吸食安纳咖在冠心病发病中的作用

Consuming of caffeine-sodium benzoate in the development of coronary heart disease

目的通过回顾和分析长期吸食安纳咖的冠心病患者的相关资料，初步探讨吸食者冠心病的可能发病机制。方法回顾分析2007年1～12月在本院心脏内科行经皮冠状动脉介入（PCI）术的569例冠心病患者的相关资料，将患者分为吸食安纳咖组（87例，男71例，女16例）和未吸食组（482例，男369例，女113例）。比较两组患者的基本情况、临床表现、冠状动脉病变情况、术前相关检查和术中冠状动脉病变特征等方面是否存在差异。结果吸食安纳咖冠心病患者的年龄[（56．67±7．81）岁]显著低于未吸食者[（64．65±7．50）岁]（P〈0．0001），吸烟情况（85．06％）较未吸食组（65．15％）普遍（P=0．0002），并发高血压者（96．56％）也显著高于未吸食组（79．88％）（P=0．0002）；同时多支病变例数（55．17％）显著高于未吸食组（38．80％）（P=0．0043），置入支架数在两根或两个以上的患者（82．76％）显著高于未吸食组（67．22％）（P〈0．0001），术后应用GPⅡb／Ⅲa受体拮抗剂的患者（16．09％）也显著增加（未吸食组6．22％，P=0．0015）；此外，纤维蛋白原含量高于正常值的患者数吸食组（27．59％）显著增高（未吸食组11．41％，P〈0．0001）；而且术中发生冠状动脉痉挛和慢血流情况在吸食组（42．53％和28．74％）显著高于未吸食组（16．39％和17．01％）（P〈0.0001和P=0.0100）。结论吸食安纳咖的冠心病患者年龄偏轻，其冠状动脉病变较未吸食患者复杂，这可能与安纳咖中的咖啡因引起血管内皮功能受损、血压升高和出凝血系统某些功能改变有关。

Objective To investigate the mechanism of the coronary heart disease in the patients with long-term consuming of caffeine-sodium benzoate by reviewing and analyzing relative clinical data. Methods A total of 569 patients undergoing percutaneous coronary intervention （PCI） in Tangdu Hospital were divided into caffeine-sodium benzoate group （ n = 87, male/female = 71/16） and control group （ n = 482, male/female = 369/113 ）. We observed whether there existed significant difference in the basic characteristics, clinical manifestations, serum biochemical examination and coronary lesion features. Results Compared with patients in control group, those in caffeine-sodium benzoate group were much younger [ （56. 67 ± 7.81 ） years vs. （64. 65 ± 7.50） years, P 〈 0. 0001 ] , and had more smokers and hypertension （85.06% vs. 65.15% , P = 0. 0002 and 96. 56% vs. 79. 88% , P = 0. 0002） ; There were more cases with muhivessal coronary diseases （55. 17% vs. 38.80% , P =0. 0043）, ≥2 stents implanted（82. 76% vs. 67.22% , P 〈0. 0001 ）or GP Ⅱ b/Ⅲ a inhibitor used post PCI （ 16. 09% vs. 6. 22%, P = 0. 0015 ） than in control group. Besides, patients with abnormal high level of serum fibrinogen were significantly higher in caffeine-sodium benzoate group than in control group （27. 59% vs. If. 41%, P 〈 0. 0001 ）. Coronary spasm （42. 53% vs. 16. 39%, P 〈 0. 0001 ） and coronary slow flow phenomenon （28.74% vs. 17.01%, P =0. 0100） were much common in caffeine-sodium benzoate group. Conclusions Patients with long-term caffeine-sodium benzoate consuming are much younger and their coronary lesions are more complicated than control patients. The underlying mechanisms are probably endothelial dysfunction, blood pressure elevation and the changes in bleeding/clotting function caused by the caffeine.