膳食营养素对冠心病患者冠状动脉斑块稳定性的影响研究

Impact of Dietary Nutrients on Coronary Plaque Vulnerability in Patients with Coronary Artery Disease

背景冠状动脉粥样硬化性心脏病(CAD)是威胁我国居民健康的重要慢性病,合理摄入各类膳食营养素对其防治至关重要。近年来研究发现冠状动脉粥样硬化斑块稳定性在CAD进程中发挥重要作用,但是膳食营养素是否通过影响冠状动脉粥样硬化斑块的稳定性进而导致CAD,目前尚不清楚。目的了解CAD患者膳食营养素的摄入情况,并探讨其对冠状动脉粥样硬化斑块稳定性的影响。方法选取2018年9月—2019年3月经冠状动脉造影确诊为CAD的患者314例为研究对象,采用半定量食物频率问卷对其进行问卷调查,应用食物营养计算器软件V2.7.3精确计算患者平均每日22类膳食营养素摄入量,应用光学相干断层成像技术分析其冠状动脉斑块稳定性情况。结果CAD患者的膳食纤维、叶酸、维生素C及钠摄入量分别为(17.21±6.59)g/d、(94.07±50.88)μg/d、(142.54±62.39)mg/d、(4.00±1.16)g/d。Logistic回归分析显示,维生素C是脂质斑块〔OR=0.994,95%CI(0.990,0.998),P=0.003〕、薄纤维帽粥样硬化斑块(TCFA)〔OR=0.988,95%CI(0.981,0.994),P<0.001〕及血栓〔OR=0.988,95%CI(0.983,0.994),P<0.001〕的保护因素;膳食纤维是巨噬细胞浸润〔OR=0.955,95%CI(0.920,0.992),P=0.016〕及TCFA〔OR=0.934,95%CI(0.900,0.970),P<0.001〕的保护因素;叶酸是TCFA〔OR=0.986,95%CI(0.978,0.993),P<0.001〕及斑块破裂〔OR=0.991,95%CI(0.985,0.997),P=0.005〕的保护因素;而钠是脂质斑块〔OR=1.597,95%CI(1.243,2.052),P<0.001〕、TCFA〔OR=1.617,95%CI(1.258,2.079),P<0.001〕、斑块破裂〔OR=1.359,95%CI(1.082,1.708),P=0.008〕及血栓〔OR=1.476,95%CI(1.077,2.022),P=0.015〕的危险因素。结论CAD患者膳食营养素摄入情况不佳,膳食纤维及维生素摄入不足,而钠摄入量严重超标。维生素C、膳食纤维、叶酸及钠摄入量是冠状动脉斑块稳定性的主要影响因素。对CAD患者进行膳食营养指导有助于预防不稳定斑块的产生,改善疾病进程。

Background Coronary artery disease(CAD)is a major chronic disease threatening Chinese residents'health.Rational intake of dietary nutrients is of vital importance to the prevention and treatment of CAD.Recently,robust evidence has indicated that coronary atherosclerotic vulnerable plaque is associated with an increased risk of disease progression.However,to the best of our knowledge,no previous study has evaluated the impact of dietary factors on coronary plaque vulnerability.Objective To investigate dietary nutrients intake and its association with coronary plaque vulnerability in CAD patients.Methods A total of 314 patients who were diagnosed with CAD by coronary angiography from September 2018 to March 2019 were invited to complete the Semi-Quantitative Food Frequency Questionnaire(SQFFQ).The Nutrition Calculator V2.7.3 was used to calculate daily intakes of 22 nutrients.Vulnerability of the coronary plaque was assessed by optical coherence tomography.Results The average intake of dietary fiber,folate,vitamin C and sodium in CAD patients was(17.21±6.59)g/d,(94.07±50.88)μg/d,(142.54±62.39)mg/d an(d 4.00±1.16)g/d,respectively.Logistic regression analysis indicated that high vitamin C intake was associated with reduced risk of lipid plaque〔OR=0.994,95%CI(0.990,0.998),P=0.003〕,thin-cap fibroatheroma(TCFA)〔OR=0.988,95%CI(0.981,0.994),P<0.001〕and thrombus〔OR=0.988,95%CI(0.983,0.994),P<0.001〕;high dietary fiber intake was associated with reduced risk of macrophage infiltration〔OR=0.955,95%CI(0.920,0.992),P=0.016〕and TCFA〔OR=0.934,95%CI(0.900,0.970),P<0.001〕;high folate intake was associated with reduced TCFA〔OR=0.986,95%CI(0.978,0.993),P<0.001〕and plaque rupture〔OR=0.991,95%CI(0.985,0.997),P=0.005〕.However,high sodium intake was associated with increased risk of lipid plaque〔OR=1.597,95%CI(1.243,2.052),P<0.001〕,TCFA〔OR=1.617,95%CI(1.258,2.079),P<0.001〕,plaque rupture〔OR=1.359,95%CI(1.082,1.708),P=0.008〕and thrombus〔OR=1.476,95%CI(1.077,2.022),P=0.015〕.Conclusion In these CAD patients,the intake of dietary fiber and vitamin was insufficient,but sodium intake exceeded the standard seriously,indicating that their dietary composition is unreasonable.The intakes of vitamin C,dietary fiber,folate and sodium are closely associated with coronary plaque vulnerability.Therefore,dietary and nutrition guidance may be a good intervention to prevent the development and delay the progression of CAD.