冠状动脉性心脏病合并高血压患者的冠状动脉病变特点

Lesion characteristics of coronary artery in hypertensives with coronary heart disease

目的探讨冠状动脉性心脏病（冠心病）合并高血压患者冠状动脉病变特点和经皮冠状动脉内介入治疗（PCI）的预后评价，并分析高血压等危险因素与冠状动脉病变严重复杂程度的相关性。方法入选2010—01—06在天津胸科医院经冠状动脉造影证实至少一支主要冠状动脉狭窄≥50％的冠心病患者462例。根据是否合并高血压分为冠心病合并高血压组（n=306）和冠心病组（n=156），观察两组患者冠状动脉病变特点并计算每例患者的SYNTAX积分，比较两组患者介入治疗和术后2年主要不良心脑血管事件（MACCE）的发生，并根据是否合并糖尿病进行糖尿病亚组分析。结果冠心病合并高血压组平均SYNTAX积分高于冠心病组[（17．53±9．72）比（15．21±10．92），P〈0．05]。冠心病合并高血压组PCI患者靶血管病变中复杂病变（58．3％比35．0％）、钙化病变和弥漫长病变比例（22．5％比10．0％，40．8％比28．3％），冠状动脉内置人支架平均数[（1．90±0．93）比（1．66±0．91）]，总MACCE发生率（17．4％比6．7％）明显高于冠心病组（均P〈0．05）。冠心病合并高血压组中，糖尿病亚组平均SYNTAX积分、三支病变比例、PCI患者复杂病变和弥漫长病变比例、再次血运重建率、总MACCE发生率和再次入院比例均高于无糖尿病亚组（均P〈0．05）。冠心病组中，糖尿病亚组平均SYNTAX积分、三支病变比例、PCI患者复杂病变和弥漫长病变比例均高于无糖尿病亚组（P％0．05），单支病变比例低于无糖尿病亚组（P〈0．05）。KaplamMeier生存分析显示，冠心病合并高血压组长期无事件生存率与冠心病组比较差异无统计学意义（X2=1．15，P〉0．05）。Logistic多因素回归分析显示年龄（OR 4．107，95％CI2．278～7．405）、男性（OR2．355，95％CI 1．328～4．174）、高血压（OR2．392，95％CI 1．305～4．384）、糖尿病（OR2．446，95％CI1．389～4．308）、高血脂症（OR 2．497，95％CI 1．428 - 4．365）和既往心肌梗死史（OR3．333，95％CI1．382～8．042）与SYNTAX积分呈正相关（均P〈0．05）。结论冠心病合并高血压患者冠状动脉病变弥漫复杂，预后较差，高血压、糖尿病、年龄、性别、高血脂症和既往心肌梗死史均是冠状动脉病变复杂性的独立预测因子。

Objective To investigate lesion characteristics of coronary artery in hypertensives with coronary heart disease （CHD） and the prognostic evaluation of percutaneous coronary intervention （PCI）, and to analyze the correlation between risk factors, such as hypertension, and the complexity of coronary artery disease. Methods From January 2010 to June 2010, a total of 462 patients from Tianjin Chest Hospital with one or more coronary artery stenosis≥50%, diagnosed by coronary angiography, were enrolled and divided into two groups according to whether they had hypertension： CHD with hypertension group （n=306） and CHD alone group（n=156）. Their lesion features of coronary artery were observed, and the SYNTAX integrals were calculated. Major adverse cardiac and cere brovascular events（MACCE） occurred two years after the operation of the two groups were analyzed, and the diabetes mellitus subgroup was analyzed according to whether the patients were combined with diabetes. Results Com pared with that of CHD alone group, the mean SYNTAX integral of CHD with hypertension group was significantly higher [（17.53±9.72） vs （15.21± 10.92）, P〈0.05]. In the CHD with hypertension group, the complex lesion （58.3% vs 35.0%}, calcification lesion, diffuse and long lesion （22.5% vs 10.0%, 40.8% vs 28.3%） of target coronary artery lesions, average coronary stenting number I-（1.90±0.93） vs （1.66±0.91）] and total rate of MACCE （17.4% vs 6.7%） of patients with PCI were all greater than those in the CHD alone group （all P〈0.05）. In CHD with hypertension group, compared with those of non-diabetes mellitus subgroup, the mean SYNTAX integral, the rate of triple vessel disease, the rates of complex lesion, long diffuse lesion and revascularization, total inci dence of MACCE, and readmission rate of diabetes mellitus subgroup were significantly higher （all P〈0.05）. In CHD alone group, compared with those of non-diabetes mellitus subgroup, the mean SYNTAX integral and the tri ple vessel lesion rate, the rates of complex lesion and long diffuse lesion of the patients with PCI were significantly higher （P〈0.05）, while the single vessel lesion rate was lower （P〈0.05） in diabetes mellitus subgroup. Kaplan- Meier survival curves showed no statistically significant difference in the survival rate without events between the two groups （X^2= 1.15, P〉0.05 ）. Logistic regression analysis presented that aging （OR 4. 107, 95% CI 2. 278- 7. 405）, male （OR 2. 355, 95% CI 1. 328-4. 174）, hypertension （OR 2. 392, 95% CI 1. 305-4. 384）, diabetes mellitus （OR 2. 446, 95% CI 1. 389-4. 308）, hypercholesterol （OR 2. 497, 95% CI 1. 428-4. 365）, and myocar dial infarction history （OR 3. 333, 95% CI 1. 382-8. 042） were positively correlated with SYNTAX integral （all P〈0.05）. Conclusions The coronary artery lesion characteristics of hypertensive patients with CHD is diffuse and complex with poor prognosis. Hypertension, aging, male, diabetes, hypercholesterol and myocardial infarction history are significant independent predicting factors for the complexity of coronary artery disease.