不稳定型心绞痛危险度分层和冠状动脉造影的关系

RELATIONSHIP BETWEEN CLINICAL CLASSIFICATION AND ANGIOGRAPHY FINDINGS IN UNSTABLE ANGINA PECTORIS

目的 探讨不稳定型心绞痛危险度分层和冠状动脉病变的关系,观察能否通过不稳定型心绞痛危险度分层预测不稳定型心绞痛患者的冠状动脉病变程度。方法 按照中华医学会心血管病分会和中华心血管病杂志编辑委员会提出的不稳定型心绞痛危险度分层,将145例不稳定型心绞痛患者分为高、中、低3个危险组,比较3组间冠状动脉造影显示的病变程度。21例稳定型心绞痛患者参与比较。采用Gensini积分方法,对各支冠状动脉病变程度进行定量评定。对其危险度分层赋予分值(不稳定型心绞痛危险度分值),低危险组1分,中危险组2分,高危险组3分,稳定型心绞痛作为对照组赋予0分,测定该分值和冠状动脉病变程度、冠状动脉完全闭塞病变及3支病变的关系。结果 低、中、高3个危险组冠状动脉病变积分分别为30.43、39.10和68.05分。高危险组积分显著高于低、中危险组(P=0.000),而低、中危险组之间积分差异无显著性。不稳定型心绞痛组冠状动脉病变积分高于稳定型心绞痛组。多元线性回归分析显示,不稳定型心绞痛危险度分值与冠状动脉病变程度显著相关(r2=0.134,P=0.000)。Logist回归分析显示,冠状动脉完全闭塞病变和3支病变与不稳定型心绞痛危险度分值显著相关(OR分别为2.148和1.881,P值分别为0.000和0.002)。结论

Objective To study the relationship between clinical classification and angiography findings in unstable angina pectoris. Methods 145 patients with unstable angina were divided into 3 groups according to the clinical classification standard proposed by the Cardiology Branch of Chinese Medical Association and the Editorial Board of Chinese Journal of Cardiology. The pathological changes among 3 groups and 21 cases with stable angina were compared and assessed by Gensini integral method. An unstable angina score from 1 to 3 was determined by severe degree. 21 patients with stable angina were scored 0. Results The coronary lesion score in group 3 is higher than those in group 1 and group 2, which are 68.05 vs 30. 43 and 39.10 in average (P = 0. 000). It is shown that the unstable angina score has significantly corellation with coronary lesion score(P = 0.000). It is identified by Logist regression analysis that the unstable angina score is a prominent predictor of coronary total occlusion (OR = 2.148, P = 0. 000) and 3 - branch disease (OR = 1. 881, P = 0. 002). Conclusion The clinical classification of unstable angina correlates with the coronary lesion degree and can be served as an predictor .