冠状动脉慢血流现象临床因素分析与内皮功能评价

Clinical risk factors and endothelial function in patients with coronary slow flow phenomenon

目的探讨冠状动脉慢血流现象(coronary slow flow phenomenon,CSFP)的危险因素,同时测定肱动脉血流介导性舒张功能(flowmedi-ateddilation,FMD),并探究其与CSFP的关系,FMD与平均冠状动脉TIMI血流帧数计数(mean TIMI f rame count,m TFC)、出现CSFP冠状动脉血管支数的关系。方法选择2014年1月至2015年12月因心绞痛就诊于中国医科大学附属第一医院,并行择期冠状动脉造影术疑诊为冠心病的患者,其中冠状动脉造影显示冠状动脉狭窄<40%且m TFC>27帧患者52例为CSFP组。选择同期冠状动脉造影显示冠状动脉狭窄<40%并且血流正常者44例为对照组。比较两组患者的临床基础资料、血生化指标、FMD水平。结果 CSFP组胱抑素C(Cys-C)明显高于对照组[(0.9±0.1)mg/L比(0.8±0.1)mg/L,P=0.012],差异有统计学意义,其余血生化指标比较,差异均无统计学意义(均P>0.05)。CSFP组FMD显著低于对照组[(4.7±2.3)%比(5.9±2.2)%,P=0.007],差异有统计学意义。CSFP组校正的TIMI帧数计数在前降支[(45.6±14.3)帧/s比(23.5±5.9)帧/s,P<0.001],TIMI帧数计数在回旋支[(32.0±10.4)帧/s比(18.0±3.9)帧/s,P<0.001]、右冠状动脉[(36.7±15.0)帧/s比(18.2±4.3)帧/s,P<0.001],及m TFC[(38.1±11.1)帧/s比(19.9±3.7)帧/s,P<0.001]均显著高于对照组,差异均有统计学意义。CSFP组患者FMD与m TFC负相关(r=0.330,P=0.001)。CSFP组患者3支慢血流现象FMD[(4.17±2.01)%比(6.34±2.69)%,P=0.037]明显低于对照组。结论 CSFP可能反映早期冠状动脉粥样硬化性改变。

Objective To investigate the risk factors and relationship of flow-mediated dilation（FMD） in the brachial artery in the development of coronary slow flow phenomenon（CSFP）.The relationship of FMD and mean TIMI frame count（m TFC）,number of vessels with CSFP was further studied. Methods A total of 96 patients who underwent coronary angiography because of symptoms of angina in our hospital from January 2014 to December 2015 were involved including 52 CSFP patients [25 male：27 female; mean age（56.3±7.1） years] and 44 normal coronary flow pattern [20 men：24 women; mean age（57.3±6.2） years].Biochemical parameters and FMD were compared between the two groups. Flow-mediated dilation（ FMD） was assessed by Doppler flow in the brachial artery. Results The plasma Cys-C level[（0.9±0.1）mg/L vs.（0.8±0.1） mg/L, P=0.012]was significantly higher in the CSFP group. The correlation between FMD and m TFC was negative（r=0.330,P=0.001）.The FMD in CSFP group [（4.7±2.3）% vs.（5.9±2.2）%,P=0.007]was significantly lower than the control group. The presence of CSFP in single vessel was found in 17 patients（32.7%）,in 2 vessels found in 11 patients（21.2%） and in all 3 coronary vessels in 24 patients（46.2%）.FMD was significantly lower in patients with CSFP in all 3 coronary vessels compaired to patients with normal coronary blood flow. Conclusions CSFP may reflect early atherosclerotic changes in the coronary artery microvasculature.