潜能未定的克隆性造血与肾功能不全冠心病患者冠脉狭窄程度的关系  

Relationship between clonal hematopoiesis of indeterminate potential and severity of coronary stenosis in coronary heart disease patients with renal insufficiency

作　　者：钟佳琳 肖若楠 向姝婷 杨彦鹏 李均[2] 肖骏[2] ZHONG Jialin;XIAO Ruonan;XIANG Shuting;YANG Yanpeng;LI Jun;XIAO Jun(School of Medicine,Chongqing University,Chongqing,400044;Department of Cardiovascular Diseases,Chongqing Emergency Medical Center/Affiliated Central Hospital of Chongqing University,Chongqing,400014;Department of Cardiovascular Diseases,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400042,China)

机构地区：[1]重庆大学医学院,重庆400044 [2]重庆市急救医疗中心(重庆大学附属中心医院)心血管内科,重庆400014 [3]重庆医科大学附属第一医院心血管内科,重庆400042

出　　处：《陆军军医大学学报》2024年第24期2765-2771,共7页Journal of Army Medical University

基　　金：重庆市科卫联合医学科研项目(2023MSXM019);重庆市中青年医学高端人才工作室建设经费资助(渝卫人〔2023〕10号);重庆市公共卫生重点专科(学科)建设经费资助(渝卫办发﹝2023﹞81号)。

摘　　要：目的探讨潜能未定的克隆性造血(clonal hematopoiesis of indeterminate potential,CHIP)与肾功能不全的冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)患者冠状动脉狭窄程度的关联。方法采用病例-对照研究设计方案,纳入2023年12月至2024年7月在重庆市急救医疗中心(重庆大学附属中心医院)和重庆医科大学附属第一医院心血管内科就诊的肾功能不全的CHD患者70例,根据Gensini评分中位数水平分为Gensini评分<44分组(34例)和Gensini评分≥44分组(36例),根据是否携带CHIP突变分为CHIP组(23例)、非CHIP组(47例),分别比较组间临床资料的差异。采用二元Logistic回归分析评估CHIP状态与冠脉病变程度的关系。结果与Gensini评分<44分组比较,Gensini评分≥44分组具有更高的CHIP携带率(17.6%vs 47.2%,P=0.008)以及NT-proBNP水平(767 vs 3480 ng/L,P=0.039)。二元Logistic回归分析显示,在校正NT-proBNP后,CHIP携带仍与较高的Gensini评分相关(OR=3.935,95%CI:1.153~13.435,P=0.029)。进一步按CHIP分组结果提示,与非CHIP组患者比较,CHIP组患者具有较高的Gensini评分(48 vs 38,P=0.004)、更高的冠脉3支血管病变比例(52.2%vs 25.5%,P=0.040)和较低的左心室射血分数(55.0%vs 58.0%,P=0.042)。结论CHIP是肾功能不全CHD患者严重冠脉病变的独立危险因素。Objective To investigate the association between clonal hematopoiesis of indeterminate potential(CHIP)and the severity of coronary artery lesions in coronary heart disease(CHD)patients with renal insufficiency.Methods A case-control trial was conducted on 70 CHD patients with renal insufficiency admitted in Chongqing Emergency Medical Center(Affiliated Central Hospital of Chongqing University)and Department of Cardiovascular Diseases of the First Affiliated Hospital of Chongqing Medical University from December 2023 to July 2024.According to the median Gensini score,they were classified into the Gensini score<44 group(n=34)and≥44 group(n=36),and based on carrying CHIP mutation or not,they were divided into CHIP group(n=23)and non-CHIP group(n=47).The differences in clinical data were compared between the above 2 pair groups respectively.Binary logistic regression analysis was used to assess the relationship between CHIP status and the severity of coronary artery lesions.Results Compared with the Gensini score<44 group,the Gensini score≥44 group had a higher CHIP carriage rate(17.2%vs 47.6%,P=0.008)as well as NT-proBNP level(767 vs 3480 ng/L,P=0.039).Binary logistic regression analysis showed that CHIP status was still associated with higher Gensini scores after adjustment of NT-proBNP(OR=3.935,95%CI=1.153~13.435,P=0.029).Further CHIP grouping results suggested that the patients in the CHIP group had higher Gensini score(48 vs 38,P=0.004),larger proportion of 3-vessle disease(52.2%vs 25.5%,P=0.040),and lower left ventricular ejection fraction(55.0%vs 58.0%,P=0.042)than those in the non-CHIP group.Conclusion CHIP is an independent risk factor for severe coronary artery disease in CHD patients with renal insufficiency.

关 键 词：潜能未定的克隆性造血 冠状动脉粥样硬化性心脏病 肾功能不全 

分 类 号：R541.4[医药卫生—心血管疾病] R559[医药卫生—内科学] R692[医药卫生—临床医学]