非心肌梗死冠心病患者的心肌微循环阻力指数及相关因素分析

Index of Myocardial Microcirculatory Resistance in Patients With Coronary Heart Disease and the Analysis of Related Factors

目的:应用微循环阻力指数(IMR)评价非心肌梗死冠状动脉性心脏病(冠心病)患者的心肌微循环状态,并分析影响IMR的相关因素。方法:连续纳入101例非心肌梗死冠心病患者,在血流储备分数(FFR)排除功能性病变或行经皮冠状动脉介入治疗(PCI)后即刻进行IMR检测。以IMR≥25 U定义为冠状动脉微血管疾病,分析IMR异常的发生率和影响因素。结果:共在116支冠状动脉靶血管中测量了IMR,IMR为14.2(11.4,19.9)U,17例(16.8%)患者IMR≥25 U。高血压、服用钙拮抗剂(CCB)的患者IMR较高(P均<0.05);服用他汀类药物和左心室舒张末期内径(LVEDD)增大的患者IMR较低(P均<0.05)。IMR与空腹血糖、高密度脂蛋白胆固醇、FFR呈正相关(r=0.203、0.203、0.207,P均<0.05),而与左心室质量指数(LVMI)呈负相关(r=-0.205,P<0.05)。多重线性回归分析提示,空腹血糖、LVEDD、他汀类药物、CCB为IMR的独立相关因素(β=1.177,P=0.003;β=-7.015,P=0.002;β=-8.568,P<0.001;β=3.250,P=0.017)。结论:近17%的非心肌梗死冠心病患者存在IMR反映的冠状动脉微血管疾病;空腹血糖、LVEDD、应用他汀类药物及CCB可能是影响IMR的独立相关因素。

Objectives： To evaluate the index of myocardial microcirculatory resistance（IMR） in patients with non-myocardial infarction（MI） coronary heart disease（CHD） and to analyze the related factors of IMR.Methods： A total of 101 patients with non-MI CHD were enrolled, the average age was（60 ± 10） years and there were 68 males. IMR of 116 coronary arteries was measured immediately after exclusion of functional abnormalities by factional flow reserve（FFR） or after percutaneous coronary intervention（PCI）. Data of clinic, laboratory, echocardiography, and coronary angiography were collected and the related factors of IMR were analyzed.Results： The success rate of IMR measurement was 100%. The median value of IMR was 14.2（11.4, 19.9） U and IMR≥25 U was only presented in 17 patients. There was no significant difference in IMR（P=0.648） and the proportion（P =0.706） of patients with IMR ≥25 U between unstable angina pectoris（UAP）（75 cases） and stable CHD（26 cases） patients. IMR was significantly higher in patients with hypertension（P=0.024） than those without hypertension and higher in patients treated with calcium channel blockers（CCB）（ P =0.020） than those not treated with CCB. Compared with the corresponding patients, IMR was significantly lower in patients taking statins（P =0.008,） and those with increased left ventricular end-diastolic diameter（LVEDD）（ P=0.005）. IMR was positively correlated with fasting plasma glucose（FPG）, high density lipoprotein cholesterol（HDL-C） and FFR（r=0.203, 0.203, 0.207, respectively, all P〈0.05）, meanwhile IMR was negatively correlated with left ventricular mass index（LVMI）（r=-0.205, P〈0.05）. Multiple linear regression analysis showedthat FPG（β=1.177, P=0.003）, LVEDD（β=-7.015, P=0.002）,statins（β=-8.568, P〈0.001）and CCB（β=3.250, P=0.017） were independent determinants of IMR.Conclusions： Nearly 17% of patients with non-MI CHD suffer from coronary microvascular diseases reflected by IMR. FPG, LVEDD, statins and CCB are the independent related factors of IMR.