中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
2期
204-208
,共5页
张伟%孙中华%米杰%罗欢%樊瑞娟%张春晓%齐向前
張偉%孫中華%米傑%囉歡%樊瑞娟%張春曉%齊嚮前
장위%손중화%미걸%라환%번서연%장춘효%제향전
慢血流%TIMI帧数%冠脉造影术%危险因素%发病机制%随访%预后%治疗
慢血流%TIMI幀數%冠脈造影術%危險因素%髮病機製%隨訪%預後%治療
만혈류%TIMI정수%관맥조영술%위험인소%발병궤제%수방%예후%치료
Slow coronary flow%TIMI frame count%Coronary angiography%Risk factors%Pathogenesis%Follow-up%Prognosis%Therapy
目的 探讨冠状动脉慢血流(slow coronary flow,SCF)现象的危险因素；通过随访了解SCF患者的预后及导致不良预后的高危因素.方法 回顾性分析2006年1月至2010年12月在泰达国际心血管病医院因可疑冠心病而行冠脉造影的患者17 390例,试验组为通过TIMI帧数法筛选的冠状动脉正常但冠状动脉血流缓慢的患者236例(1.36％)；对照组为同期(40 ～50例/年)连续性入选的冠状动脉正常且血流速度正常的患者240例.通过logistic回归分析探讨导致SCF的危险因素,并对所有研究对象于2012年3月至4月进行随访,了解其不良事件(急性冠脉综合征、恶性心律失常、猝死)的发生情况及导致不良事件的高危因素.结果 (1) SCF组男性比例(76.69％ vs.42.08％,P=0.000)、吸烟率(58.48％ vs.27.50％,P=0.000)、体质量指数.[(26.78±3.75) vs.926.13±3.20),P=0.043]、血尿酸浓度[(344.90±86.18) μmol/L vs.(304.43±76.44)μmol/L,P=0.000]、血肌酐浓度[(68.27±15.10) μmol/L vs.(60.92±13.17) μmol/L,P=0.000],甘油三酯水平[(1.85±1.23) mmol/Lvs.(1.65±0.81) mmol/L,P =0.037]均高于对照组,而年龄[(55.61±8.15)岁vS.(58.86±8.56)岁,P=0.000]、高密度胆固醇水平[(1.14±0.28) mmol/Lvs.(1.19 ±0.30) mmol/L,P=0.048]低于对照组.(2)多因素logistic回归分析显示,男性、吸烟、高体质量指数、高尿酸是SCF发生的独立预测因子.(3) SCF现象在冠状动脉的分布情况:单支病变7.29％,双支病变26.04％,三支病变66.67％,以三支受累最常见.(4)于2012年3月至4月进行随访,随访过程中发现,SCF组2例(0.8％)患者发生恶性心律失常,1例(0.4％)患者发生急性冠脉综合征(ACS),无猝死事件.对照组均无上述事件的发生.结论 年轻的男性吸烟者更容易发生SCF,较高的体质量指数及血尿酸水平也是SCF的独立危险因素；慢血流现象以三支冠脉同时受累最常见；随访发现恶性心律失常及ACS事件均发生于慢血流组.
目的 探討冠狀動脈慢血流(slow coronary flow,SCF)現象的危險因素；通過隨訪瞭解SCF患者的預後及導緻不良預後的高危因素.方法 迴顧性分析2006年1月至2010年12月在泰達國際心血管病醫院因可疑冠心病而行冠脈造影的患者17 390例,試驗組為通過TIMI幀數法篩選的冠狀動脈正常但冠狀動脈血流緩慢的患者236例(1.36％)；對照組為同期(40 ～50例/年)連續性入選的冠狀動脈正常且血流速度正常的患者240例.通過logistic迴歸分析探討導緻SCF的危險因素,併對所有研究對象于2012年3月至4月進行隨訪,瞭解其不良事件(急性冠脈綜閤徵、噁性心律失常、猝死)的髮生情況及導緻不良事件的高危因素.結果 (1) SCF組男性比例(76.69％ vs.42.08％,P=0.000)、吸煙率(58.48％ vs.27.50％,P=0.000)、體質量指數.[(26.78±3.75) vs.926.13±3.20),P=0.043]、血尿痠濃度[(344.90±86.18) μmol/L vs.(304.43±76.44)μmol/L,P=0.000]、血肌酐濃度[(68.27±15.10) μmol/L vs.(60.92±13.17) μmol/L,P=0.000],甘油三酯水平[(1.85±1.23) mmol/Lvs.(1.65±0.81) mmol/L,P =0.037]均高于對照組,而年齡[(55.61±8.15)歲vS.(58.86±8.56)歲,P=0.000]、高密度膽固醇水平[(1.14±0.28) mmol/Lvs.(1.19 ±0.30) mmol/L,P=0.048]低于對照組.(2)多因素logistic迴歸分析顯示,男性、吸煙、高體質量指數、高尿痠是SCF髮生的獨立預測因子.(3) SCF現象在冠狀動脈的分佈情況:單支病變7.29％,雙支病變26.04％,三支病變66.67％,以三支受纍最常見.(4)于2012年3月至4月進行隨訪,隨訪過程中髮現,SCF組2例(0.8％)患者髮生噁性心律失常,1例(0.4％)患者髮生急性冠脈綜閤徵(ACS),無猝死事件.對照組均無上述事件的髮生.結論 年輕的男性吸煙者更容易髮生SCF,較高的體質量指數及血尿痠水平也是SCF的獨立危險因素；慢血流現象以三支冠脈同時受纍最常見；隨訪髮現噁性心律失常及ACS事件均髮生于慢血流組.
