冠状动脉慢血流与冠状动脉微循环障碍的相关性研究

Relationship Between Slow Coronary Flow and Coronary Microcirculatory Dysfunction in Relevant Patients

目的:探讨冠状动脉(冠脉)慢血流(SCF)与冠脉微循环的相关性,以及SCF发生、发展的相关危险因素。方法:在接受冠脉造影的患者中,选择被诊断为SCF的32例为SCF组,冠脉血流正常和无明显狭窄病变的32例为对照组,分别记录和测定两组患者的一般资料和各项生化指标、高敏C反应蛋白(hs-CRP)、心肌梗死溶栓治疗临床试验(TIMI)血流帧数以及冠脉微循环阻力指数(IMR),分析各项指标与SCF的关系。结果:与对照组比较,SCF组患者的高密度脂蛋白胆固醇(HDL-C)和载脂蛋白-A1水平较低[(1.57±0.38)mmol/L vs(1.62±0.43)mmol/L,(1.41±0.31)mmol/L vs(1.57±0.38)mmol/L];hs-CRP水平较高[(3.63±1.67)μg/m L vs(1.74±0.75)μg/m L];IMR明显升高[(29.28±7.68)vs(24.94±6.67)],差异均有统计学意义(P<0.05)。且IMR与TIMI血流帧数及hs-CRP呈正相关(r=0.766,P=0.019;r=0.565,P<0.01)。结论 :(1)冠脉微循环功能障碍与SCF发生、发展呈相关性。(2)在冠脉微循环障碍中,炎症反应可能起到一定作用,HDL-C和载脂蛋白-A1水平的降低,可能也参与了冠脉微循环障碍的病理过程,从而在一定程度导致SCF。

Objective： To study the relationship between slow coronary flow （SCF） and coronary microcirculatory dysfunction in relevant patients and to explore the risk factors for SCF development. Methods： Our research was conducted in 2 groups： SCF group, the patients with coronary angiography confirmed diagnosis and Control group, the subjects with normal coronary flow. n=32 in each group. The general information, blood levels of biochemical indicators, hs-CRP levels, TIMI flow frame and the index of microcirculatory resistance （IMR） were examined, their relationships to SCF were analyzed. Results： Compared with Control group, the patients in SCF group showed the lower levels of HLL-C （1.57 ±0.38） mmol/L vs （1.62 ± 0.43） mmol/L and Apo-A1 （1.41 ± 0.31） mmol/L vs （1.57 ± 0.38） mmol/L, while higher level of hs-CRP （3.63 ± 1.67）μg/mL vs （1.74 ±0.75） μg/mL; SCF groups had increased IMR （29.28 ± 7.68） vs （24.94± 6.67）, all P〈0.05. IMR was positively related to TIMI flow frame （r=0.766, P=0.019） and hs-CRP （r=0.565, P=0.000）. Conclusion： ① Microcirculatory dysfunction was related to SCF. ② Inflammatory reaction, decreased blood levels of HDL-C and Apo-A 1 might be involved in pathological process of SCF.