传统心血管病危险因素与血管内超声检测的冠状动脉粥样硬化斑块负荷的关系

Association between coronary risk factors and atherosclerotic disease burden measured by intravascular ultrasound

目的研究冠心病患者的心血管疾病危险因素和血管内超声（IVUS)检测的冠状动脉粥样硬化斑块负荷严重程度的关系。方法人选在北京安贞医院经冠脉造影发现原位冠状动脉狭窄(20%~70%)的连续病例，使用IVUS测定冠状动脉粥样硬化斑块负荷标准化的斑块体积（标准化的TAV)，斑块体积狭窄率(PAV)，斑块负荷（PB)和定量冠脉造影（QCA)所测的面积狭窄百分比等，采用多重线性回归的统计方法分析心血管疾病的危险因素与冠状动脉粥样硬化斑块负荷之间的相关性。结果共人选130例患者（男性107例，女性23例），单因素分析提示，男性（r=0.619，P=0.001)、糖尿病〇=0.547，/3=0.001)、陈旧性心肌梗死〇=0.413，/3=0.001)，1'(：〇=0.181，/3=0.040)和HDL-CO=0.589，P=0.001)与PAV明显相关，但是LDL-C、吸烟史、高血压等与PAV无相关性;男性、糖尿病与标准化TAV相关性强，吸烟史也与标准化TAV具有相关性;年龄（男性>45岁或女性>55岁）、糖尿病、男性和hs-CRP与冠脉的病变长度具有相关性。多重线性回归分析中，糖尿病和男性均与斑块负荷严重程度的指标(PAV和标准化TAV)具有较强的正相关，HDL-C与PAV呈负相关;糖尿病、男性和年龄(男性>45岁或女性>55岁）与病变长度具有相关性。男性、糖尿病和HDL-C是病变最重处斑块负荷强有力的预测因子。HDL-C与QCA所测的面积狭窄率呈负相关，收缩压与QCA所测的面积狭窄率成正相关。结论男性和糖尿病是斑块负荷严重程度（PB、PAV和标准化TAV)独立的危险因素，HDL-C是斑块负荷的保护因素。

Objective To investigate the relationship between established cardiovascular risk factors and the extent of coronary atherosclerotic plaque in a single-center study in Beijing. Methods Eligibility required evidence of coronary artery disease on screening angiography, defined as the presence of ^ 1 stenosis in a native coronary artery with > 20% and < 70% luminal diameter narrowing by visual estimation. To assess the correlation of cardiovascular risk factors with atherosclerotic plaque burden [ including normalized total atheroma volume ( TAV ) , percent atheroma volume ( PAV ) and percent area stenosis ] measured by IVUS,and with angiographic percent area stenosis in patients with coronary artery disease. Results Consecutive 130 patients met the inclusion criteria were enrolled, average age of the patients was 59 ± 11 years and 107 ( 82. 3% ) patients were male. In univariate analysis, there was a strong association between diabetes, male gender, a history of prior myocardial infarction, TC and HDL-C levels with PAV. For Normalized TAV,male gender or diabetes were predictors of more severe disease. For lesion length, Age( men^ 45years or women ^55years) , diabetes, male gender or high sensitivity C-reactive protein were predictors of more severe disease. In multivariate analysis, diabetes and male gender remained strong predictors of increased atheroma volume ( including PAV and Normalized TAV) . HDL-C was negatively correlated with PAV. Diabetes,male gender and age (m en ^ 45 years or women^55 years) were still correlated with lesion length. Male gender,diabetes and HDL-C were strong predictive factors of the most severe stenosis in target vessel. HDL-C was negatively correlated with angiographic percent area stenosis. Systolic blood pressure was positively related to angiographic percent area stenosis. Conclusions Male and diabetes are strong independent indicators of plaque burden ( Plaque burden, PAV and normalized TAV) in patients with coronary heart disease. HDL-C is also a negatively strong predictor of plaque burden in patients with coronary heart disease.