冠状动脉微循环阻力指数与传统心血管危险因素、Hcy及LP-PLA2的相关性研究  

Correlational study between index of microcirculatory resistance and coronary risk factors, homocysteine and lipoprotein associated phospholipase

作　　者：岑锦明[1] 杨希立[1] 郭军[2] 张爱东[2] 熊卿圆 梁茜[1] 张健瑜[1] 李健[1] 蔡炜标[1] 梅百强[1] 许兆延[1] Jin-ming Cen;Xi-li Yang;Jun Guo;Ai-dong Zhang;Qing-yuan Xiong;Qian Liang;Jian-yu Zhang;Jian Li;Wei-biao Cai;Bai-qiang Mei;Zhao-yan Xu(Department of Cardiovascular Medicine,Foshan Municipal First People’s Hospital,Foshan, Guangdong 528000,China;Department of Cardiovascular Medicine,the first Affiliated Hospital of Jinan University,Guangzhou,Guangdong 510632,China;Department of laboratory medicine,the Chancheng District Central Hospital of Foshan,Foshan,Guangdong 528031,China)

机构地区：[1]广东省佛山市第一人民医院心血管内科,广东佛山528000 [2]暨南大学附属第一医院心血管内科,广东广州510632 [3]广东省佛山市禅城区中心医院检验科,广东佛山528031

出　　处：《中国现代医学杂志》2018年第33期64-70,共7页China Journal of Modern Medicine

基　　金：广东省佛山市卫生和计生局医学科研项目(No:20160062);广东省佛山医学类科技攻关项目(No:2015AB00315)

摘　　要：目的探讨冠状动脉(冠脉)微循环障碍与LP-PLA2、Hcy的相关性,以及其发生、发展的相关危险因素。方法 63例冠脉造影显示临界病变(狭窄40%～70%,且测量冠脉血流储备分数(FFR)>0.8),冠脉造影术后测量前降支微循环阻力指数(IMR)值,以IMR中位数为界分为IMR正常组(<21.3 u)和IMR升高组(≥21.3 u)。分别记录和测定两组一般资料、相关生化指标、心血管疾病危险因素和血浆脂蛋白相关磷脂酶A2(LP-PLA2)及同型半胱氨酸(Hcy)值,分析各指标与IMR的关系。结果 63例患者完成IMR测量,IMR范围:6.5～42.3 u,中位数:21.3 u,与正常组比较,IMR升高组HDL-C和CFR更低,而Hcy和年龄较高(P <0.05);IMR值与Hcy、年龄及LDL-C(r=0.263)呈正相关(P <0.05),与CFR、HDL-C呈负相关(P <0.05),与LPLPA2水平无相关性(P>0.05);多因素logistic回归分析显示,年龄、Hcy是IMR升高的危险因素(P <0.05),HDL-C、CFR是IMR升高的保护因素(P <0.05)。结论 (1) FFR>0.8的冠脉临界病变中,CFR可作为评估冠脉微循环的指标;(2)年龄和Hcy是冠脉微循环障碍的危险因素,CFR和HDL-C是冠脉微循环的保护因素;(3)年龄的增长、HDL-C水平的降低和Hcy可能参与冠脉微循环障碍的病理过程,导致IMR值升高。Objective To investigate clinical application and risk factors of index of microcirculatory resistance(IMR).Methods A total of 63 patients who were admitted into our hospital from August 2014 to April 2017 were involved in this study.All patients manifested with syndrome of myocardial ischemia but artery angiography suggested intermediate coronary arterial lesions(stenosis between 40%-70%)and FFR>0.8.IMR and CFR was measured in target coronary artery and all patients were divided into 2 groups based on IMR:normal group in which patients had IMR<21.3 u,and abnormal group in which patients had IMR>21.3 u.The general and clinical information as well as levels of LP-PLA2 and Hcy were recorded.Results IMR ranged from 6.5 to 42.3 U.Patients in abnormal group showed decreased levels of HDL-C and CFR while increased levels of Hcy and age when compared with those in normal group[(1.21±0.33)mmol/L vs(1.51±0.33)mmol/L,P<0.05;(2.20±0.49)vs(2.71±0.52),P<0.05;(17.33±3.67)μmol/L vs(14.74±4.50)μmol/L,P<0.05;(66.0±9.67)yrs vs(58.0±8.05)yrs,P<0.05].IMR was positively related to Hcy(r=0.510,P<0.05),age(r=0.376,P<0.05),and LDL-C(r=0.263,P<0.05)while negatively related to CFR(r=-0.520,P<0.05)and HDL-C(r=-0.559,P<0.05).No obvious correlation between IMR and LP-PLA2,male history,history of diabetes mellitus,smoking history,HbA1c,BMI,FBG,TC or TG was identified(P>0.05).Multivariable logistic regression analysis showed that age[O^R=1.090,(95%Cl:1.012,1.173),P=0.023]and Hcy[O^R=1.016,(95%Cl 0.841,1.228),P=0.027]were independent risk factors of IMR.HDL-C[O^R=0.095,(95%Cl:0.015,0.614),P=0.013]and CFR[O^R=0.201,(95%Cl:0.048,0.848),P=0.029]were independent protective factors of IMR.Conclusion CFR may be an indicator of coronary microcirculation dysfunction when FFR>0.8;Hcy and age are independent risk factors while HDL-C levels and CFR are independent protective factors of coronary microcirculation dysfunction.

关 键 词：冠状动脉微循环障碍 微循环阻力指数 同型半胱氨酸 脂蛋白相关磷脂酶A2 

分 类 号：R543.3[医药卫生—心血管疾病]