冠状动脉介入手术相关微循环功能障碍影响因素分析  

The analysis of factors influencing microcirculatory dysfunction related to coronary intervention surgery

作　　者：谢剑昶 童国新 何颖 纪昊 胡青青 陈森江 高贝贝 蔡丽丽 黄进宇 Xie Jianchang

机构地区：[1]浙江大学医学院附属杭州市第一人民医院城北院区,310000 [2]浙江大学医学院附属杭州市第一人民医院,310000 [3]浙江中医药大学第四临床医学院,310053

出　　处：《浙江临床医学》2023年第11期1597-1599,共3页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划(2023KY180);杭州市农业和社会发展科研项目(20220919Y066)。

摘　　要：目的通过基于冠状动脉造影的冠状动脉微循环功能检查评估术前、术后微循环功能变化,分析影响因素对经皮冠状动脉介入治疗(PCI)相关的微循环功能障碍的相关性。方法回顾性分析165例稳定性冠心病患者,均接受冠状动脉药物涂层支架植入手术,统计人口学、实验室检验、冠状动脉造影影像、冠状动脉内超声等资料。对冠状动脉造影影像进行定量血流分数(QFR)检查和微循环阻力指数(AMR)分析。对术前QFR、血流速度、AMR进行倾向得分匹配,匹配容差为0.02,共有92例患者匹配成功。结果根据术前、术后AMR数值,AMR值术后大于术前为微循环功能恶化组,术后小于术前者为微循环功能改善组,两组患者分别为100例和65例。无论是匹配前还是匹配后,恶化组患者术后的血流速度更慢(P<0.01),AMR值更高(P<0.01)。在IVUS影像数据分析中,在倾向得分匹配后恶化组斑块负荷更高(P<0.01),斑块体积比更高(P=0.013),管腔面积更小(P=0.011)。在斑块成分分析中,恶化组脂质成分更高(P=0.035),但在倾向得分匹配后,两组差异无统计学意义(P=0.271)。Logistics回归分析提示,斑块负荷过高是PCI术后微循环功能障碍的危险因素(OR=1.105,95%CI:1.027~1.188,P=0.007)。结论基于冠状动脉内超声和无压力导丝的微循环功能检测,病变处的管腔面积过小、斑块负荷过高与PCI术后微循环功能恶化有相关性。斑块负荷过高是微循环恶化的危险因素。Objective To evaluate the pre and post-percutaneous coronary intervention(PCI)changes in microcirculatory function by coronary microcirculatory function testing based on coronary angiography and to analyze the relevance of influencing factors on PCI-related microcirculatory dysfunction(CMD).Methods A retrospective analysis was performed of 165 patients admitted to our hospital with stable coronary artery disease who underwent coronary drug-eluting stent implantation,including demographic data,laboratory tests,coronary angiographic images,and intracoronary ultrasound(IVUS).Coronary angiographic images were evaluated for quantitative flow ratio(QFR)and angiographic microvascular resistance(AMR).Propensity score matching(PSM)was performed for pre-PCI QFR,flow velocity,and AMR with a matching tolerance of 0.02,and a total of 92 patients were successfully matched.Results Based on pre and post PCI AMR values,post-PCI AMR values greater than pre-PCI were defined as the worsening microcirculatory function group,and post-PCI AMR values less than pre-PCI were defined as the improving microcirculatory function group,with 100 and 65 patients in the two groups,respectively.Both before and after matching,patients in the deteriorated group had slower flow velocity(P<0.01)and higher AMR values(P<0.01).In the analysis of IVUS imaging,the worsened group had higher plaque burden(P<0.01),higher plaque volume ratio(P=0.013),and smaller lumen area(P=0.011)after propensity score matching.In plaque composition analysis,lipid composition appeared to be higher in the worsened group(P=0.035),but after PSM,the difference between the two groups was not significant(P=0.271).Logistics regression analysis suggested that excessive plaque load was a risk factor for microcirculatory dysfunction after PCI(OR=1.105,95%CI:1.027~1.188,P=0.007).Conclusion Based on IVUS and coronary arteriongraphy-microcirculatory function testing,there is a correlation between too small a lumen area at the lesion,excessive plaque loading,and deterioration of microcircu

关 键 词：经皮冠状动脉介入治疗 微循环功能障碍 斑块特点 冠状动脉造影 冠状动脉内超声 

分 类 号：R541.4[医药卫生—心血管疾病]