藏族冠心病患者CCTA与临床指标相关性研究

Study on the correlation between CCTA and clinical indicators in tibetan patients with coronary heart disease

目的:探究藏族冠心病患者冠状动脉CT血管成像(CCTA)影像学指标与临床指标相关性,寻找与藏族冠心病患者高危因素相关的特异性影像学与临床指标。方法:收集2021年9月—2022年5月在西藏自治区人民政府驻成都办事处医院行CCTA扫描及实验室检查经临床诊断为冠心病的藏族及汉族患者共159例(汉族组84例,藏族组75例),获取冠周脂肪CT值、冠周脂肪体积、冠脉狭窄程度、实验室检查结果等定量参数,分析藏族冠心病患者的独立危险因素及各因素对藏族冠心病的预测价值。结果:两组人群的实验室检查指标红细胞、血红蛋白、红细胞压积、高密度胆固醇以及影像学标记物左冠状动脉前降支(LAD)无狭窄、右冠状动脉(RCA)无狭窄、钙化积分分级(0~1级、3级)差异具有统计学意义(P<0.05)。总胆固醇[OR=1.034,95%CI(0.720~1.354)]、低密度脂蛋白胆固醇[OR=2.094,95%CI(1.162~2.893)]、钙化积分分级[OR=1.601,95%CI(1.296~1.924)]是藏族患者整体狭窄度的独立危险因素,钙化积分分级[OR=1.167,95%CI(0.419~1.681)]是汉族患者整体狭窄度的独立危险因素。结论:藏族冠心病患者LAD、RCA狭窄程度较汉族患者轻,提示可能与藏族人群世居高海拔缺氧环境导致冠状动脉管径代偿性增粗相关。总胆固醇、低密度脂蛋白胆固醇、钙化积分分级是藏族冠心病患者整体狭窄度的独立危险因素,这可能与藏族冠心病患者血脂相关指标升高相关。

Objective To explore the correlation between coronary CT angiography(CCTA)imaging indicators and clinical indicators of Tibetan patients with coronary heart disease,find out the high-risk factors of Tibetan patients with coronary heart disease,and screen out specific imaging and clinical indicators.Methods A total of 159 Tibetan and Han population patients with coronary artery disease diagnosed clinically with CCTA scan were continuously collected in Chengdu Office Hospital of the People's Government of the Xizang Autonomous Region from September 2021 to May 2022.CCTA examination and laboratory examination were performed to obtain quantitative parameters such as the CT value of pericoronal fat,the volume of pericoronal fat,the degree of coronary stenosis,and laboratory examination results.The independent risk factors of Tibetan patients with coronary artery disease and the predictive value of each factor on Tibetan coronary artery disease were analyzed.Results In the laboratory examination,there were statistically significant differences between the two groups in red blood cells,hemoglobin,hematocrit and high-density cholesterol,the differences of imaging markers between the two groups were mainly left anterior descending(LAD)stenosis degree(no stenosis),right coronary artery(RCA)stenosis degree(no stenosis),calcification integral grade(0-1 grade,3 grade(P<0.05).Total cholesterol[OR=1.034,95%CI(0.720-1.354)],low density lipoprotein cholesterol[OR=2.094,95%CI(1.162-2.893)],calcification score grading[OR=1.601,95%CI(1.296-1.924)]were independent risk factors of total stenosis in Tibetan patients,and calcification score grading[OR=1.167,95%CI(0.419-1.681)]were independent risk factors of total stenosis in Han patients.Conclusion The degree of LAD and RCA stenosis in Tibetan patients with coronary heart disease was lighter than that in the Han population group,which may be related to the compensatory enlargement of coronary artery diameter caused by the high altitude hypoxia environment of Tibetan people.Total cholesterol,low density lipoprotein cholesterol and calcification score are independent risk factors for total stenosis in Tibetan patients,which may be related to the increase of blood lipid related indicators in Tibetan patients with coronary heart disease.