冠状动脉慢血流患者危险因素分析及临床随访  

The risk factors and clinical follow-up of 236 patients with slow coronary flow

作　　者：张伟[1] 孙中华[1] 米杰[1] 罗欢[1] 樊瑞娟[1] 张春晓[1] 齐向前[1] 

机构地区：[1]泰达国际心血管病医院天津医科大学心血管病临床学院心内二科,天津300457

出　　处：《中华急诊医学杂志》2014年第2期204-208,共5页Chinese Journal of Emergency Medicine

摘　　要：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；�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 even

关 键 词：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 

分 类 号：R541.4[医药卫生—心血管疾病]