高松原,侯为洁,张斌,范芳芳,龚艳君,郑博

• 1:北京大学第一医院心血管内科
• 2:北京大学第一医院心血管疾病研究所

摘要(Abstract)：

目的 本研究旨在通过荟萃分析评估冠状动脉疾病（CAD）患者中钙化结节（CN）的患病率并探究其危险因素。方法 系统检索PubMed、Web of Science与Embase数据库，筛选涉及CN患病率及危险因素的研究文献。检索时限均为建库至2024年1月1日。采用R Software 4.2.2进行数据统计分析。结果 最终纳入46项研究，共17 926例患者，CN的总体患病率为5.72%(95%CI 4.47%～7.31%)。其中13项研究（含4 187例患者）同时报告了CN的患病率8.72%(95%CI 6.43%～11.71%)，且危险因素分析，高血压病（OR 1.75,95%CI 1.29～2.37）、糖尿病（OR 1.84,95%CI 1.46～2.33）、慢性肾病（OR 2.50,95%CI 1.67～3.74）以及血液透析（OR 7.77,95%CI 4.77～12.67）均与较高的CN发生风险显著相关（均P<0.001）；而肥胖（OR0.39,95%CI 0.18～0.83）和吸烟史（OR 0.61,95%CI 0.47～0.80）则与较低的CN风险有关（均P<0.05）。结论 CAD患者群体中CN的总体患病率处于较低水平，但CN患病率受到多种临床因素的共同影响。未来需开展更深入的研究，以揭示这些影响因素背后的具体生物学机制。

关键词(KeyWords)： 钙化结节;冠状动脉疾病;血管内超声;光学相干断层成像

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目(2023YFC2506500、2023YFC2506501)

