疑诊冠状动脉性心脏病患者冠状动脉CT检查后吸烟及用药情况的改变  

Changes in Smoking and Medication after Coronary CT Angiography in Patients with Suspected Coronary Heart Disease

作　　者：马亚南[1] 侯志辉[1] 安云强 高扬[1] 尹卫华[1] 任心爽 吕滨[1] MA Ya-nan;HOU Zhi-hui;AN Yun-qiang;GAO Yang;YIN Wei-hua;REN Xin-shuang;LYU Bin(Department of Radiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院放射影像科,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第3期3977-3981,共5页Molecular Cardiology of China

基　　金：国家重点研发计划(2016YFC1300400)。

摘　　要：目的探讨疑诊冠状动脉性心脏病(简称"冠心病")患者行冠状动脉CT血管成像(coronary computed tomography angiography,CCTA)检查对其吸烟和主要用药情况的影响。方法纳入2017年2月至2018年7月门诊疑诊冠心病行CCTA检查并完成随访的连续患者2077例,记录患者检查前后吸烟状态以及抗血小板药物、降脂药物的服用情况,按照CT提示有无≥50%狭窄,分为冠心病组和无冠心病组,比较CCTA检查后2组间吸烟情况与服用抗血小板药物和降脂药物情况的变化。结果患者平均年龄(57.12±10.39)岁,男性占68.1%。CT结果提示无冠心病组1555例,冠心病组522例,平均随访391(143~693)d,98例患者出现主要不良心血管事件(major adverse cardiovascular events,MACE),包含71例血运重建。CCTA检查后,吸烟人数总体减少325例(32.24%)。冠心病组抗血小板药物及降脂药物的服用人数分别增加5例(2.27%)、33例(20.00%),无冠心病组两种药物的服用人数分别减少158例(41.15%)、84例(27.10%)。冠心病组检查后戒烟率(检查前吸烟,检查后不吸烟)较无冠心病组高(24.33%:13.76%,P<0.001)。冠心病组新增抗血小板与降脂药物服用(检查前不服用药物,检查后服用)均较无冠心病组高(22.03%:5.92%,23.37%:7.14%,P<0.001)。多因素logistic回归分析显示CCTA结果(冠心病)与戒烟(OR:1.458,95%CI:1.108~1.918)、新增服用抗血小板药物(OR:5.082,95%CI:3.617~7.141)及新增服用降脂药物(OR:3.997,95%CI:2.906~5.496)相关(P<0.001),且是新增服用抗血小板药物的独立相关因素。结论CCTA检查结果提示冠心病,可提高戒烟率,增加抗血小板与降脂药物的使用;相反,CCTA结果显示无冠心病,可减少抗血小板与降脂药物的使用。CCTA检查可促进疑诊冠心病患者向更积极健康的生活方式改变,且更合理地使用心血管病预防药物。Objective To determine the influence of coronary computed tomographic angiography(CCTA)on the changes of smoking,antiplatelet and lipid-lowering medication use in patients with suspected coronary heart disease.Methods A total of 2077 consecutive outpatients suspected with coronary heart disease were enrolled from February 2017 to July 2018.They all had undergone CCTA examinations and completed the follow-up data after CCTA examination.The smoking status、antiplatelet and lipid-lowering medication use were recorded pre-and post-CCTA.According to the CT indication of≥50%stenosis,patients were divided into two groups:"coronary artery disease group(CAD)"and"non-coronary artery disease group(non-CAD)",and the changes in smoking status,antiplatelet and lipid-lowering drug use between the two groups were compared.Results The mean age of these patients was(57.12±10.39)years old(68.1%men).CT results showed that there were 1555 cases in the non-CAD group and 522 cases in the CAD group.Major adverse cardiovascular events(MACE)occurred in 98 patients in the follow-up of 391 days(range 143-693),including 71 cases of revascularization.After CCTA examination,the number of smokers decreased by 325(32.24%),the number of antiplatelet and lipid-lowering drugs increased by 5(2.27%)and 33(20.00%)respectively in the CAD group while decreased by 158(41.15%)and 84(27.10%)respectively in the non-CAD group.The smoking cessation rate in the CAD group was higher than that in the non-CAD group after examination(24.33%vs 13.76%,P<0.01).The initiation of antiplatelet and lipid-lowering drugs in CAD group was higher than that in non-CAD group(22.03%vs 5.92,23.37%vs 7.14%,P<0.01).Multivariate logistic regression analysis showed that CCTA results-identified CAD were correlated with smoking cessation,initiation of antiplatelet lipidlowering drugs(OR:1.458,95%CI:1.108-1.918;OR:5.082,95%CI:3.617-7.141;OR:3.997,95%CI:2.906-5.496,all P<0.01),and was an independent correlation factor for the initiation of antiplatelet drugs.Conclusion CAD presence

关 键 词：冠状动脉CT血管造影 冠状动脉性心脏病 吸烟 抗血小板药 降脂药 

分 类 号：R541.4[医药卫生—心血管疾病] R816.2[医药卫生—内科学]