不同肥胖类型对男性非阻塞性冠心病患者冠状动脉微循环功能的影响

Impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease

目的探讨不同肥胖类型对男性非阻塞性冠心病患者冠状动脉微循环功能的影响。方法回顾性分析山西医科大学第一医院2015年12月至2021年8月可疑冠状动脉微循环功能障碍(CMD)的男性患者资料。所有患者行一日法静息和负荷^(13)N-氨水正电子发射断层显像心肌灌注显像。以体重指数(BMI)≥28 kg/m^(2)为判定全身肥胖的标准,以腰围≥90 cm为判定腹型肥胖的标准,以负荷心肌血流量(MBF)<2.3 ml·min^(-1)·g^(-1)或冠状动脉血流储备(CFR)<2.5为判定CMD的标准。依据BMI及腰围对患者进行分组,并比较各组患者的MBF、CFR、CMD患病率,以及血流动力学参数和心功能间的差异。结果共纳入136例研究对象。依据BMI和腰围被分为对照组(n=45),单纯腹型肥胖组(n=53)和复合型肥胖组(n=38)。3组间的静息MBF差异无统计学意义(F=0.02,P=0.994)。单纯腹型肥胖组[(2.44±0.85)ml·min^(-1)·g^(-1)]及复合型肥胖组[(2.49±0.71)ml·min^(-1)·g^(-1)]负荷MBF较对照组[(2.82±0.64)ml·min^(-1)·g^(-1)]低(P均<0.05),但前两组间的负荷MBF差异无统计学意义(P=0.772)。单纯腹型肥胖组的CFR低于对照组(2.87±0.99比3.32±0.62,P=0.012),复合型肥胖组的CFR(3.02±0.91)虽然也低于对照组,但差异无统计学意义(P=0.117)。单纯腹型肥胖组(62.3%)及复合型肥胖组(52.6%)的CMD患病率均高于对照组(22.2%)(P均<0.01)。腰围(OR=1.057,95%CI:1.013~1.103,P=0.011)是男性CMD的独立危险因素。结论在非阻塞性冠心病的男性患者中,腹型肥胖可能与冠状动脉微循环功能下降有关,单纯腹型肥胖的男性患CMD的风险最大。

Objective This study sought to investigate the impact of different obesity patterns on coronary microvascular function in male patients with non-obstructive coronary artery disease.Methods We retrospectively analyzed clinical data of male patients diagnosed with suspected coronary microvascular dysfunction(CMD)in the First Hospital of Shanxi Medical University between December 2015 and August 2021.All patients underwent the one-day rest and stress^(13)N-ammonia positron emission tomography myocardial perfusion imaging.Overall obesity was defined by body mass index(BMI)≥28 kg/m^(2)and abdominal obesity was defined by waist circumference≥90 cm.Hyperemic myocardial blood flow(MBF)<2.3 ml·min^(-1)·g^(-1)or coronary flow reserve(CFR)<2.5 were referred as CMD.All patients were grouped based on their BMI and waist circumference.MBF,CFR,the incidence of CMD,hemodynamic parameters,and cardiac function were compared among the groups.Results A total of 136 patients were included.According to BMI and waist circumference,patients were categorized into 3 groups:control group(n=45),simple abdominal obesity group(n=53)and compound obesity group(n=38).Resting MBF did not differ between groups(F=0.02,P=0.994).Compared with the control group,hyperemic MBF was significantly lower in the simple abdominal obesity and compound obesity groups((2.82±0.64)ml·min^(-1)·g^(-1),(2.44±0.85)ml·min^(-1)·g^(-1)and(2.49±0.71)ml·min^(-1)·g^(-1),both P<0.05,respectively).Hyperemic MBF was comparable among the groups of patients with obesity(P=0.772).CFR was significantly lower in the simle abdominal obesity group compared with the control group(2.87±0.99 vs.3.32±0.62,P=0.012).Compared with the control group,CFR tended to be lower in the compound obesity group(3.02±0.91 vs.3.32±0.62,P=0.117).The incidence of CMD was significantly higher in both the simple abdominal obesity and compound obesity groups than in the control group(62.3%,52.6%vs.22.2%,both P<0.01,respectively).Waist circumference was an independent risk factor for male CMD(OR=1.057,95%CI:1.013-1.103,P=0.011).Conclusions In male patients with non-obstructive coronary artery disease,abdominal obesity is associated with decreased coronary microvascular function.Male patients with simple abdominal obesity face the highest risk of CMD.