovember2013.According to the results of percutaneous coronary angiography,made all subjects into two groups,one is the coronary group(30subjects included),the other is the control group(10subjects included),thenaccording to the results of myocardial contrast echocardiography,made thecoronary group into two groups:myocardial microcirculation dysfunctiongroup(20subjects included), myocardial microcirculation normal group(10subjects included).Collecting all patients the middle cleaning urine sample inearly morning before coronary angiography, and before collecting the urinesample,the patients should have the light diet at least3days.They are alsoasked for avoiding strenuous activity, and the women patients should avoidthe menstrual period. Use the immune turbidimetric method to measureurinary albumin levels.Exclusion criteria for:1. Allergic to iodine contrast agent and sulfurhexafluoride.2. Don’t want to participants.3. Other heart disease such asrheumatic heart disease, cardiomyopathy, pericarditis.4.The use of ACEI andARB recently and the drugs that influence the level of urine trace albumin.5.The patients that have blood system diseases or cancer.6. Having symptoms ofcardiac insufficiency which causing by a variety of reasons.7.Having urinarysystem diseases such as nephritis, nephrotic syndrome, urinary tractinfection.8.The patiens whose serum creatinine increased significantly andhave the renal insufficiency.9.The patients who have severe obstructivepulmonary disease (COPD) and acoustic conditions that can not obtainsatisfactory image.10. The patients who have serious cardiac arrhythmias suchas atrial fibrillation, more than2degrees of atrioventricular block.11.Thepatients with Acute myocardial infarction within1week and the patients withunstable angina who were Angina pectoris repeatedly in three days.12. Thepatients with severe hypertension.13. The patients with severe heart failure,severe anemia, severe purple purple and severe electrolyte disorder.Each selected object signed informed consent before myocardial contrastechocardiography(MCE), and have stopped using drugs which affectmyocardial contraction force and coronary microcirculation function. Letpatients lie with left side and monitor synchronous ECG. Set the color doppler ultrasonic diagnostic instrument mechanical index to1.3.Recordingcardiac four-chamber view and two-chamber eager image below in base state.After the static ultrasound examination,use contrast myocardial imagingprograms to image. Puncture the middle of the left elbow vein and indwelltrocar, extract contrast agent2ml, inject it within2mins,then inject5mlphysiological salineslowly to push flush. Pay attention to the subjects duringthe process of test.Four cavity, two cavity hearts, in turn, to observe thecardiac apex, left ventricular papillary muscle level short shaft section images,observe the filling of microbubble in heart cavity and intramyocardial. Usehigh mechanical index (flash) ultrasonic launch break microbubbles in themyocardium intermittent,observe the myocardial reperfusion. All patientsobtained satisfactory resulst of left ventricular and myocardial image. Afterthe check, playback sampled dynamic image,analyze the results by twoobservers.According to the left ventricular16segments dividing method tomake quantitative analysis.Aaccording to the results of myocardial acousticimage to score,1point represent contrast agent even fully,（good perfusion）.0.5points represent the contrast agent sparse,0points represent contrastfilling defected（no perfusion）.Results：1The situation of age,sex, lipid, hypertention and DM in thecoronary group and the control group has no significant difference,but themicroalbuminuria lever is higher in the coronary group than in the controlgroup (P<0.05)2The microalbuminuria lever in the myocardial microcirculationdysfunction group(20subjects included)and myocardial microcirculation innormal group are significantly different(P<0.05).3The A、β and A×β lever in the myocardial microcirculationdysfunction group(20subjects included) are lower than the lever in themyocardial microcirculation in normal group,and the difference issignificantly different(P<0.01).4A have negative correlation wih the urine trace albumin,(r=-0.611, P<0.01).、βhave negative correlation wih the urine trace albumin,(r=-0.687, P <0.01).and A*beta have negative correlation wih the urine trace albumin(r=-0.730, P <0.01).Conclusion：the microalbuminuria lever is higher in the myocardialmicrocirculation dysfunction group(20subjects included),and A*beta havenegative correlation wih the urine trace albumin.The results reminde that themicroalbuminuria may participate in the microcirculation dysfunction.As asimple, rapid and non-invasive detection methods, microalbuminuria isexpected to be a predictor of myocardial microcirculation. |
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