高原冠心病患者功能性缺血的危险因素分析  

Analysis of risk factors for functional ischemia in patients with high altitude coronary heart disease

作　　者：罗云霞 李高华 贺锐 李斌 张腾 LUO Yunxia;LI Gaohua;HE Rui;LI Bin;ZHANG Teng(Department of Internal Medicine,Changdu People's Hospital,Changdu 854000,Xizang,China;Department of Cardiology,Chongqing People's Hospital,Chongqing 401120,China)

机构地区：[1]西藏昌都市人民医院内二科,西藏昌都854000 [2]重庆市人民医院心内科,重庆401120

出　　处：《西部医学》2025年第3期436-439,446,共5页Medical Journal of West China

基　　金：2022年西藏自治区自然科学基金项目(XZ202201ZR0013G)。

摘　　要：目的探讨高原冠心病患者功能性缺血的危险因素,并分析其诊断价值。方法连续性收集2022年1月—2023年8月于昌都市人民医院行冠脉造影(CAG),至少有一支冠脉血管狭窄在50%~90%并接受血流储备分数(FFR)检查的60例冠心病患者的一般临床资料及手术资料。根据FFR值,将患者分为FFR<0.8组(n=25)和FFR≥0.8组(n=35),比较两组间临床资料及FFR值的影响因素。结果FFR<0.8组血红蛋白(Hb)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、D-二聚体、海拔均高于FFR≥0.8组(P<0.05),而FFR≥0.8组高密度脂蛋白胆固醇(HDL-C)水平、淋巴细胞(Lym)高于FFR<0.8组(P<0.05)。FFR值与高血压病、LDL-C、D-二聚体、海拔呈负相关(P<0.05);与Lym、HDL-C水平呈正相关(P<0.05)。多因素Logistic回归分析示D-二聚体(OR=3.762,95%CI:1.239~11.417,P<0.05)、Hb(OR=1.076,95%CI:1.019~1.137,P<0.05)和LDL-C(OR=3.608,95%CI:1.365~9.535,P<0.05)是影响FFR值的独立危险因素,而HDL-C(OR=0.003,95%CI:0~0.199,P<0.05)和Lym(OR=0.089,95%CI:0.009~0.919,P<0.05)是影响FFR值的独立保护因素。Hb和LDL-C曲线下面积分别是0.644、0.662。结论对于高原冠心病患者,Hb和LDL-C对功能性缺血具有较好的预测能力,对指导治疗及预防有一定的价值。Objective To explore the risk factors of functional ischemia in patients with coronary heart disease at high altitude and analyze their diagnostic value.Methods The general clinical data and surgical data of 60 patients with coronary heart disease who underwent coronary angiography in Changdu people's Hospital from January 2022 to August 2023 and underwent Fractional flow reserve(FFR)examination with at least one coronary artery stenosis of 50%-90%were collected.According to the FFR value,they were divided into two groups:FFR<0.8 and FFR≥0.8.The clinical data and influencing factors of FFR value between the two groups were compared.Results The hemoglobin(Hb),Low density lipoprotein cholesterol(LDL-C),uric acid(UA),D-dimer and altitude of FFR<0.8 group were higher than those of FFR≥0.8 group(P<0.05),while the High-density lipoprotein cholesterol(HDL-C),lymphocyte(Lym)level of FFR≥0.8 group was higher than that of FFR<0.8 group(P<0.05).FFR was negatively correlated with hypertension,LDL-C,D-dimer and altitude(P<0.05).It was positively correlated with Lym and serum HDL-C levels(P<0.05).Multivariate logistic regression analysis showed that D-Dimer(OR=3.762,95%CI:1.239-11.417,P<0.05),Hb(OR=1.076,95%CI:1.019-1.137,P<0.05)and LDL-C(OR=3.608,95%CI:1.365-9.535,P<0.05)were independent risk factors for FFR,while HDL-C(OR=0.003,95%CI:0-0.199,P<0.05)and Lym(OR=0.089,95%CI:1.365-9.535,P<0.05)were independent risk factors for FFR.The areas under the curve of Hb and LDL-C were 0.644 and 0.662,respectively.Conclusion For patients with high altitude coronary heart disease,Hb and LDL-C have good predictive ability for functional ischemia,and have certain value in guiding treatment and prevention.

关 键 词：高原 冠心病 血流储备分数 血红蛋白 低密度脂蛋白胆固醇 

分 类 号：R541.4[医药卫生—心血管疾病]