非阻塞性冠状动脉疾病患者心肌缺血的影响因素

Influencing factors of myocardial ischemia in patients with non-obstructive coronary artery disease

目的探讨非阻塞性冠状动脉疾病(NOCAD)患者心肌缺血的相关影响因素。方法选取2018年8月至2020年6月就诊于郑州大学第五附属医院行冠脉造影术或冠脉CT血管成像冠脉狭窄<50%的NOCAD患者113例,依据心肌声学造影判断是否存在心肌缺血将其分为缺血组(59例)和非缺血组(54例)。纳入年龄、血脂异常、糖尿病、高血压、肥胖、左室肥厚、病变冠状动脉数、室间隔厚度、左室质量指数等指标,用多因素logistic回归分析探索心肌缺血的影响因素。结果入选患者中超过50%有心肌缺血。两组肥胖、左室肥厚、室间隔厚度、左室质量指数比较,差异有统计学意义(P<0.05),但年龄、性别、体重指数、糖尿病、高血压、血脂异常、吸烟、血糖、总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、左室舒张末内径、左室收缩末内径、左室后壁厚度、病变冠状动脉数比较,差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,年龄、肥胖、高血压、血脂异常、病变冠状动脉数、糖尿病、左室质量指数、室间隔厚度与心肌缺血无关(P>0.05);左室肥厚是心肌缺血的独立危险因素(OR>1,P<0.05)。结论左室肥厚是NOCAD患者心肌缺血的独立影响因素。

Objective To investigate the related factors of myocardial ischemia in patients with non-obstructive coronary artery disease(NOCAD).Methods A total of 113 NOCAD patients who received coronary angiography or coronary computed tomography angiography with coronary artery stenosis<50%in the Fifth Affiliated Hospital of Zhengzhou University from August 2018 to June 2020 were selected.Based on myocardial contrast echocardiography,they were divided into two groups:ischemia group(59 cases)and non-ischemia group(54 cases).Age,dyslipidemia,diabetes mellitus,hypertension,obesity,left ventricular hypertrophy,number of diseased coronary arteries,interventricular septal thickness,left ventricular mass index,and other indicators were included.Multivariate logistic regression analysis was used to explore the influencing factors of myocardial ischemia.Results More than 50%of the enrolled patients had myocardial ischemia.There were statistically significant differences in obesity,left ventricular hypertrophy,interventricular septal thickness and left ventricular mass index between two groups(P<0.05).But there were no statistically significant differences in the age,sex,body mass index,diabetes mellitus,hypertension,dyslipidemia,smoking,blood glucose,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,left ventricular end diastolic dimension,left ventricular end systolic dimension,left ventricular posterior wall thickness,number of diseased coronary arteries(P>0.05).Multivariate logistic regression analysis showed that age,obesity,hypertension,dyslipidemia,number of diseased coronary arteries,diabetes mellitus,left ventricular mass index,and interventricular septal thickness were not associated with myocardial ischemia(P>0.05).Left ventricular hypertrophy was an independent risk factor for myocardial ischemia(OR>1,P<0.05).Conclusion Left ventricular hypertrophy is an independent risk factor for myocardial ischemia in NOCAD patients.