冠状动脉扩张患者临床特点及近期预后

Clinical characteristics and short-term prognosis in patients with coronary artery ectasia

目的：研究冠状动脉扩张（CAE）患者的临床特点及近期预后。方法纳入2009年1月~2011年10月2258例因典型或不典型胸痛行冠脉造影（CAG）患者的影像资料进行回顾性分析，共发现CAE患者102例，通过多元回归分析，分析年龄、性别、吸烟史、高血压病和糖尿病与CAE的相关性，按照是否合并狭窄分为单纯冠状动脉扩张组（n=25）和冠状动脉扩张合并狭窄组（n=77），进一步将CAE合并狭窄患者按照所采用的治疗策略不同分为介入治疗亚组和药物治疗亚组，对所有CAE患者随访2年，评价主要心血管事件（MACE，包括再发心绞痛、心肌梗死、死亡）发生率有无差异。结果 CAE发生率4.52％（102/2258），扩张合并狭窄较单纯扩张更为常见（75.50%vs.24.50％）。多元回归分析结果显示，男性是CAE的独立危险因素（OR=3.32；95%CI：1.80~6.20）。单纯扩张组与扩张合并狭窄组MACE发生率无明显差异（37.5%vs.32.0%，P＞0.05）；但在扩张合并狭窄组中，介入治疗亚组患者的MACE发生率显著低于药物治疗亚组（15.09%vs.72.73%，P＜0.01）。结论 CAE常与狭窄同时存在，更好发于男性，CAE预后与是否合并狭窄无关，但对于合并狭窄的患者，及时采用介入治疗能够改善近期预后。

Objective To study the clinical characteristics and short-term prognosis in patients with coronary artery ectasia （CAE）.Methods The patients （n=2258） with typical or atypical chest pain and CAG examination were chosen from Jan. 2009 to Oct. 2011, and their image data was retrospectively analyzed. There were totally 102 patients with CAE selected. The correlation between age, sex, smoking history, hypertension and diabetes and CAE was analyzed through multiple regression analysis. The patients were divided into simple CAE group （n=25） and CAE complicating stenosis group （n=77）, and further CAE complicating stenosis group was divided into intervention subgroup and drug treating subgroup. All patients were followed up for 2 years. The incidence of MACE （including angina pectoris, myocardial infarction and death） were reviewed.Results The incidence of CAE was 4.52% （102/2258）, and CAE complicating stenosis was more common compared with simple CAE （75.50%vs. 24.50%）. The multiple regression analysis showed that male was an independent risk factor of CAE （OR=3.32;95%CI： 1.80-6.20）. The incidence of MACE had no significant difference between simple CAE group and CAE complicating stenosis group （37.5%vs. 32.0%,P〉0.05）, but in CAE complicating stenosis group, it was significantly lower in intervention subgroup than that in drug treating subgroup （15.09%vs. 72.73%,P〈0.01）.Conclusion CAE is commonly accompanied by stenosis and prevalent in male patients. The prognosis of CAE is not correlated to stenosis complication, but timely intervention treatment can improve the short-term prognosis in the patient with CAE complicating stenosis.