冠状动脉迂曲冠状动脉粥样硬化和糖尿病对CMVD发生的影响研究  

Study on Effects of Coronary Tortuosity, Diabetes Mellitus and Coronary Atherosclerosis on the Occurrence of Cmvd

作　　者：洪钰锟 李起栋[1] 黄丹 凌宏量 曹明智 赵卫云 HONG Yukun;LI Qidong;HUANG Dan(171th Hospital of PLA, Jiangxi Jiujiang 332000, China)

机构地区：[1]解放军第171医院心血管二科

出　　处：《河北医学》2019年第12期2004-2008,共5页Hebei Medicine

基　　金：江西省自然科学基金资助项目,(编号:20171BAB304809)

摘　　要：目的:研究冠状动脉迂曲、冠状动脉粥样硬化(CA)和糖尿病对冠状动脉微血管病变(CMVD)发生的影响。方法:采用回顾性研究,收集本院2014年6月至2019年6月257例具有典型心绞痛症状,行冠状动脉造影提示无冠状动脉明显狭窄患者的临床资料,按照静息负荷心肌灌注显像结果,分为A组(无CMVD)105例和B组(发生CMVD)152例。比较两组临床基本资料、冠状动脉造影结果和超声心动图参数等差异,采用单因素和多因素Logistic回归分析患者发生CMVD的影响因素。结果:相比A组,B组有糖尿病史的比例显著升高,同型半胱氨酸(Hcy)、低密度脂蛋白胆固醇(LDL-C)及超敏C反应蛋白(hs-CRP)浓度均显著升高(P<0.01)。相比A组,B组CA和冠状动脉迂曲检出率均显著升高,校正的TIMI血流帧数显著增加(P<0.05)。经多因素Logistic回归分析发现,CA、糖尿病、冠状动脉迂曲均是患者发生CMVD的独立危险因素(P<0.01)。结论:CA、糖尿病、冠状动脉迂曲均为心绞痛而无冠状动脉明显狭窄患者发生CMVD的独立危险因素,提示CA、糖尿病、冠状动脉迂曲与此类患者CMVD的发生密切相关。Objective: To study the effects of coronary artery tortuosity, coronary atherosclerosis(CA) and diabetes on coronary microvascular disease(CMVD). Methods: A retrospective study was conducted to collect the clinical data of 257 patients with typical angina pectoris symptoms from June 2014 to June 2019 in our hospital, and the clinical data of patients without obvious coronary artery stenosis indicated by coronary angiography were collected. According to the results of resting load myocardial perfusion imaging, 105 patients in group A(without CMVD) and 152 patients in group B(with CMVD). The differences in the basic clinical data, coronary angiography results and echocardiography parameters between the two groups were compared, and the influencing factors of CMVD were analyzed by univariate and multivariate Logistic regression. Results: Compared with group A, the proportion of diabetes history was significantly increased in group B, and the concentrations of homocysteine(Hcy), low-density lipoprotein cholesterol(LDL-C) and hypersensitive C-reactive protein(hs-CRP) were all significantly increased(P<0.01). Compared with group A, the detection rate of CA and coronary artery tortuosity in group B was significantly increased, and the corrected TIMI blood flow frame number was significantly increased(P<0.05). Multivariate Logistic regression analysis showed that CA, diabetes and coronary artery tortuosity were all independent risk factors for patients with CMVD(P<0.01). Conclusion: CA, diabetes and coronary artery tortuosity are all independent risk factors for CMVD in patients with angina pectoris but without obvious coronary artery stenosis, suggesting that CA, diabetes and coronary artery tortuosity are closely related to the occurrence of CMVD.

关 键 词：心绞痛 冠状动脉微血管病变 冠状动脉迂曲 冠状动脉粥样硬化 糖尿病 

分 类 号：R54[医药卫生—心血管疾病]