中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2011年
7期
642-646
,共5页
戴宇翔%李晨光%黄浙勇%仲昕%钱菊英%刘学波%葛雷%樊冰%王齐冰%张峰%黄东%姚康%马剑英%朱明辉%葛均波
戴宇翔%李晨光%黃浙勇%仲昕%錢菊英%劉學波%葛雷%樊冰%王齊冰%張峰%黃東%姚康%馬劍英%硃明輝%葛均波
대우상%리신광%황절용%중흔%전국영%류학파%갈뢰%번빙%왕제빙%장봉%황동%요강%마검영%주명휘%갈균파
冠状动脉疾病%冠状血管造影术%血脂异常
冠狀動脈疾病%冠狀血管造影術%血脂異常
관상동맥질병%관상혈관조영술%혈지이상
Coronary artery disease%Coronary angiography%Dyslipidemia
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、HDL-C水平下降.
目的 探討冠狀動脈血流緩慢(SCF)的臨床特點及實驗室檢查的相關性.方法 通過TIMI血流分級法和TIMI幀數法聯閤判斷,入選2008年1月至2009年12月因胸痛等心肌缺血癥狀于複旦大學附屬中山醫院心內科行冠狀動脈造影(CAG)示心外膜冠狀動脈無明顯病變但存在SCF的患者共140例,對照組為連續性入選同期行CAG證實心外膜冠狀動脈完全正常且血流正常的患者共140例.入院時記錄所有研究對象的臨床資料,測量併記錄糖代謝、脂代謝等實驗室指標,併進行統計學分析.結果 (1)SCF組的年齡小于對照組[(57.8±10.7)歲比(59.8±8.2)歲,P<0.01],糖尿病病史(49.3% 比 30.7%)、目前吸煙率(59.3%比46.4%)均高于對照組(P均<0.05),空腹血糖(FBG)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)/高密度脂蛋白膽固醇(HDL-C)(2.76±1.19比2.37±1.14)、載脂蛋白B(apoB)/載脂蛋白A1(apoA1)(0.95±0.27比0.83±0.55)水平高于對照組(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]水平低于對照組(P均<0.01).(2)140例SCF患者中,最常見的血管受纍情況是三支血管同時存在SCF(92例),而最常見的受纍血管為右冠狀動脈(RCA)(119例).(3)多因素logistic迴歸分析顯示在調整其他因素的影響後,吸煙(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異常(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)是髮生SCF的獨立預測因子.結論 年輕的吸煙患者更容易髮生SCF,SCF患者存在糖代謝和脂代謝異常,脂代謝異常錶現為TG升高、HDL-C水平下降.
목적 탐토관상동맥혈류완만(SCF)적림상특점급실험실검사적상관성.방법 통과TIMI혈류분급법화TIMI정수법연합판단,입선2008년1월지2009년12월인흉통등심기결혈증상우복단대학부속중산의원심내과행관상동맥조영(CAG)시심외막관상동맥무명현병변단존재SCF적환자공140례,대조조위련속성입선동기행CAG증실심외막관상동맥완전정상차혈류정상적환자공140례.입원시기록소유연구대상적림상자료,측량병기록당대사、지대사등실험실지표,병진행통계학분석.결과 (1)SCF조적년령소우대조조[(57.8±10.7)세비(59.8±8.2)세,P<0.01],당뇨병병사(49.3% 비 30.7%)、목전흡연솔(59.3%비46.4%)균고우대조조(P균<0.05),공복혈당(FBG)、감유삼지(TG)、저밀도지단백담고순(LDL-C)/고밀도지단백담고순(HDL-C)(2.76±1.19비2.37±1.14)、재지단백B(apoB)/재지단백A1(apoA1)(0.95±0.27비0.83±0.55)수평고우대조조(P균<0.05),HDL-C[(1.05±0.35)mmol/L비(1.42±0.74)mmol/L]화apoA1[(1.10±0.19)mmol/L비(1.31±0.31)mmol/L]수평저우대조조(P균<0.01).(2)140례SCF환자중,최상견적혈관수루정황시삼지혈관동시존재SCF(92례),이최상견적수루혈관위우관상동맥(RCA)(119례).(3)다인소logistic회귀분석현시재조정기타인소적영향후,흡연(OR=1.92,95% CI:1.04～3.57,P<0.05)、당뇨병(OR=2.44,95% CI:1.32～4.76,P<0.01)、FBG이상(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)급apoA1(OR=0.55,95% CI:0.40～0.75,P<0.01)시발생SCF적독립예측인자.결론 년경적흡연환자경용역발생SCF,SCF환자존재당대사화지대사이상,지대사이상표현위TG승고、HDL-C수평하강.
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.
