影响冠状动脉左前降支近段临界病变血流储备分数的相关因素分析  

The analysis of angiographic characteristics and values of fractional fl ow reserve on intermediate lesion of proximal left anterior descending coronary artery

作　　者：张薇 王志强 周志明[1,2] 杨士伟[1,2] 贾德安[1,2] 韩红亚[1,2] 周玉杰 ZHANG Wei;WANG Zhi-qiang;ZHOU Zhi-ming;YANG Shi-wei;JIA De-an;HAN Hong-ya;ZHOU Yu-jie(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内12病区,北京100029 [2]北京市心肺血管疾病研究所,冠心病精准治疗北京市重点实验室,首都医科大学冠心病临床诊疗与研究中心

出　　处：《中国介入心脏病学杂志》2021年第3期143-147,共5页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划“精准医学研究”重点专项(2017YFC0908800);北京市医院管理局“登峰”计划专项(DFL20150601);北京市医院管理局“使命”计划专项(SML20180601);北京市卫生健康委员会科技创新中心建设项目(PXM2019_026272_000006、PXM2019_026272_000005)。

摘　　要：目的探讨可能对冠状动脉左前降支近段临界病变血流储备分数(FFR)产生影响的因素。方法纳入2017年9月至2020年1月首都医科大学附属北京安贞医院167例冠状动脉左前降支近段临界病变的患者,行左前降支FFR检查,根据FFR值分为FFR≥0.75组(105例)及FFR<0.75组(62例),比较两组患者相关临床指标的差异,探讨FFR值与病变狭窄程度之间的关系。进行logistic多因素回归分析与FFR值相关的因素。结果两组患者性别、年龄、吸烟史、合并高血压病、合并糖尿病、体重指数、左心室射血分数、最小管腔直径、直径狭窄率、空腹血糖、总胆固醇、高密度脂蛋白胆固醇以及糖化血红蛋白水平等比较,差异均无统计学意义(均P>0.05);FFR<0.75组病变长度[(20.17±7.42)mm比(16.98±6.01)mm,P=0.045]及分支血管积分[(3.36±1.38)分比(2.71±1.04)分,P=0.023]显著大于FFR≥0.75组,差异有统计学意义。Pearson相关分析显示,FFR值与直径狭窄率无相关关系(r=0.371,P=0.067)。logistic多因素回归分析显示,病变长度(OR 2.197,95%CI 1.608~3.372,P=0.017)、分支血管积分(OR 2.101,95%CI 1.079~3.035,P=0.020)与FFR<0.75相关。结论左前降支近段临界病变冠状动脉狭窄的病变长度及病变以远的分支血管积分可能对FFR值产生影响。Objective To explore the effective factors of angiographic characteristics and values of fractional flow reserve(FFR)on intermediate lesion of proximal coronary artery stenosis.Methods Total of 167 patients with intermediate lesion of proximal left anterior descending(LAD)coronary artery in Beijing Anzhen Hospital affiliated to Capital Medical University were selected to proceed coronary angiography(CAG)and FFR measurement between September 2017 and January 2020.Patients were divided into the group with FFR≥0.75(105 patients)and the other group with FFR<0.75(62 patients)according to FFR results.Clinical factors were evaluated to explore the relationship between percent diameter stenosis(%DS)and FFR value.The independent influencing factors of FFR value were investigated by multiple logistic regression analysis.Results There were no significant differences between the two groups in those factors such as gender,age,smoking history,hypertension,diabetes mellitus,body mass index,left ventricular ejection fraction and minimum lumen diameter(MLA),%DS,fasting blood-glucose,total cholesterol,high density lipoprotein cholesterol and hemoglobin A1C levels.There were significant differences on the lesion length[(20.17±7.42)mm vs.(16.98±6.01)mm,P=0.045]and the braching vascular score[(3.36±1.38)points vs.(2.71±1.04)points,P=0.023]between groups.It was no correlation between%DS and FFR value(r=0.371,P=0.067)by Pearson’s correlation analysis.The lesion length(OR 2.197,95%CI 1.608–3.372,P=0.017)and the branching vascular score(OR 2.101,95%CI 1.079–3.035,P=0.020)were correlated with FFR<0.75 via multivariate logistic regression analysis.Conclusions FFR value of intermediate lesion of proximal LAD could be affected by the angiographic lesion characteristics including the lesion length and braching vascular score.

关 键 词：冠状动脉 临界病变 血流储备分数 

分 类 号：R543.5[医药卫生—心血管疾病]