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血脂异常及性别与冠状动脉计算机断层扫描血管造影评估的冠状动脉钙化的关联

Association of Dyslipidemia and Sex With Coronary Artery Calcium Assessed by Coronary Computed Tomography Angiography.

作者信息

Asami Masahiko, Yamaji Kyohei, Aoki Jiro, Tanimoto Shuzou, Watanabe Mika, Horiuchi Yu, Furui Koichi, Kato Nahoko, Hara Kazuhiro, Tanabe Kengo

机构信息

Division of Cardiology, Mitsui Memorial Hospital.

Department of Cardiology, Bern University Hospital.

出版信息

Int Heart J. 2017 Oct 21;58(5):695-703. doi: 10.1536/ihj.16-481. Epub 2017 Sep 30.

Abstract

Previous studies reporting that statin increases coronary artery calcium (CAC) were conducted exclusively on patients with statin as a prevention, regardless of the presence or absence of dyslipidemia. The impact of sex on CAC has not been fully evaluated. We aimed to determine the association of dyslipidemia and sex with CAC using 320-row multi-detector computed tomography (MDCT).Of the 356 consecutive patients who underwent coronary MDCT, 251 patients were enrolled, after excluding those with prior stenting and/or coronary bypass grafting or images showing motion artifacts. The primary outcome measures were the percent calcium volume (PCV) and percent atheroma volume (PAV) per coronary vessel.Multivariable analyses indicated that PCV was significantly higher in dyslipidemia patients without statins than in the subjects without dyslipidemia [partial regression coefficient (PRC): 2.59, 95% confidence interval (CI): 0.83 to 4.34, P = 0.004]. In contrast, PCV was similar in dyslipidemia patients taking statins and those without dyslipidemia (PRC: -1.09, 95% CI: -2.82 to 0.65, P = 0.22). There was no significant difference in PCV between men and women, although women exhibited a significantly lower PAV (PRC: -2.87, 95% CI: -4.54 to -1.20, P = 0.001).In low-risk patients, these results could be translated into hypotheses, which should be tested in future prospective studies. Furthermore, there was no significant difference in CAC between men and women, but women had lower PAV than men.

摘要

以往报道他汀类药物会增加冠状动脉钙化(CAC)的研究仅针对将他汀类药物作为预防手段的患者,而不论其是否存在血脂异常。性别对CAC的影响尚未得到充分评估。我们旨在使用320排多层螺旋CT(MDCT)来确定血脂异常和性别与CAC之间的关联。

在356例连续接受冠状动脉MDCT检查的患者中,排除那些曾接受过支架置入和/或冠状动脉搭桥手术或图像显示有运动伪影的患者后,纳入了251例患者。主要观察指标是每条冠状动脉血管的钙化体积百分比(PCV)和动脉粥样硬化体积百分比(PAV)。

多变量分析表明,未服用他汀类药物的血脂异常患者的PCV显著高于无血脂异常的受试者[偏回归系数(PRC):2.59,95%置信区间(CI):0.83至4.34,P = 0.004]。相比之下,服用他汀类药物的血脂异常患者和无血脂异常的患者的PCV相似(PRC:-1.09,95% CI:-2.82至0.65,P = 0.22)。男性和女性的PCV没有显著差异,尽管女性的PAV显著较低(PRC:-2.87,95% CI:-4.54至-1.20,P = 0.001)。

在低风险患者中,这些结果可以转化为假设,应在未来的前瞻性研究中进行检验。此外,男性和女性的CAC没有显著差异,但女性的PAV低于男性。

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