老年男性冠心病患者血清睾酮水平冠状动脉病变及预后的相关性

Correlation of serum testosterone level with coronary artery disease features and its prognosis in elderly male patients with coronary heart disease

目的研究老年男性冠心病患者血清睾酮水平与冠状动脉(冠脉)病变程度、冠脉斑块特征、支架置入情况及主要心血管不良事件(MACE)的相关性。方法回顾性研究,选择经冠脉造影(CAG)明确诊断为冠心病并准备接受经皮冠脉介入治疗的杭州市第三人民医院老年科住院的老年男性患者63例,其中低睾酮组30例,对照组33例,两组患者均行光学相干断层成像(OCT)检查,明确冠脉病变特点,并指导支架置入。同时分析血清睾酮水平与血脂、糖化血红蛋白(HbA1c)、冠脉病变程度、斑块特点、支架置入情况及MACE的相关性。对两组患者随访12个月,明确患者支架置入后再狭窄率及支架最小管腔直径变化。结果低睾酮组与对照组患者比较,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1c)升高(t=7.808、-5.871、6.611,均P<0.05)。以睾酮为自变量,进行线性回归分析,TC、LDL-C、HbA1c与睾酮呈负相关(β=-0.733、-0.716、-0.581,P<0.05)。与对照组患者比较,低睾酮组患者血管2支以上病变多见(χ^(2)=8.66,P<0.05);低睾酮组患者混合斑块、脂质斑块、钙化斑块更多(χ^(2)=7.87,P<0.05);低睾酮组患者斑块不稳定多见(χ^(2)=6.14,P<0.05)。低睾酮组患者与对照组患者冠脉置入支架为93.3%(28例)比66.7%(22例),差异有统计学意义(χ^(2)=6.82,P<0.05)。Logistic回归分析结果显示,血清睾酮、TC及HbA1c水平与支架置入相关(OR=0.971、425.523、0.004,P<0.05)。OCT指导下冠脉内支架置入,两组支架置入时的最小支架内管腔直径比较差异无统计学意义(t=-1.064,P>0.05)。随访12个月,低睾酮组与对照组患者MACE为26.7%(8例)比6.1%(2例),差异有统计学意义(χ^(2)=5.00,P<0.05)。Logistic回归分析结果显示,血清睾酮、LDL-C水平与MACE相关(OR=0.968、0.008,P<0.05)。结论血清睾酮与TC、LDL-C、HbA1c呈负相关,与冠脉病变程度、斑块性质、MACE及支架置入相关,血清睾酮可用于冠心病病变特点和病情的评估,并有助于冠心病预后的预测。OCT能很好地指导冠脉支架置入。

Objective To investigate the correlation of serum testosterone level with severity and characteristics of coronary plaque,stent implantation rate and major cardiovascular adverse events(MACE)in elderly male patients with coronary heart disease(CHD).Methods In this retrospective study,a total of 63 elderly male patients of the Third People's Hospital of Hangzhou with coronary angiography(CAG)-confirmed CHD and to undergo percutaneous coronary intervention(PCI)were selected.According to serum testosterone level,they were divided into the low testosterone(low T)group and the normal testosterone(normal T)group.Optical coherence tomography(OCT)was performed in both groups to define the characteristics of coronary artery lesions and guide stent implantation.The correlation of serum testosterone level with blood lipids,glycated hemoglobin(HbA1c),degree of coronary artery lesions,plaque characteristics,stent implantation and MACE in two groups were analyzed.The in-stent restenosis rate after stent implantation and the variation of minimum lumen diameter of stent were determined during 12 months follow up in both groups.Results Total cholesterol(TC),low-density lipoprotein(LDL-C)and HbA1c were higher in the low T group than in the normal T group(t=7.808、-5.871、6.611,all P<0.05).When taking testosterone as the independent variable,and TC,triglycerides(TG),LDL-C,high density lipoprotein cholesterol(HDL-C)and HbA1c as the dependent variables,linear regression analysis showed that TC,LDL-C and HbA1c were negatively correlated with testosterone level(β=-0.733,-0.716,-0.581,P<0.05).More than 2 vascular lesions were more common in low testosterone group versus the control group(χ^(2)=8.66,P<0.05).Mixed plaques,lipid plaques,and calcified plaques were more commonly found in low testosterone group versus the control group(χ^(2)=7.87,P<0.05).Unstable plaques were more common in the low T group(χ^(2)=6.14,P<0.05).The low T group vs the normal T group,coronary stent implantation rate were 93.3%(28/30 cases)vs.66.7%(22/33 cases),the difference was statistically significant(χ^(2)=6.82,P<0.05).When testosterone,TC,TG,LDL-C,HDL-C,HbA1c were taken as the independent variables,and the stent implantation rate was the dependent variable,logistic regression analysis results showed that only testosterone,TC and HbA1c were independently correlated with stent implantation rate(OR=0.971、425.523、0.004,P<0.05).There was no statistically significant difference in minimum stent lumen diameters between the two groups under OCT-guided coronary stent implantation(t=-1.064,P>0.05).During 12 months follow up,the MACE0 incidence was 26.7%(8/30 cases,in low T group)than 6.1%(2/33 cases,in normal T group),with statistically significant difference(χ^(2)=5.00,P<0.05).When taking testosterone,TC,TG,LDL-C,HDL-C and HbA1c as the independent variables,and MACE as the dependent variable,logistic regression analysis results showed that only testosterone and LDL-C were independently correlated with MACE(OR=0.968,0.008,P<0.05).Conclusions Serum testosterone level is negatively correlated with TC,LDL-C and HbA1c,and may be correlated with the degree of coronary artery lesions,plaque properties,MACE and stent implantation rate of CHD patients.Serum testosterone can be used to evaluate the characteristics and conditions of CHD,and help to predict the prognosis of CHD.The OCT is a good guide tool for coronary stent implantation.