冠状动脉慢血流的临床特点及相关因素的研究

The clinical characteristics and risk factors of coronary slow flow phenomenon

目的总结冠状动脉慢血流的临床特点,探讨影响CSF发生的可能相关因素。方法选取38例诊断为CSF的患者,详细记录一般临床资料、生化指标以及冠脉造影结果数据。另取同时期冠脉造影正常的38例健康者为对照组（normal coronary flow,NCF）,比较两组间临床资料之间的差异,并行多元Logistic回归分析。结果两组患者平均血流帧数差异有高度统计学意义[（33.49±5.82）vs（19.61±1.60）,P〈0.01]。CSF组吸烟比率明显高于NCF组（47.4%vs 23.7%,P〈0.05）。两组患者的红细胞分布宽度、高敏C反应蛋白及同型半胱氨酸比较有高度统计学意义[（12.73±0.47）%vs（13.22±0.87）%,（1.33±0.48）mg/L vs（2.21±0.70）mg/L,（9.51±2.47）μmol/L vs（11.99±2.82）μmol/L,P〈0.01],CSF组患者纤维蛋白原水平亦明显高于NCF组[（348.32±70.83）mg/d L vs（314.00±47.79）mg/d L,P〈0.05]。多元Logistic回归分析结果显示,高敏C反应蛋白（OR=13.592,95%CI：3.795~48.675,P=0.000）与红细胞分布宽度（OR=3.906,95%CI：1.134~13.455,P=0.031）水平是CSF的独立危险因素。结论炎症和血管内皮功能失调参与了CSF的发病机制。CSF患者可能处在高血液黏稠度状态。

Objective To investigate the clinical characteristics and risk factors of coronary slow flow phenomenon（CSF）retrospectively. Methods A total of 38 CSF patients determined by TIMI frame count method according to coronary angiography and 38 patients with normal coronary flow were enrolled in this research. Clinical data and biochemical parameters were compared between the two groups. Multiple Logistic regression analysis was performed to determine the risk factors of CSF. Results TIMI frame count was significantly higher in CSF group [（33.49±5.82） vs（19.61±1.60）,P〈0.01]. Baseline data analysis showed that level of smoking（47.4% vs 23.7%,P〈0.05）, fibrinogen（348.32±70.83 mg/d L vs 314.00±47.79 mg/d L, P〈0.05） and red cell distribution width [（13.22±0.87）% vs（12.73±0.47）%, P〈0.01], high sensitivity C-reactive protein [（2.21±0.70） mg/L vs（1.33±0.48）mg/L, P〈0.01], Homocysteine [（11.99±2.82）μmol/L vs（9.51±2.47）μmol/L, P〈0.01] in CSF group were higher compared with the control group. Multiple Logistic regression analysis showed that high sensitivity C-reactive protein（OR=13.592, 95%CI： 3.795-48.675,P=0.000） and red blood cell distribution width（OR=3.906, 95%CI： 1.134-13.455,P=0.031） were the independent risk factors of CSF. Conclusion Increasing inflammatory and impaired vascular endothelial function may play a role in the pathogenesis of CSF. Patients with CSF are likely in hypercoagulable state.