Qin Yuhan, Tang Chengchun, Ma Changle, Yan Gaoliang
Medical Department, Southeast University.
Department of Cardiovascular, Zhongda Hospital affiliated to Southeast University, Nanjing, People's Republic of China.
Coron Artery Dis. 2019 May;30(3):211-215. doi: 10.1097/MCA.0000000000000709.
Coronary artery ectasia (CAE) is the aneurysmal dilatation of the coronary artery, recognized as a special clinical form of coronary stenosis besides atherosclerosis. Its exact pathophysiological mechanism remains unknown. Moreover, few studies have focused on the relationship between triglyceride and CAE. We aimed to find the risk factors for CAE and analyze the relationship between serum lipid and CAE.
We conducted a prospective cohort study on patients admitted because of typical or atypical chest discomfort suggestive of angina in Zhongda Hospital affiliated to Southeast University from January 2010 to June 2018. We included 100 consecutive patients with CAE; the control group included 100 consecutive patients with coronary atherosclerosis and no ectasia. We recorded and compared the general data, cardiovascular risk factors, blood examination index, and coronary angiography data between the two groups. t-Test, Mann-Whitney U-test, χ-test, logistic regression analysis, and receiver operating characteristic curve analysis were used for statistical analysis to assess the risk factors for CAE and analyze the relationship between hyperlipidemia and CAE.
Sex, weight, BMI, diastolic blood pressure, hypertension, hemoglobin, D-dimer, triglyceride, total cholesterol, and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio were significantly higher in the CAE group than in the control group (P=0.0028, 0.001, <0.001, <0.001, 0.008, <0.001, 0.050, <0.001, 0.043, and 0.004, respectively). Logistic regression analysis showed that sex, BMI, diastolic blood pressure, D-dimer, triglyceride, and LDL/HDL ratio were independent risk factors for CAE [odds ratio (OR)=2.076, 95% confidence interval (CI)=1.232-2.673, P=0.016; OR=1.184, 95% CI=1.607-1.436, P<0.001; OR=1.177, 95% CI=1.026-1.264, P=0.007; OR=1.004, 95% CI=1.002-1.007, P=0.019; OR=3.736, 95% CI=2.028-6.883, P<0.001; and OR=1.569, 95% CI=1.229-2.419, P=0.026, respectively]. The receiver operating characteristic curve for the model combining triglyceride with LDL/HDL ratio for predicting CAE showed an area under the curve of 0.706 and 95% CI of 0.634-0.778 (P<0.001). Sex, BMI, diastolic blood pressure, D-dimer, and triglyceride combined with LDL/HDL ratio have a better predictive value for CAE (area under the curve=0.898, 95% CI=0.849-0.947, P<0.001).
Sex, BMI, diastolic blood pressure, D-dimer, triglyceride, and LDL/HDL ratio are all risk factors for CAE. Hyperlipidemia has a good predictive value for CAE.
冠状动脉扩张（CAE）是冠状动脉的瘤样扩张，被认为是除动脉粥样硬化之外冠状动脉狭窄的一种特殊临床形式。其确切的病理生理机制尚不清楚。此外，很少有研究关注甘油三酯与CAE之间的关系。我们旨在寻找CAE的危险因素，并分析血脂与CAE之间的关系。
我们对2010年1月至2018年6月在东南大学附属中大医院因典型或非典型胸痛提示心绞痛而入院的患者进行了一项前瞻性队列研究。我们纳入了100例连续的CAE患者；对照组纳入了100例连续的冠状动脉粥样硬化且无扩张的患者。我们记录并比较了两组患者的一般资料、心血管危险因素、血液检查指标和冠状动脉造影数据。采用t检验、Mann-Whitney U检验、χ检验、逻辑回归分析和受试者工作特征曲线分析进行统计分析，以评估CAE的危险因素并分析高脂血症与CAE之间的关系。
CAE组的性别、体重、BMI、舒张压、高血压、血红蛋白、D-二聚体、甘油三酯、总胆固醇以及低密度脂蛋白/高密度脂蛋白（LDL/HDL）比值均显著高于对照组（P分别为0.0028、0.001、<0.001、<0.001、0.008、<0.001、0.050、<0.001、0.043和0.004）。逻辑回归分析显示，性别、BMI、舒张压、D-二聚体、甘油三酯和LDL/HDL比值是CAE的独立危险因素[比值比（OR）分别为2.076，95%置信区间（CI）为1.232 - 2.673，P = 0.016；OR = 1.184，95% CI = 1.607 - 1.436，P < 0.001；OR = 1.177，95% CI = 1.026 - 1.264，P = 0.007；OR = 1.004，95% CI = 1.002 - 1.007，P = 0.019；OR = 3.736，95% CI = 2.028 - 6.883，P < 0.001；OR = 1.569，95% CI = 1.229 - 2.419，P = 0.026]。甘油三酯与LDL/HDL比值联合预测CAE的受试者工作特征曲线显示曲线下面积为0.706，95% CI为0.634 - 0.778（P < 0.001）。性别、BMI、舒张压、D-二聚体以及甘油三酯与LDL/HDL比值联合对CAE具有更好的预测价值（曲线下面积 = 0.898，95% CI = 0.849 - 0.947，P < 0.001）。
性别、BMI、舒张压、D-二聚体、甘油三酯和LDL/HDL比值均为CAE的危险因素。高脂血症对CAE具有良好的预测价值。
