非阻塞性冠状动脉疾病女性患者冠状动脉血流储备异常的预测因素

Predictor analysis of abnormal coronary flow reserve in women with non-obstructive coronary artery disease

目的探讨非阻塞性冠状动脉疾病女性患者的冠状动脉血流储备(CFR)异常的预测因素和临床特点。方法回顾性分析非阻塞性冠状动脉疾病女性患者223例,包括一般临床特点、生命体征、在院期间超声左心室射血分数、核素心肌血流定量显像以及实验室血液检测指标,其中左心室整体CFR值≥2.5为CFR正常组,左心室整体CFR值<2.5为CFR异常组。结果CFR异常组的总胆固醇和低密度脂蛋白胆固醇(LDL-C)水平明显高于CFR正常组(P=0.011,P=0.002)。多因素分析显示,仅LDL-C是CFR异常的独立预测因素(OR=3.346;95%CI=1.254-8.930;P=0.016)。ROC曲线分析显示预测CFR异常的最佳LDL-C截断值为3.36 mmol/L,敏感性为40%,特异性为77%(AUC=0.609;95%CI=0.535-0.683)。结论在非阻塞性冠状动脉疾病女性患者中,LDL-C水平是CFR异常的独立预测因素,LDL-C水平高于正常的女性,更容易合并冠状动脉微血管功能障碍。

Objective To explore the predictors and clinical features of abnormal coronary flow reserve(CFR)in women with non-obstructive coronary artery disease(NOCAD).Methods We performed a retrospective analysis of 223 NOCAD female patients from the aspects of general clinical features,vital signs,left-ventricular ejection fraction(LVEF)on the echocardiography during hospitalization,nuclear myocardial perfusion imaging parameters and laboratory blood tests indexes for further statistical analysis.The patients were divided into two groups:normal CFR group(CFR≥2.5)and abnormal CFR group(CFR<2.5).Results The levels of total cholesterol and low density lipoprotein cholesterol(LDL-C)were significantly higher in abnormal CFR group than those in normal CFR group(P=0.011,P=0.002).Multiple logistic regression analysis revealed that LDL-C level was only found to be independently associated with abnormal CFR(OR=3.346;95%CI=1.254-8.930;P=0.016).The receiver operating characteristic(ROC)curve analysis showed that the optimal cut-off value of LDL-C level for predicting abnormal CFR was 3.36 mmol/L with a sensitivity of 40% and specificity of 77%(AUC=0.609;95%CI=0.535-0.683).Conclusion The LDL-C level is found to be independently associated with abnormal CFR in NOCAD female patients,and coronary microvascular dysfunction is more likely to occur in women with abnormal LDL-C level.