冠心病合并代谢综合征患者冠状动脉粥样硬化的特性  

Coronary atherosclerosis lesion features in coronary artery disease patients complicating with metabolic syndrome

作　　者：高扬[1] 吕滨[1] 侯志辉[1] 曹慧丽 于方方 蒋世良[1] 戴汝平[1] 

机构地区：[1]国家心血管病中心中国医学科学院北京协和医学院阜外心血管病医院放射科心血管疾病国家重点实验室,100037

出　　处：《中华心血管病杂志》2013年第11期935-939,共5页Chinese Journal of Cardiology

基　　金：国家“十一五”科技支撑计划项目（2007BAI05B02）

摘　　要：目的 以冠状动脉CT血管造影（CCTA）和侵入性冠状动脉造影（ICA）为手段,分析其中合并代谢综合征患者冠状动脉粥样硬化斑块负荷和冠状动脉病变特点.方法 连续入选2008年1月至201 1年6月因冠心病或疑诊冠心病在我院3个月内同时行CCTA和ICA检查的患者,排除既往接受冠状动脉旁路移植术（CABG）或直接经皮冠状动脉介入治疗（PCI）者.冠状动脉病变按16节段分析,比较代谢综合征和非代谢综合征2组患者在钙化积分、斑块特征及梗阻性病变程度的差异.结果 共纳入872例患者,平均年龄（60.2±10.0）岁,男性634例（72.70％）.代谢综合征组377例,非代谢综合征组495例.冠状动脉钙化积分中位数为102（10,410）,明显高于非代谢综合征组的58（0,274）（P＜0.01）.与非代谢综合征组比较,代谢综合征组无钙化患者所占比例较低[19.63％（74/377）比30.71％ （152/495）,P＜0.01],而钙化积分≥1000的重度钙化所占比例较高[8.22％（31/377）比4.65％ （23/495）,P=0.03];左主干及各支冠状动脉中远段钙化斑块所占比例较高（P均＜0.05）;单支病变患者所占比例较低[23.61％ （89/377）比36.77％（182/495）,P＜0.01],而二支病变[29.71％ （112/377）比22.83％（113/495）,P＜0.05]和三支病变[35.54％（134/377）比24.44％（121/495）,P＜0.01]所占比例较高.结论 代谢综合征患者冠状动脉重度钙化多,左主干和各支冠状动脉中、远段钙化斑块数显著增高,钙化病变更弥漫,且梗阻性病变累及的血管数更多.Purpose To compare coronary plaque burden, composition, distribution and the degree of coronary artery steuosis in invasive coronary angiography （ICA） diagnosed coronary artery disease （CAD） patients with or without metabolic syndrome （MetS）. Methods From January 2008 to June 2011, consecutive patients underwent both coronary computed tomography angiography （ CCTA ） and ICA within three months were enrolled. Patients with history of previous percutaneous coronary interventions （PCI） and coronary artery bypass grafting （CABG） were excluded. Plaque characteristics and maximal luminal diameter stenosis were analyzed on a 16-segment basis as suggested by the American Heart Association classification. Results The study population consisted of 872 patients [ age （ 60. 2 _＋ 10. 0） years, 72. 70% males ~ including 377 patients with MetS and 495 patients without MetS. The median coronary artery calcium score （CACS） was higher in MetS patients than in non-MetS patients [ 102（10,410） vs. 58（0,274）, P 〈 0. 01 ]. Percentage of patients with no coronary artery calcium was significantly lower in MetS group than in non-MetS group [ 19.63 % （ 74/377 ） vs. 30. 71% （ 152/495 ） , P 〈 0. 01 ] , while percentage of patients with severe coronary calcium （ CACS ≥ 1000 ） were significantly higher in MetS than non-MetS group [ 8.22% （31/377） vs. 4. 65% （23/495）, P = 0. 03 ]. The proportion of patients with 1-vessel disease was lower [23.61% （89/377） vs. 36.77% （182/495） ,P 〈0. 01 ], 2-vessel [29. 71% （112/377） vs. 22. 83% （ 113/495） ,P 〈 0. 05 ~ and 3-vessel disease [ 35.54% （ 134/377 ） vs. 24.44% （ 121/495 ）, P 〈 0.01 ] were higher in Nets group than in non-NetS group. Calcified plaque of LM and the middle and distal coronary artery were significantly higher in MetS group than in non-MetS group （ all P 〈 0. 05 ）. Conclusions CAD patients with MetS are associated with severer coronary artery calcium deposition and higher percentage of c

关 键 词：冠状动脉硬化 代谢综合征X 冠状血管造影术 

分 类 号：R541.4[医药卫生—心血管疾病] R589[医药卫生—内科学]