作者(Author): 高松原,侯为洁,张斌,范芳芳,龚艳君,郑博

参考文献(References)：

• [1]Shin D,Karimi Galougahi K,Spratt JC,et al.Calcified nodule in percutaneous coronary intervention:therapeutic challenges[J].JACC Cardiovasc Interv,2024,17(10):1187-1199.DOI:10.1016/j.j cin.2024.03.032.
• 2 R?ber L,Mintz GS,Ko skinas KC,等.冠状动脉内影像学临床应用专家共识(第一部分):对冠状动脉介入治疗的指导与优化[J].中华心血管病杂志,2019,47(1):5-25.DOI:10.10 9 3/eurheartj/ehy285.
• [3]Virmani R,Burke AP,Farb A,et al.Pathology of the vulnerableplaque[J].J Am Coll Cardiol,2006,47(8 Suppl):C13-C18.DOI:10.1016/j.jacc.2005.10.065.
• [4]何晴,董淑娟,李静超,等.非ST段抬高型心肌梗死患者梗死相关血管闭塞状态与血栓类型的关系[J].中国介入心脏病学杂志,2024,32(4):203-210.DOI:10.3969/j.issn.1004-8812.2024.04.004.
• [5]《冠状动脉钙化病变诊治中国专家共识》专家组.冠状动脉钙化病变诊治中国专家共识(2021版)[J].中国介入心脏病学杂志,2021,29(5):251-259.DOI:10.3969/j.issn.1004-8812.2021.05.002.
• [6]血管内超声在冠状动脉疾病中应用的中国专家共识专家组.血管内超声在冠状动脉疾病中应用的中国专家共识(2018)[J].中华心血管病杂志,2018,46(5):344-351.DOI:10.3760/cma.j.issn.0253-3758.2018.05.005.
• [7]Sánchez-Elvira G,Coma-Canella I,Artaiz M,et al.Characterization of coronary plaques with combined use of intravascular ultrasound,virtual histology and optical coherence tomography[J].Heart Int,2010,5(2):e 12.DOI:10.4081/hi.2010.e12.
• [8]徐迎佳,方唯一,杨向军.冠脉钙化小结血管内超声影像识别、发生率和分布特征[J].介入放射学杂志,2011,20(8):606-609.DOI:10.3969/j.issn.1008-794X.2011.08.005.
• [9]Cascón-Pérez JD,de la Torre-Hernández JM,Ruiz-Abellón MC,et al.Characteristics of culprit atheromatous plaques obtained in vivo by intravascular ultrasound radiofrequency analysis:results from the CULPLAC study[J].Am Heart J,2013,165(3):400-407.DOI:10.1016/j.ahj.2012.12.011.
• [10]Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque ero sion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography[J].J Am Coll Cardiol,2013,62(19):1748-1758.DOI:10.1016/j.jacc.2013.05.071.
• [11]Wang L,Parodi G,Maehara A,et al.Variable underlying morphology of culprit plaques associated with ST-elevation myocardial infarction:an optical coherence tomography analysis from the SMART trial[J].Eur Heart J Cardiovasc Imaging,2015,16(12):1381-1389.DOI:10.1093/ehjci/jev105.
• [12]Higuma T,Soeda T,Abe N,et al.A combined optical coherence tomography and intravascular ultrasound study on plaque rupture,plaque erosion,and calcified nodule in patients with ST-segment elevation myocardial infarction:incidence,morphologic characteristics,and outcomes after percutaneous coronary intervention[J].JACC Cardiovasc Interv,2015,8(9):1166-1176.DOI:10.1016/j.jcin.2015.02.026.
• [13]Kajander OA,Pinilla-Echeverri N,Jolly SS,et al.Culprit plaque morphology in STEMI-an optical coherence tomography study:insights from the TOTAL-OCT substudy[J].EuroIntervention,2016,12(6):716-723.DOI:10.4244/EIJV12I6A116.
• [14]Soeda T,Higuma T,Abe N,et al.Morphological predictors for no reflow phenomenon after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction caused by plaque rupture[J].Eur Heart J Cardiovasc Imaging,2017,18(1):103-110.DOI:10.1093/ehjci/jev341.
• [15]Lee T,Mintz GS,Matsumura M,et al.Prevalence,predictors,and clinical presentation of a calcified nodule as assessed by optical coherence tomography[J].JACC Cardiovasc Imaging,2017,10(8):883-891.DOI:10.1016/j.jcmg.2017.05.013.
• [16]Nishiguchi T,Tanaka A,Taruya A,et al.Prognosis of spontaneous coronary artery dissection treated by percutaneouscoronary intervention with optical coherence tomography[J].J Cardiol,2017,70(6):524-529.DOI:10.1016/j.jjcc.2017.03.009.
• [17]Kubo T,Ino Y,Matsuo Y,et al.Reduction of in-stent thrombus immediately after percutaneous coronary intervention by pretreatment with prasugrel compared with clopidogrel:An optical coherence tomography study[J].J Cardiol,2017,69(2):436-441.DOI:10.1016/j.jjcc.2016.04.005.
• [18]Hu S,Zhu Y,Zhang Y,et al.Management and outcome of patients with acute coronary syndrome caused by plaque rupture versus plaque erosion:an intravascular optical coherence tomography study[J].J Am Heart Assoc,2017,6(3):e004730.DOI:10.1161/JAHA.116.004730.
• [19]Souteyrand G,Viallard L,Combaret N,et al.Innovative invasive management without stent implantation guided by optical coherence tomography in acute coronary syndrome[J].Arch Cardiovasc Dis,2018,111(11):666-677.DOI:10.1016/j.acvd.2017.10.006.
• [20]Kobayashi N,Takano M,Tsurumi M,et al.Features and outcomes of patients with calcified nodules at culprit lesions of acute coronary syndrome:an optical coherence tomography study[J].Cardiology,2018,139(2):90-100.DOI:10.1159/000481931.
• [21]Sugiyama T,Yamamoto E,Bryniarski K,et al.Nonculprit plaque characteristics in patients with acute coronary syndrome caused by plaque erosion vs plaque rupture:a 3-vessel optical coherence tomography study[J].JAMA Cardiol,2018,3(3):207-214.DOI:10.1001/jamacardio.2017.5234.
• [22]Yokota T,Higuma T,Endo T,et al.Prasugrel versus clopidogrel for residual thrombus burden in patients with STsegment elevation myocardial infarction:an optical coherence tomography study[J].Coron Artery Dis,2018,29(8):663-669.DOI:10.1097/MCA.0000000000000663.
