腹型肥胖对急性冠脉综合征患者冠状动脉病变严重程度的影响

Influence of Abdominal Obesity on Severity of Coronary Artery Lesion in Patients with Acute Coronary Syndromes

目的:研究腹型肥胖对急性冠脉综合征(ACS)患者冠状动脉病变严重程度的影响。方法:选择2012年4月至2013年4月在我院接受治疗的ACS患者120例,根据腰围身高比(RWH)将患者分为无腹型肥胖者60例(对照组,RWH<0.5)及腹型肥胖者60例(观察组,RWH<0.5)。测量所有患者的基本参数,计算RWH,利用冠脉造影判断冠脉病变的支数和程度,根据Gensini评分法对冠脉造影结果进行评价,分析冠脉病变范围、Gensini积分和RWH的相关性。结果:观察组的收缩压(SBP)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)及Gensini积分水平均显著高于对照组,差异均有统计学意义(均P<0.05)。观察组的高密度脂蛋白(HDL-C)水平显著低于对照组,差异有统计学意义(P<0.05)。双支病变的RWH及Gensini积分水平显著高于单支病变,三支病变的RWH及Gensini积分水平显著高于单支病变及双支病变,差异均有统计学意义(均P<0.05)。根据Spearman法分析相关性可知,冠脉病变范围、Gensini积分和RWH均呈正相关(r=0.635,0.739;P=0.000,0.000)。结论:ACS患者RWH水平增高与冠脉病变的严重程度关系密切,有效控制腹型肥胖对于降低心血管类疾病发病率以及降低冠脉病变的程度具有重要意义。

Objective： To explore the influence of abdominal obesity on the severity of coronary artery lesion in patients with acute coronary syndromes （ACS）. Methods： A total of 120 patients with ACS, who were treated in First People＇s Affiliated Hospital of Shanghai Jiaotong University from April 2012 to April 2013, according to the ratio of waist to height （RWH）, were divided into 60 cases of non-abdominal obesity（as control group, RWH〈0.5）, and 60 cases of abdominal obesity（as observation group, RWH〈0.5）. Tthe basic data of the two groups were measured, and the RWH was calculated. The severity and the numbers of coronary artery lesion were judged by using coronary angiography. The coronary angiography results were evaluated by Gensini score. The correlation between the range of coronary artery lesion, Gensini score and RWH were analyzed. Results： The levels of SBP, FBG, TC, TG, LDL-C and Gensini score in the observation group were significantly higher than those in the control group, the differences were statistically significant （P〈0.05）, but the HDL-C in the observation group was significantly lower than that in the control group, the difference was statistically significant（P〈0. 05）. Gensini score and RWH in the patients with two arteries lesions were significantly higher than those in the patients with single artery lesion, and Gensini score and RWH in the patients with three arteries lesions were higher than those in the patients with single artery and two arteries lesions, the differences were statistically significant （P〈0.05）. Spearman correlation analysis showed that the range of coronary artery lesion and Gensini score were positively correlated with RWH （r=0.635, 0.739; P=0.000, 0.000）. Conclusion： The high level of RWH in the patients with ACS is closely correlated with the severity of coronary artery lesion,therefore, so effectively controlling the abdominal obesity has an important significance in reducing the morbidity of cardiovascular disease and alleviating the severity of coronary artery lesion.