목적 탐토관상동맥만혈류(slow coronary flow,SCF)현상적위험인소；통과수방료해SCF환자적예후급도치불량예후적고위인소.방법 회고성분석2006년1월지2010년12월재태체국제심혈관병의원인가의관심병이행관맥조영적환자17 390례,시험조위통과TIMI정수법사선적관상동맥정상단관상동맥혈류완만적환자236례(1.36％)；대조조위동기(40 ～50례/년)련속성입선적관상동맥정상차혈류속도정상적환자240례.통과logistic회귀분석탐토도치SCF적위험인소,병대소유연구대상우2012년3월지4월진행수방,료해기불량사건(급성관맥종합정、악성심률실상、졸사)적발생정황급도치불량사건적고위인소.결과 (1) SCF조남성비례(76.69％ vs.42.08％,P=0.000)、흡연솔(58.48％ vs.27.50％,P=0.000)、체질량지수.[(26.78±3.75) vs.926.13±3.20),P=0.043]、혈뇨산농도[(344.90±86.18) μmol/L vs.(304.43±76.44)μmol/L,P=0.000]、혈기항농도[(68.27±15.10) μmol/L vs.(60.92±13.17) μmol/L,P=0.000],감유삼지수평[(1.85±1.23) mmol/Lvs.(1.65±0.81) mmol/L,P =0.037]균고우대조조,이년령[(55.61±8.15)세vS.(58.86±8.56)세,P=0.000]、고밀도담고순수평[(1.14±0.28) mmol/Lvs.(1.19 ±0.30) mmol/L,P=0.048]저우대조조.(2)다인소logistic회귀분석현시,남성、흡연、고체질량지수、고뇨산시SCF발생적독립예측인자.(3) SCF현상재관상동맥적분포정황:단지병변7.29％,쌍지병변26.04％,삼지병변66.67％,이삼지수루최상견.(4)우2012년3월지4월진행수방,수방과정중발현,SCF조2례(0.8％)환자발생악성심률실상,1례(0.4％)환자발생급성관맥종합정(ACS),무졸사사건.대조조균무상술사건적발생.결론 년경적남성흡연자경용역발생SCF,교고적체질량지수급혈뇨산수평야시SCF적독립위험인소；만혈류현상이삼지관맥동시수루최상견；수방발현악성심률실상급ACS사건균발생우만혈류조.
Objective To investigate the risk factors of slow coronary flow (SCF) phenomenon; To study the prognosis of SCF patients and analyze the high risk factors of adverse events by follow-up.Methods 17930 patients were analyzed retrospectively who had undergone routine coronary angiography because of suspected coronary artery disease at TEDA International Cardiovascular Hospital from January 2006 to December 2010.By Thrombolysis in myocardial infarction Frame Count method,236 patients with normal coronary artery but slow coronary flow were enrolled in the SCF group and 240 patients with normal coronary artery and normal coronary flow (40-50patients per year) were enrolled in the control group.After that,the risk factors leading to SCF were analyzed by the multivariate logistic regression analysis and all patients were followed up from March 2012 to April 2012 to know about the incidence of adverse events (acute coronary syndrome,malignant arrhythmia and sudden cardiac death) and the high risk factors leading to the adverse events.Results (1) Compared to the patients in the control group,the patients in SCF group have higher percentage of male (76.69％ vs.42.08％,P =0.000) 、rate of smokers (58.48％ vs.27.50％,P =0.000) 、BMI (26.78 ±3.75 vs.26.13 ±3.20,P =0.043) 、serum uric acid (344.90 ± 86.18 vs.304.43 ±76.44,P =0.000) 、serum creatinine (68.27 ± 15.10 vs.60.92 ± 13.17,P =0.000)、triglyceride (1.85 ± 1.23 vs.1.65 ± 0.81,P =0.037) but younger age and lower high density lipoprotein cholesterol (1.14 ± 0.28 vs.1.19 ± 0.30,P =0.048).(2) By multivariate logistic regression analysis,male,smoking status,hiah BMI and serum uric acid are all independent factors for SCF.(3) The SCF phenomenon noted in lvessel,2 vessels and 3 vessels accounted for 7.29％,26.04％,66.67％,respectively.(4) During the follow-up,2 patients with malignant arrhythmia and 1 patients with ACS were found in SCF group,no sudden cardiac death took place.None of the adverse events happened in the control group.Conclusions Younger male smokers are prone to have SCF,high BMI and serum uric acid are also independent factors for SCF; The SCF phenomenon is most common in three coronary arteries.Both malignant arrhythmia and acute coronary syndrome took place in the SCF group in the follow-up.
