冠状动脉内径及迂曲与原发性微血管性心绞痛的相关性研究

Relationship between Luminal Diameter and Tortuosity of Coronary Artery and Primary Microvascular Angina

背景微血管性心绞痛(MVA)是易被忽视的疾病,目前因无明确的相关指标而导致常规冠状动脉造影无法快速准确判定MVA,且国内外相关研究较少。目的探讨冠状动脉内径及迂曲与原发性MVA的相关性。方法回顾性选取2008年1月—2010年9月就诊于滨州医学院附属医院以心绞痛症状入院并行冠状动脉造影的患者1361例为研究对象。首先根据冠状动脉造影结果计算每例患者的SYNTAX评分,大于0分者为冠心病(CAD)组,等于0分者再按照临床标准分为MVA组及非冠心病(NCAD)组。比较三组患者的基线资料〔包括年龄、性别、既往病史、红细胞沉降率(ESR)、血红蛋白(Hb)、中性粒细胞/淋巴细胞比值(NLR)、血脂指标、肾功能指标、胆红素及平均冠状动脉近段内径和冠状动脉迂曲的情况〕,并进一步应用多因素Logistic回归方程分析其基线资料与原发性MVA的相关性。结果MVA组与CAD组的平均年龄、高血压比例、糖尿病比例、平均冠状动脉近段内径、冠状动脉迂曲比例、ESR、Hb、NLR、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肌酐(Cr)、血糖(Glu)比较,差异有统计学意义(P<0.05)。MVA组与NCAD组性别、平均年龄、高血压比例、糖尿病比例、吸烟史、平均冠状动脉近段内径、冠状动脉迂曲比例、Hb比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析发现,相较CAD组,冠状动脉近段平均内径〔OR=8.279,95%CI(5.459,12.556),P<0.001〕、冠状动脉迂曲〔OR=6.761,95%CI(3.755,12.174),P<0.001〕、Hb〔OR=1.057,95%CI(1.031,1.083),P<0.001〕、女性〔OR=3.019,95%CI(1.379,6.609),P=0.006〕、高血压〔OR=0.194,95%CI(0.106,0.353),P<0.001〕、糖尿病〔OR=0.105,95%CI(0.020,0.548),P=0.008〕、LDL-C〔OR=0.617,95%CI(0.412,0.914),P=0.019〕是原发性MVA的独立影响因素;相较NCAD组,平均冠状动脉近段内径〔OR=9.246,95%CI(6.050,14.129),P<0.001〕、冠状动脉迂曲〔OR=4.105,95%CI(2.288,7.363),P<0.001〕、Hb〔OR=1.042,95%CI(1.017,1.068),P=0.001〕、Glu〔OR=1.214,95%CI(1.030,1.432),P=0.021〕、高血压〔OR=0.282,95%CI(0.154,0.517),P<0.001〕及糖尿病〔OR=0.138,95%CI(0.026,0.745),P=0.021〕是原发性MVA的独立影响因素。多因素Logistic回归分析示原发性MVA〔OR=5.150,95%CI(3.366,7.881),P<0.001〕、女性〔OR=1.460,95%CI(1.097,1.944),P=0.009〕、高血压〔OR=1.564,95%CI(1.169,2.094),P=0.003〕和HDL-C〔OR=1.479,95%CI(1.067,2.050),P=0.019〕是冠状动脉迂曲的独立危险因素。结论高血压、糖尿病与原发性MVA独立负相关,Hb、平均冠状动脉近段内径、冠状动脉迂曲与原发性MVA独立正相关。平均冠状动脉近段内径增大、冠状动脉迂曲可能是原发性MVA的继发表现而不是原因。

Background Microvascular angina(MVA)is a disease that is easy to be ignored in the clinic.At present,there is no clear correlation evaluation index in routine coronary angiography,so it is unable to determine MVA quickly and accurately,and there is no relevant research at home and abroad.Objective To explore the relationship between the luminal diameter and tortuosity of coronary artery and primary MVA.Methods From January 2008 to September 2010,a total of 1361 patients with angina pectoris and underwent coronary angiography were studied in Binzhou Medical University Hospital.The SYNCAX score of each patient was calculated according to the results of coronary angiography.The patients with a score greater than 0 were divided into coronary heart disease(CAD)group,and the patients with a score equal to 0 were divided into MVA group and non coronary heart disease(NCAD)group according clinical diagnosis.Baseline characteristics〔mean age,sex,past medical history,mean erythrocyte sedimentation rate(ESR),hemoglobin,neutrophil/lymphocyte ratio(NLR),blood lipid parameters,renal function parameters,bilirubin,mean luminal diameter of proximal coronary artery,and tortuosity of coronary artery〕were compared across the three groups.Multivariate Logistic regression model was used to analyze the relationship of baseline characteristics with primary MVA.Results There were significant differences between MVA group and CAD group in mean age,prevalence of hypertension,diabetes,and tortuosity of coronary artery,mean luminal diameter of proximal coronary artery,ESR,hemoglobin,NLR,TG,LDL-C,HDL-C,Cr and fasting blood glucose(P<0.05).There were significant differences between MVA group and NCAD group in sex,prevalence of hypertension,diabetes,and tortuosity of coronary artery,smoking history distribution,mean age,mean luminal diameter of artery of proximal coronary,and hemoglobin(P<0.05).Multivariate Logistic regression analysis showed that,compared with CAD group,mean luminal diameter of proximal coronary artery〔OR=8.279,95%CI(5.459,12.556),P<0.001〕,tortuosity of coronary artery〔OR=6.761,95%CI(3.755,12.174),P<0.001〕,hemoglobin〔OR=1.057,95%CI(1.031,1.083),P<0.001〕,female〔OR=3.019,95%CI(1.379,6.609),P=0.006〕,hypertension〔OR=0.194,95%CI(0.106,0.353),P<0.001〕,diabetes〔OR=0.105,95%CI(0.020,0.548),P=0.008〕and LDL-C〔OR=0.617,95%CI(0.412,0.914),P=0.019〕were independent influencing factors of primary MVA.Compared with the non-CAD group,mean luminal diameter of proximal coronary artery〔OR=9.246,95%CI(6.050,14.129),P<0.001〕coronary artery tortuosity〔OR=4.105,95%C(I 2.288,7.363),P<0.001〕,hemoglobin〔OR=1.042,95%CI(1.017,1.068),P=0.001〕,fasting blood glucose〔OR=1.214,95%CI(1.030,1.432),P=0.021〕,hypertension〔OR=0.282,95%CI(0.154,0.517),P<0.001〕and diabetes〔OR=0.138,95%CI(0.026,0.745),P=0.021〕were independent influencing factors of primary MVA.Multivariate Logistic regression analysis showed that primary MVA〔OR=5.150,95%CI(3.366,7.881),P<0.001〕,female〔OR=1.460,95%CI(1.097,1.944),P=0.009〕,hypertension〔OR=1.564,95%CI(1.169,2.094),P=0.003〕and elevated HDL-C〔OR=1.479,95%CI(1.067,2.050),P=0.019〕were independent risk factors of tortuosity of coronary artery.Conclusion Hypertension and diabetes are independently negatively correlated with primary MVA,while hemoglobin,mean luminal diameter of proximal coronary artery,and tortuosity of coronary artery are independently positively correlated with primary MVA.Increase of mean luminal diameter of proximal coronary artery and tortuosity of coronary artery may be secondary manifestations rather than the cause of primary MVA.