[冠状动脉迂曲与冠状动脉微血管疾病之间的关系]

[Relationship between coronary tortuosity and coronary microvascular disease].

作者信息

Wang Z Y, Wang Y B, Hao G Z, Jiang Y F, Gu X S, Fan W Z, Gong Q, Wang Q, Fu X H

机构信息

Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2018 May 24;46(5):359-363. doi: 10.3760/cma.j.issn.0253-3758.2018.05.007.

DOI:10.3760/cma.j.issn.0253-3758.2018.05.007

PMID:29804437

Abstract

To explore the relationship between coronary tortuosity and coronary microvascular disease (CMVD). Patients with typical angina symptoms and without serious coronary artery stenosis by coronary angiography were enrolled from June 2014 to December 2016, and CMVD was diagnosed by single photon emission tomography (SPECT). According to the SPECT results, patients were divided to the CMVD group and non-CMVD group. The baseline clinical characteristics, results of coronary angiography were compared between the two groups. The logistic analysis was used to analyze the relationship between coronary tortuosity and CMVD. A total of 117 cases were enrolled, with 69 cases in the CMVD group and 48 cases in the non-CMVD group. No differences were found in gender distribution, age, hypertension, lipid abnormality, hyperuricemia and uses of statins between the two groups (all >0.05). Incidence of diabetes (78.26%(54/69) vs. 35.42% (17/48) , <0.05), hs-CRP ((4.29±2.15)mmol/L vs. (2.63±1.20)mmol/L, <0.001), LDL-C ((2.98±0.96)mmol/L vs. (2.52±0.83)mmol/L, 0.008) and homocysteine ((13.7±5.61)mmol/L vs. (11.5±4.38)mmol/L, 0.025) levels were higher in the CMVD group than in the non-CMVD group. The data derived from echocardiographic examination were similar between the two groups. The Corrected TIMI frame counts were higher in the CMVD group than in non-CMVD group (LAD: 31.56±4.92 vs. 27.31±3.75, LCX: 29.47±4.18 vs. 26.62±3.19, RCA: 29.09±5.05 vs. 26.24±3.28, all <0.001). The incidences of coronary atherosclerosis (76.81% (53/69) vs. 27.08% (13/48) , <0.001) and coronary tortuosity ( (60.87% (42/69) vs. 33.33% (16/48) , 0.035) were also higher in the CMVD group than in non-CMVD group. Logistic analysis found that coronary tortuosity (6.111, 95% 2.707-13.794, <0.001), diabetes (6.565, 95% 2.883-14.948, <0.001) and coronary atherosclerosis (8.918, 95% 3.822-20.808, <0.001) were independent risk factors of CMVD. Coronary tortuosity, diabetes and coronary atherosclerosis are related to CMVD in this patient cohort.

摘要

探讨冠状动脉迂曲与冠状动脉微血管疾病（CMVD）之间的关系。选取2014年6月至2016年12月期间有典型心绞痛症状且冠状动脉造影无严重冠状动脉狭窄的患者，采用单光子发射断层扫描（SPECT）诊断CMVD。根据SPECT结果，将患者分为CMVD组和非CMVD组。比较两组患者的基线临床特征及冠状动脉造影结果。采用logistic分析探讨冠状动脉迂曲与CMVD的关系。共纳入117例患者，其中CMVD组69例，非CMVD组48例。两组患者在性别分布、年龄、高血压、血脂异常、高尿酸血症及他汀类药物使用情况方面均无差异（均>0.05）。CMVD组糖尿病发病率（78.26%（54/69）对35.42%（17/48），<0.05）、超敏C反应蛋白（hs-CRP）水平（（4.29±2.15）mmol/L对（2.63±1.20）mmol/L，<0.001）、低密度脂蛋白胆固醇（LDL-C）水平（（2.98±0.96）mmol/L对（2.52±0.83）mmol/L，0.008）及同型半胱氨酸水平（（13.7±5.61）mmol/L对（11.5±4.38）mmol/L，0.025）均高于非CMVD组。两组超声心动图检查数据相似。CMVD组校正的心肌梗死溶栓治疗（TIMI）帧数高于非CMVD组（左前降支：31.56±4.92对27.31±3.75，左旋支：29.47±4.18对26.62±3.19，右冠状动脉：29.09±5.05对26.24±3.28，均<0.001）。CMVD组冠状动脉粥样硬化发生率（76.81%（53/69）对27.08%（13/48），<0.001）及冠状动脉迂曲发生率（60.87%（42/69）对33.33%（16/48），0.035）也高于非CMVD组。logistic分析发现冠状动脉迂曲（6.111，95%可信区间2.707 - 13.794，<0.001）、糖尿病（6.565，95%可信区间2.883 - 14.948，<0.001）及冠状动脉粥样硬化（8.918，95%可信区间3.822 - 20.808，<0.001）是CMVD的独立危险因素。在该患者队列中，冠状动脉迂曲、糖尿病及冠状动脉粥样硬化与CMVD相关。