冠状动脉慢血流现象相关危险因素的分析

Analysis of the clinical risk factors of coronary slow flow phenomenon

目的初步探讨冠状动脉慢血流现象的危险因素。方法回顾性分析我院2010年7月至2013年1月因疑似冠心病行冠状动脉造影检查。明确冠状动脉无明显病变的患者142例，采用心肌梗死溶栓（TIMI）记帧法记录各支冠状动脉的TIMI帧数，冠状动脉平均TIMI帧数大于27为冠状动脉慢血流，将患者分为冠状动脉慢血流组（CSF组，68例）和对照组（74例）。对两组间各项临床指标的差异进行比较，并采用多元Logistic回归分析对冠状动脉慢血流的危险因素进行回归分析。结果CSF组与对照组患者高密度脂蛋白胆固醇[（1．02±0．28）mmol／L vs．（1．29±0.33）mmol／L]、血同型半胱氨酸水平[（24．46±2．54）mmol/L vs．（11．81±2．80）mmol／L]、体质指数[（25．91±1．72）kg/m2 vs．（22．82±1．53）kg/m2]、吸烟量[（374．24±182．48）支年vs．（198．68±116．53）支年]比较差异均有统计学意义（P〈0．05），多元Logistic回归分析表明体质指数升高（OR=I．38，95％CI：1．0246～1．8278，P=0．031）、大量吸烟（OR=1．0067，95％CI：1．0025．1．0109．P=0．0017）、高同型半胱氨酸血症（OR=I．12，95％CI：1．1023～1．1291，P=0．0014）为冠状动脉慢血流发生的危险因素。结论体质指数升高、高同型半胱氨酸血症和大量吸烟作为冠状动脉慢血流现象的危险因素，可能参与冠状动脉慢血流现象发生的病理生理过程。

Objective To investigate the clinical risk factors of coronary slow flow phenomenon. Methods One hundred and forty-two patients with angiographically proven normal coronary arteries admitted during July 2010 to Jan 2013 were included in this study. Coronary flow rates of all patients were documented by Thrombolysis In Myocardial Infarction frame count （TIMI frame count）. Patients whose average TIMI frame count greater than 27 were included in the Coronary Slow Flow Phenomenon group （n=68） and others were included as the control group （n=74）. Comparison of cate- gorical and continuous variables between the two groups was performed using chi-square and unpaired t-test respectively. Multivariate analysis evaluating predictors of coronary slow flow phenomenon was performed using logistic regression test. Results Body mass index （BMI）, hyperhomocysteinemia （HHcy）, smoking and low-lipid lipoprotein level were significantly higher in the coronary slow flow group compared with the control group （P 〈 0.015）. High-density lipoproteins was lower in the coronary slow flow group compared with the control group, the difference was statistically significant （P 〈 0.05）. After adjusted with other variables by logistic regression test, BMI （OR 1.38, 95%CI：1.02-1.82, P = 0.031）, smoking （OR1.0067, 95% CI：1.0025-1.0109, P = 0.0017） and HHcy （OR 1.12, 95%CI：1.0023-1.1291, P = 0.0014） were proven to be the risk factors for slow coronary flow. Conclusion Increasing in BMI, smoking and HHcy may play a role in the pathogenesis of slow coronary flow.