冠状动脉慢血流影响因素及强化他汀联合脂质体携载前列腺素E1治疗效果研究

Slow Coronary Flow:Analysis of Influencing Factors and Effect of Intensive Statin Combined with Liposomal Prostaglandin E1

目的分析冠状动脉慢血流(SCF)的影响因素,探讨强化他汀联合脂质体携载前列腺素E1(LipoPGE1)治疗SCF的临床效果。方法入选2010年10月—2012年10月主因典型或不典型缺血性胸痛症状在我院住院并行冠状动脉造影未发现心外膜冠状动脉有确切病变的SCF患者63例(A组),均通过校正TIMI帧数法判断为SCF;入选同期住院但冠状动脉造影和血流正常的患者107例(B组)。采用多因素Logistic回归分析SCF发病的相关影响因素。将SCF患者根据治疗方案分为常规他汀治疗组(a组)、强化他汀治疗组(b组)及强化他汀联合Lipo-PGE1治疗组(c组)。SCF患者入院时及治疗1、3个月时检测肝功能、血脂、肌酸激酶、超敏C反应蛋白(hs-CRP),超声测量肱动脉血流介导的血管舒张功能(FMD),并填写西雅图心绞痛量表。结果多因素Logistic回归分析显示,吸烟(OR=6.260,P<0.05),高水平的低密度脂蛋白(LDL,OR=3.880,P<0.05)、糖化血红蛋白(HbA1c,OR=9.249,P<0.05)、hs-CRP(OR=2.988,P<0.05)及降低的FDM(OR=0.635,P<0.05)为SCF的独立危险因素。组内比较:与入院时比较,a、b、c组治疗1个月时总胆固醇(TC)、LDL(a组除外)、hs-CRP下降,高密度脂蛋白(HDL)、FMD及西雅图心绞痛评分上升(P<0.05);与治疗1个月时比较,a、b、c组治疗3个月时TC、LDL(a、c组除外)、hs-CRP下降,HDL(b组除外)、FMD及西雅图心绞痛评分上升(P<0.05)。组间比较:b、c组治疗1、3个月时TC、LDL、hs-CRP均低于a组(P<0.05)。b、c组于治疗1个月时HDL均高于a组(P<0.05),c组治疗3个月时HDL高于其他两组(P<0.05)。c组于治疗1、3个月时FDM高于其他两组(P<0.05);b组治疗1、3个月时FDM均高于a组(P<0.05)。c组治疗1个月时西雅图心绞痛评分均高于其他两组(P<0.05);b、c组治疗1、3个月时西雅图心绞痛评分高于a组(P<0.05)。结论 SCF的独立危险因素为吸烟,高水平的LDL、HbA1c、炎性反应及降低的FDM;强化他汀联合Lipo-PGE1治疗能更好地改善FMD,最终明显改善SCF患者的临床症状。

Objective To analysis the influencing factors of slow coronary flow （SCF） and the clinical effects of in- tensive statin combined with liposomal prostaglandin E1 （ Lipo - PGE1 ） on SCF. Methods Sixty - three SCF patients hospital- ized from October 2010 to October 2012 （group A） and 107 patients with normal coronary angiography and blood flow （group B） were enrolled in this study. The influencing factors related to SCF were detected by multivariate Logistic regression analysis. Group A were subdivided, based on treatment protocols, into groups a, b （given intensive statin treatment）, c （given inten- sive statin combined with Lipo- PGE1 ）. Liver function, blood lipids, creatine kinase （CK）, high -sensitivity C -reactive protein （hs -CRP） were determined, brancial artery flow -mediated dilatation （FMD） measured and Seattle Angina Question- naire filled out in SCF patients on admission and months 1, 3 after admission. Results Multivariate Logistic regression analysis showed that smoking （ OR = 6. 260, P 〈 0.05）, high low - hensity lipoprotein （ LDL, OR = 3. 880, P 〈 0.05 ）, glycosylated hemoglobin （HbA,0, OR =9. 249, P 〈0. 05）, hs - CRP （ OR = 2. 988, P 〈 O. 05） and reduced FDM （ OR = 0. 635, P 〈 0.05） were independent risk factors of SCF. TC, LDL （ except LDL in group a）, hs - CRP decreased, HDL, FDM and Seat-tie Agina scores increased in groups a, b, c in 1 month of treatment as compared with those during hospitalization, and also in 3 month to 1 month （except LDL in group a and c, HDL in group b）. TC, LDL, hs -CRP were lower in groups b, c than in group a in months 1, 3 of treatment （ P 〈 0. 05 ） ; HDL higher in groups b, c than in group a in month 1 of treatment （ P 〈 0. 05）, and higher in group c than in groups a, b in months 3 （P 〈 0.05） ; FDM higher in group c than in groups a, b （P 〈 0. 05 ）, and higher in group b than in group a in months 1, 3 （P 〈 0. 05 ）. Seattle Angina scores were higher in group c than in groups a, b in month 1 of treatment （P 〈 0. 05）, higher in groups b, c than in group a in months 1, 3 （P 〈 0. 05）. Conclu- sion The independent risk factors of SCF are smoking, increased LDL, HbA^o, inflammatory reaction and reduced vascular en- dothelial function. Intensive statin combined with Lipo - PGE1 can improve vascular endothelial function better and SCF patients＇ symptoms at last