冠脉血流储备分数的可能影响因素及对冠脉支架置入的指导作用  

Factors affect on fractional flow reserve and the value in guiding stenting

作　　者：孙婧煜 李勋[2] 钱雪松[1] 盛宇峰[1] 朱明辉[1] 孟丽琴[1] 焦念方 周勇[1] Sun Jingyu Li Xun Qian Xuesong Sheng Yufeng Zhu Minghui Meng Liqing Jiao Nianfang Zhou Yong(Department of Cardiology, the First People＇s Hospital of Zhangjiagang City, Zhangjiagang 215600 Department of Cardiology,the First Affiliated Hospital of Soochow University ,Suzhou 215000, China)

机构地区：[1]张家港市第一人民医院心血管内科,江苏张家港215600 [2]苏州大学附属第一医院心血管内科,江苏苏州215000

出　　处：《南京医科大学学报（自然科学版）》2016年第11期1351-1355,1367,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：苏州市青年科研项目(KJXW2014040)

摘　　要：目的 :探讨冠心病患者冠脉血流储备分数(fractional flow reserve,FFR)测值的影响因素及FFR指导支架置入的效果。方法:选择张家港市第一人民医院2012年2月—2015年1月住院的存在反复胸闷胸痛症状、发生急性心梗及既往曾行PCI术并复查冠脉造影的冠心病患者60例,记录年龄、性别、吸烟史,以及血低密度脂蛋白胆固醇(low-density lipoproteincholesterol,LDL-C)、总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)及血糖(blood glucose,BG)等一般资料;全部患者进行冠脉动脉造影,记录狭窄程度及长度,并行FFR测定。根据FFR测定值分为两组:FFR≥0.8组与FFR<0.8组,比较两组患者的一般资料,并分析上述因素与FFR之间的相关性。对FFR<0.8的患者行支架置入术,并测定支架置入术后FFR值,比较支架置入术前后FFR值。随访1年,记录两组患者的心因性再入院、再发心绞痛、再血管化治疗、心律失常、心力衰竭、急性心肌梗死发生情况。结果:160例患者均完成冠状动脉造影和FFR测定,FFR≥0.8组与FFR<0.8组的一般资料比较差异无统计学意义;两组患者的冠脉狭窄程度和狭窄长度存在显著差异(P均<0.001),并且FFR与冠脉狭窄程度和长度呈显著负相关(P均<0.001);2FFR<0.8组,支架置入前后FFR值差异有统计学意义(P<0.001),置入支架后的FFR值与FFR≥0.8组的FFR值相比无显著差异(P=0.085);3根据不同的狭窄程度分别统计左前降支、右冠状动脉、左回旋支的病变数及FFR值并进行比较,结果显示狭窄程度相同的不同血管所测得的FFR值无统计学差异(P均>0.05);4随访结果显示,FFR≥0.8组和FFR<0.8并置入支架组之间再发心绞痛、原有病变再血管化治疗、心律失常和心力衰竭的发生率比较均无显著差异(P均>0.05),两组均无急性心肌梗死的发生。结论:FFR测值与冠状动脉狭窄的程度和长度呈显著负相关;狭窄程度越重,狭窄病变越长,对冠状动脉�Objective：To investigate the factors affect on fractional flow reserve（FFR）,and to evaluate the value of FFR in guiding stenting. Methods：Sixty patients with coronary heart disease and hospitalized in the department of cardiology of the First People ＇s Hospital of Zhangjiagang City from February 2012 to January 2015 were retrospectivly enrolled,including patients with chest tightness and chest pains,suffered acute myocardial infarction and those who underwent coronary angiography again after stenting. General data such as age,gender,smoking history and the levels of low-density lipoprotein-cholestero l（LDL-C）,total cholesterol（TC）,triglyceride（TG）and blood glucose（BG）were recorded. All patients underwent coronary angiography and FFR measurement. The degree of stenosis and length were recorded. Patients were divided into two groups：FFR ≥0.8 and FFR 0.8. General data were compared between the two groups,and the correlations with FFR were analyzed. Stents were implanted only when the FFR0.80,and FFR were measured again when stenting were finished. We compared FFR before and after stenting. The numbers of readmission for cardiac causes,a new episode of angina,revascularization of the target lesion,arrhythmia,heart failure and acute myocardial infarction were recorded and compared between the two groups in the first year. Results： 1All of the 60 patients had completed coronary angiography and FFR measurement. There were no differences of general data between the FFR ≥0.8 group and the FFR 0.8 group. Therewere significant differences of degree of stenosis and the length of stenosis between the two groups（both P〈0.001）,and there were significant negative correlations between FFR and degree of stenosis and the length of stenosis（P〈0.001）.（2）In patients with FFR0.8,there were significant differences in FFR before and after stenting（P〈0.001）. There was no difference of FFR between patients after stenting in the FFR0.8 group and those in the FFR≥0.8 group（P=0.085�

关 键 词：血流储备分数 冠状动脉造影 狭窄程度 狭窄长度 

分 类 号：R541.4[医药卫生—心血管疾病]