冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系

Relationship between clinical features,peripheral microcirculatory and severity of coronary artery disease in patients with coronary heart disease

目的探讨冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系。方法选取我院2016年3月-2021年3月220例冠心病患者作为研究对象,根据冠状动脉病变程度将患者分为轻、中度组(n=142)和重、极重度组(n=78)。收集两组入院时年龄、性别、身体质量指数(BMI)、糖尿病、高血压各项信息。测定两组入院1 d后叶酸(FA)、维生素B_(12)(VB_(12))、总胆红素(TBIL)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。采用手指复温试验测定患者外周微循环。对比两组基础资料、实验室指标及手指复温时间(RT),利用ROC曲线分析FA、VB_(12)、TBIL、TC、LDL-C、RT对冠心病患者重、极重度冠状动脉病变发生的预测价值,将有差异的单因素纳入Logistic模型,行量化赋值,明确冠心病患者重、极重度冠状动脉病变发生的危险因素。结果重、极重度组年龄≥60岁、高血压患者占比显著高于轻、中度组,FA、VB_(12)、TBIL水平显著低于轻、中度组,TC、LDL-C、RT显著高于轻、中度组,差异均有统计学意义(P<0.05)。FA、VB_(12)、TBIL、TC、LDL-C、RT预测冠心病患者重、极重度冠状动脉病变发生的曲线下面积分别为0.931、0.732、0.869、0.849、0.775、0.967,均P<0.05。经多因素Logistic回归分析证实,年龄≥60岁、高血压、FA≤6.555μg/L、VB_(12)≤268.295 ng/L、TBIL≤10.015μmol/L、TC≥5.015 mmol/L、LDL-C≥2.680 mmol/L、RT≥405.240 s是冠心病患者重、极重度冠状动脉病变发生的危险因素。结论年龄≥60岁、高血压患者发生重、极重度冠状动脉病变可能性较大,患者FA、VB_(12)、TBIL、TC、LDL-C水平及外周微循环与冠状动脉病变程度密切相关,可用于评估患者病情严重程度。

Objective To explore the relationship between clinical features,peripheral microcirculatory and the severity of coronary artery disease(CAD)in patients with coronary heart disease(CHD).Methods Totally 220 CHD patients admitted to our hospital from March 2016 to March 2021 were assigned into mild and moderate group(n=142)and severe and extremely severe group(n=78).The data of age,gender,body mass index(BMI),diabetes mellitus(DM),and hypertension on admission were collected;the indicators of the two groups were measured on day 1 admission,including folic acid(FA),vitamin B_(12)(VB_(12)),total bilirubin(TBIL),triglyceride(TG),total cholesterol(TC),high density lipoprotein-cholesterol(HDL-C)and low density lipoprotein-cholesterol(LDL-C).The rewarming test of finger skin was used to measure peripheral microcirculatory;the predictive value of FA,VB_(12),TBIL,TC,LDL-C,RT for severe and extremely severe CAD in CHD patients was analyzed according to receiver operating characteristic(ROC)curve by comparing the basic data,laboratory index,finger rewarming time(RT)of two groups.The different single factors were included in the Logistic model and quantified to determine the risk factors of severe and extremely severe CAD in CHD patients.Results Compared with mild and moderate group,the proportion of patients with age≥60 and hypertension in severe and extremely severe group was significantly increased;FA,VB_(12) and TBIL in severe and extremely severe group were significantly decreased;TC,LDL-C and RT were obviously higher;and with statistically significant difference(P<0.05).The areas under curve(AUC)of FA,VB_(12),TBIL,TC,LDL-C and RT in predicting in the pathogenesis of severe and extremely severe CAD in CHD patients were 0.931,0.732,0.869,0.849,0.775 and 0.967,respectively(all P<0.05).Multivariate Logistic regression analysis showed that the risk factors of severe and extremely severe CAD in CHD patients were age≥60 years old,hypertension,FA≤6.555μg/L,VB_(12)≤268.295 ng/L,TBIL≤10.015μmol/L,TC≥5.015 mmol/L,LDL-C≥2.680 mmol/L,RT≥405.240 s.Conclusion Patients with age≥60 years old and hypertension are more likely to have severe and extremely severe CAD.The levels of FA,VB_(12),TBIL,TC,LDL-C and peripheral microcirculatory are closely correlated with severity of CAD,which can be used to evaluate the severity of patients.