冠状动脉血流缓慢的危险因素分析

Analysis of Risk Factors in Native Slow Coronary Flow

探讨冠状动脉血流缓慢(Slow coronary flow,SCF)的临床特点、实验室检查、冠状动脉造影等特点,寻找SCF发生的影响因素。方法:通过TIMI血流帧计数法(Thrombolysis in myocardial infarction frame count,TFC)判断血流速度,入选2003年1月至2011年12月因胸痛等心肌缺血症状于我院心导管室行冠状动脉造影(Coronary artery angiography,CAG)的SCF患者376例,对照组为同期行CAG证实无冠脉显著狭窄且血流正常的患者共300例。记录临床资料,实验室指标及血流速度。结果:慢血流组年龄低于对照组[(57.9±10.1)岁比(61.0±9.4)岁,p=0.006],男性比例和吸烟史均高于对照组(分别为76.9%比42.0%,p<0.001和43.6%比24.0%,p<0.001)。慢血流组患者尿酸和甘油三酯升高,高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(Apo-A1)明显低于对照组,分别为:尿酸:(364±90)μmol/L VS.(327±92)μmol/L,p<0.001;甘油三酯:(1.86±1.14)mmol/L VS.(1.64±0.91)mmol/L,p=0.007;HDL-C:(1.10±0.25)mmol/L VS.(1.22±0.36)mmol/L,p<0.001;和Apo-A1:(1.12±0.21)g/L VS.(1.29±0.26)g/L,p<0.001。多因素Logistic回归分析显示性别、甘油三酯、HDL-C和Apo-A1是预测慢血流发生的独立危险因素,其ORadj值依次为2.966(95%CI:1.891-4.654,p<0.001),1.395(95%CI:1.139-1.707,p=0.001),11.178(95%CI:3.896-32.070,p<0.001)和0.010(95%CI:0.003-0.037,p<0.001)。结论:性别、甘油三酯、HDL-C和Apo-A1是预测慢血流发生的独立危险因素。

Objective To analyze the clinical, laboratory and angiographic characteristics of patients with slow coronary flow （SCF）, and to explore its influencing factors. Method： In this retrospective study, blood velocity was calculated with the method of Thrombolysis in myocardial infarction frame count （TFC）. From January 2003 to December 2011,376 SCF patients and 300 control patients, who performed coronary artery angiography （CAG） in our DSA room, were enrolled in the study. CAG of SCF patients showed no more than 40% stenosis and delayed contrast occupation. Control subjects performed normal coronary artery and flow velocity. The clinical and laboratory data were obtained from medical records at admission, and blood velocity of each coronary artery was calculated according to TFC. Result： Compared to control subjects, SCF patients were younger [（57.9±10.1） years old VS. （61.0±9.4） years old, p=0.006], more men and smokers （male： 76.9% VS. 42.0%, p〈0.001; smokers： 43.6% VS. 24.0%, p〈0.001）, high level of uric acid and triglyceride （TG）, low level of high density lipoprotein cholesterol （HDL-C）, and apoliporotein Al （Apo-Al） [uric acid： （364±90）μmol/L VS. （327±92）μmol/L, p〈0.001; TG： （1.86±1.14）mmol/L VS. （1.64±0.91）mmol/L, p=0.007; HDL-C： （1.10±0.25） mmol/L VS. （1.22±0.36） mmol/L, p〈0.001; and Apo-A 1 （1.12±0.21）g/L VS. （1.29±0.26）g/L, p〈0.001 ]. After adjustment for confounding factors in logistic analysis, the independent predictors for SCF were gender, TG, HDL-C, and Apo-Al, respectively ORadj=2.966 （95%Ci： 1.891- 4.654, p〈0.001）, 1.395 （95%CI： 1.139-1.707, p=0.001）, 11.178 （95%CI： 3.896-32.070, p〈0.001）,0.010 （95% CI： 0.003-0.037, p〈0.001）. Conclusion Gender, TG, HDL-C, and Apo-Al were independent predictors of native SCF.