血管活性物质与桡动脉痉挛关系的配对病例对照研究

Vasoactive substances and radial artery spasm:a matched case-control study

目的桡动脉痉挛是经桡动脉介入诊疗中最常见的并发症。本研究初步探讨血管活性物质和桡动脉痉挛的关系,为临床桡动脉痉挛的预防提供理论依据。方法本研究为前瞻性、配对病例对照研究。所有患者均为仅接受经桡动脉冠状动脉造影的患者,按照性别相同,年龄相差2岁以内进行1:2配对。痉挛的判断使用临床桡动脉痉挛的定义。检测两组患者血清一氧化氮、内皮素-1、前列环素、血栓素A2、去甲肾上腺素浓度,并多因素回归分析桡动脉痉挛发生的危险因素。结果入选60例发生桡动脉痉挛的单纯冠状动脉造影患者,配对入选120例未发生桡动脉痉挛的单纯冠状动脉造影患者。痉挛组和对照组中一氧化氮[(63.5875±21.2763)μmol/L比(55.6425±18.1542)μmol/L,F=7.442,P=0.351]和血栓素A2[(0.9768±0.1953)ng/ml比(0.7824±0.2051)ng/ml,F=1.058,P=0.284]浓度差别没有统计学意义,内皮素-1[(298.5839±65.3291)ng/ml比(81.4391±20.4283)ng/ml,F=2.034,P<0.001]和去甲肾上腺素[(202.3721±38.3829)ng/ml比(56.4828±15.6025)ng/ml,F=39.267,P=0.005]高于对照组,前列环素[(8.8294±2.5322)pg/ml比(15.5430±4.8267)pg/ml,F=14.586,P=0.038]低于对照组。多因素回归分析发现,内皮素-1(OR2.954,95%CI1.569～5.354,P=0.005)和去甲肾上腺素(OR4.642,95%CI2.619～8.332,P=0.018)是术中发生桡动脉痉挛的危险因素。结论内皮素-1和去甲肾上腺素浓度是术中桡动脉痉挛发生的危险因素。

Objective This study is to discuss the relationship of vasoactive substances and radial artery spasm（RAS）,and to provide theoretic basis for the prevention of RAS.Methods This is a prospective,matched case-control study.During the procedure of transradial coronary angiography,patients with RAS and without RAS were matched 1：2 according to same gender and similar age within 2 years.Blood samples were obtained before the procedure,and were tested for nitric oxide,endothelin-1,prostacyclin,thromboxane A2 and norepinephrine.Logistic regression was made to find out the risk factors of RAS.Results Sixty patients suffered form RAS and 120 patients without RAS were enrolled.The concentration of nitric oxide [（63.5875±21.2763） μmol/L vs.（55.6425L±18.1542） μmol/L,F=7.442,P=0.351] and thromboxane A2 [（0.9768±0.1953） ng/ml vs.（0.7824±0.2051） ng/ml,F=1.058,P=0.284] was of no difference between the RAS group and the control group.The concentration of endothelin-1 [（298.5839±65.3291） ng/ml vs.（81.4391±20.4283） ng/ml,F=2.034,P〈0.001] and norepinephrine [（202.3721±38.3829） ng/ml vs.（56.4828±15.6025） ng/ml,F=39.267,P=0.005] was higher,prostacyclin [（8.8294±2.5322） pg/ml vs.（15.5430±4.8267） pg/ml,F=14.586,P=0.038] was lower in RAS group.Multiple regression showed that endothelin-1（OR 2.954,95% CI 1.569-5.354,P=0.005） and norepinephrine（OR 4.642,95% CI 2.619-8.332,P=0.018） were the risk factors of RAS.Conclusion Multiple regression showed that endothelin-1 and norepinephrine were the risk factors of RAS during transradial coronary angiography.