老年高血压患者前降支冠状动脉微循环阻力指数影响因素分析

Factors influencing microcirculation resistance of left anterior descending coronary artery in elderly hypertensive patients

目的探讨老年高血压患者前降支冠状动脉微循环阻力指数(IMR)变化及影响因素。方法选取2015年7月~2016年8月南京医科大学附属淮安第一医院冠状动脉造影狭窄<50%的老年患者147例,其中高血压组87例,对照组60例,多普勒压力导丝测定前降支IMR,对比2组临床特征、生化指标和心脏彩色超声结果,计算尿白蛋白/尿肌酐比(albumin to creatinine ratio,ACR)和左心室质量指数(left ventricular mass index,LVMI),分析IMR影响因素。结果高血压组ACR、LVMI、舒张功能不全、基线平均传输时间、充血平均传输时间、IMR明显高于对照组[31.52±18.57 vs 17.13±11.32,P=0.008;(83.3±18.2)g/m^2 vs(78.4±11.6)g/m^2,P=0.045;56.3%vs25.0%,P=0.005;(0.89±0.37)s vs(0.77±0.44)s,P=0.032;(0.56±0.16)s vs(0.28±0.16)s,P=0.001;31.32±7.22 vs 24.54±6.55,P=0.001],冠状动脉血流储备明显低于对照组(2.13±0.42 vs 3.24±0.33,P=0.001)。多因素logistic回归分析显示,ACR、LVMI、舒张功能不全是高血压组IMR升高的危险因素(OR=4.12,95%CI:3.63~4.61,P=0.04;OR=1.99,95%CI:1.75~2.23,P=0.03;OR=4.75,95%CI:4.48~5.02,P=0.04)。结论老年高血压患者前降支冠状动脉IMR升高,与蛋白尿、心肌肥厚、舒张功能不全相关。

Objective To study the factors influencing microcirculation resistance （IMR） of left anterior descending coronary artery in elderly hypertensive patients. Methods One hundred and forty-seven elderly patients with their coronary artery stenosis 〈50% admitted to our hospital from July 2015 to August 2016 were divided into hypertension group （n=87） and control group （n= 60）. The IMR of their left anterior descending coronary artery was tested with Doppler guidewire. Their clinical data, biochemical and color cardiac ultrasonographic parameters, albumin/creatinine ratio （ACR）,and left ventricular mass index （LVMI） were recorded. Factors influencing IMR were analyzed. Results The ACR and LVMI were significantly higher,the diastolic insuffi ciency was significantly severer,the baseline mean transit time at rest （bTmn） and hyperemia mean transit time （hTmn） were significantly longer,and the IMR was significantly greater in hy pertension group than in control group （P〈0.05 ,P〈0.01）. Multivariate logistic regression analysis showed that ACR,LVMI,and diastolic insufficiency were the risk factors for IMR in elderly hypertension patients（OR=4. 12,95%CI：3. 63-4. 61,P=0. 04;OR=1. 99,95%CI.1. 75 -2.23,P=0.03;OR=4.75,95%CI：4.48-5.02,P=0.04）.Conclusion Elevated IMR of left anterior descending coronary artery is associsted with albuminuria myocar dial hypertrophy,and diastolic insufficiency in elderly hypertensive patients.