摘要
目的 探讨冠状动脉血流缓慢（SCF）的临床特点及实验室检查的相关性.方法 通过TIMI血流分级法和TIMI帧数法联合判断,入选2008年1月至2009年12月因胸痛等心肌缺血症状于复旦大学附属中山医院心内科行冠状动脉造影（CAG）示心外膜冠状动脉无明显病变但存在SCF的患者共140例,对照组为连续性入选同期行CAG证实心外膜冠状动脉完全正常且血流正常的患者共140例.入院时记录所有研究对象的临床资料,测量并记录糖代谢、脂代谢等实验室指标,并进行统计学分析.结果 （1）SCF组的年龄小于对照组[（57.8±10.7）岁比（59.8±8.2）岁,P〈0.01],糖尿病病史（49.3% 比 30.7%）、目前吸烟率（59.3%比46.4%）均高于对照组（P均〈0.05）,空腹血糖（FBG）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）/高密度脂蛋白胆固醇（HDL-C）（2.76±1.19比2.37±1.14）、载脂蛋白B（apoB）/载脂蛋白A1（apoA1）（0.95±0.27比0.83±0.55）水平高于对照组（P均〈0.05）,HDL-C[（1.05±0.35）mmol/L比（1.42±0.74）mmol/L]和apoA1[（1.10±0.19）mmol/L比（1.31±0.31）mmol/L]水平低于对照组（P均〈0.01）.（2）140例SCF患者中,最常见的血管受累情况是三支血管同时存在SCF（92例）,而最常见的受累血管为右冠状动脉（RCA）（119例）.（3）多因素logistic回归分析显示在调整其他因素的影响后,吸烟（OR=1.92,95% CI：1.04～3.57,P〈0.05）、糖尿病（OR=2.44,95% CI：1.32～4.76,P〈0.01）、FBG异常（OR=2.13,95% CI：1.16～3.98,P〈0.05）、TG（OR=1.47,95% CI：1.03～2.13,P〈0.05）、HDL-C（OR=0.47,95% CI：0.24～0.85,P〈0.05）及apoA1（OR=0.55,95% CI：0.40～0.75,P〈0.01）是发生SCF的独立预测因子.结论 年轻的吸烟患者更容易发生SCF,SCF患者存在糖代谢和脂代谢异常,脂代谢异常表现为TG升高。
Objective To analyze the clinical and angiographic characteristics of patients with slow coronary flow （SCF）. Methods In this retrospective study, 140 patients with SCF and 140 control subjects without SCF were included. SCF were diagnosed by the combination of TIMI flow grade method and TIMI frame count method. All subjects had angiographically normal coronary arteries. The clinical and laboratory data were obtained from medical records at admission. Results Compared to control group, patients with SCF were younger [（57.8±10.7）years vs. （59.8±8.2）years], rate of smokers （59.3% vs. 46.4%） and diabetes mellitus （49.3% vs. 30.7%）, fasting blood glucose （FBG） level [（7.8±2.8） mmol/L vs. （6.2±2.0） mmol/L, P〈0.05] and triglyceride （TG） level [（2.11±1.93） mmol/L vs. （1.67±1.01） mmol/L,P〈0.05] were higher, while high density lipoprotein cholesterol （HDL-C） level [（1.05±0.35） mmol/L vs. （1.42±0.74） mmol/L, P〈0.01] and apolipoprotein A1（apoA1） level [（1.10±0.19）mmol/L vs. （1.31±0.31）mmol/L, P〈0.01] were lower. Among the 140 SCF patients, left anterior descending artery （LAD）, left circumflex artery （LCX） and right coronary artery （RCA） were involved at the same time in 92 patients. Among the three vessels, RCA is the most frequent involved vessel （n=119）. After adjusting for other risk factors, current smoking （OR=1.92,95% CI：1.04-3.57,P〈0.05）, DM history （OR=2.44,95% CI：1.32-4.76,P〈0.01）, FBG （OR=2.13,95% CI：1.16-3.98,P〈0.05）, TG （OR=1.47,95% CI：1.03-2.13,P〈0.05）, HDL-C （OR=0.47,95% CI：0.24-0.85,P〈0.05） and apoA1 （OR=0.55,95% CI：0.40-0.75,P〈0.01） were independent factors for SCF （all P〈0.05）. Conclusions Our results demonstrated that patients with SCF were prone to have a significant metabolic disorder compared to the control group. Patients with high levels of FBG, TG and low levels of HDL-C were more likely to suffer from SCF, which maybe explained by the development of coronary endothelium and microvascular dysfunction
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2011年第7期642-646,共5页
Chinese Journal of Cardiology