• [23]Dai J,Xing L,Jia H,et al.In vivo predictors of plaque erosion in patients with ST-segment elevation myocardial infarction:a clinic al,angiographical,and intravascular optical coherence tomography study[J].Eur Heart J,2018,39(22):2077-2085.DOI:10.1093/eurheartj/ehy101.
• [24]Shibuya J,Kobayashi N,Asai K,et al.Comparison of coronary culprit lesion morphology determined by optical coherence tomography and relation to outcomes in patients diagnosed with acute coronary syndrome during winter-vs-other seasons[J].Am J Cardiol,2019,124(1):31-38.DOI:10.1016/j.amjcard.2019.03.045.
• [25]Fang C,Dai J,Zhang S,et al.Culprit lesion morphology in young patients with ST-segment elevated myocardial infarction:a clinical,angiographic and optical coherence tomography study[J].Atherosclerosis,2019,289:94-100.DOI:10.1016/j.atherosclerosis.2019.08.011.
• [26]Ohashi H,Ando H,Takashima H,et al.Diagnostic performance of high-resolution intravascular ultrasound for the detection of plaque rupture in patients with acute coronary syndrome[J].Circ J,2019,83(12):2505-2511.DOI:10.1253/circj.CJ-19-0644.
• [27]Yamamoto MH,Maehara A,Song L,et al.Optical coherence tomography assessment of morphological characteristics in suspected coronary artery disease,but angiographically nonobstructive lesions[J].Cardiovasc Revasc Med,2019,20(6):475-479.DOI:10.1016/j.carrey.2018.07.011.
• [28]Hou F,Zhou Y,Liu W,et al.Characteristics of culprit lesions in young patients with metabolic syndrome and classiccardiovascular risk factors[J].Exp Ther Med,2020,19(4):2766-2772.DOI:10.3892/etm.2020.8484.
• [29]Leistner DM,Kr?nkel N,Meteva D,et al.Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap:results from the prospective translational OPTICO-ACS study[J].Eur Heart J,2020,41(37):3549-3560.DOI:10.109 3/eurheartj/ehaa703.
• [30]Taruya A,Tanaka A,Nishiguchi T,et al.Lesion characteristics and prognosis of acute coronary syndrome without angiographically significant coronary artery stenosis[J].Eur Heart J Cardiovasc Imaging,2020,21(2):202-209.DOI:10.1093/ehjci/jez079.
• [31]Khalifa AKM,Kubo T,Ino Y,et al.Optical coherence tomography comparison of percutaneous coronary intervention among plaque rupture,erosion,and calcified nodule in acute myocardial infarction[J].Circ J,2020,84(6):911-916.DOI:10.1253/circj.CJ-20-0014.
• [32]Yonetsu T,Hoshino M,Lee T,et al.Plaque morphology assessed by optical coherence tomography in the culprit lesions of the first episode of acute myocardial infarction in patients with low low-density lipoprotein cholesterol level[J].J Cardiol,2020,75(5):485-493.DOI:10.1016/j.jjcc.2020.01.001.
• [33]Takahata M,Ino Y,Kubo T,et al.Prevalence,features,and prognosis of artery-to-artery embolic ST-segment-elevation myocardial infarction:an optical coherence tomography study[J].J Am Heart Assoc,2020,9(24):e017661.DOI:10.1161/JAHA,120.017661.
• [34]Nakano S,Otake H,Kawamori H,et al.Association between visit-to-visit variability in low-density lipoprotein cholesterol and plaque rupture that leads to acute coronary syndrome[J].Circ Rep,2021,3(9):540-549.DOI:10.1253/circrep.CR-21-0080.
• [35]Li J,Tan Y,Zhou P,et al.Association of trimethylamine N-Oxide levels and calcification in culprit lesion segments in patients with ST-segment-elevation myocardial infarction evaluated by optical coherence tomography[J],Front Cardiovasc Med,2021,8:628471.DOI:10.3389/fcvm.2021.628471.
• [36]Sugane H,Kataoka Y,Otsuka F,et al.Cardiac outcomes in patients with acute coronary syndrome attributable to calcified nodule[J].Atherosclerosis,2021,318:70-75.DOI:10.1016/j.athero sclero sis.2020.11.005.
• [37]Prasad K,Reddy SS,Kaur J,et al.Gender-based in vivo comparison of culprit plaque characteristics and plaque micro structures using optical coherence tomography in acute coronary syndrome[J].J Cardiovasc Thorac Res,2021,13(4):277-284.DOI:10.34172/jcvtr.2021.46.
• [38]Song L,Chen RZ,Zhao XX,et al.Mean platelet volume/platelet count ratio and culprit plaque morphologies:an optical coherence tomography study in patients with ST segment elevation myocardial infarction[J].J Cardiovasc Transl Res,2021,14(6):1093-1103.DOI:10.1007/s12265-021-10113-z.
• [39]Gomes PM,Almeida BO,Marinelli Pedrini S,et al.Morphology and phenotype characteristics of atherosclerotic plaque in patients with acute coronary syndrome:contemporary optical coherence tomography findings[J].Coron Artery Dis,2021,32(8):698-705.DOI:10.1097/MCA.0000000000001027.
• [40]Terada K,Kubo T,Kameyama T,et al.NIRS-IVUS for differentiating coronary plaque rupture,erosion,and calcified nodule in acute myocardial infarction[J].JACC CardiovascImaging,2021,14(7):1440-1450.DOI:10.1016/j.jcmg.2020.08.030.
• [41]Wang Y,Fang C,Zhang S,et al.Predictors of coronary plaque erosion in current and non-current smokers with STsegment elevation myocardial infarction-an optical coherence tomography study[J].Circ J,2021,85(10):1814-1822.DOI:10.1253/circj.CJ-20-0890.
• [42]Nagasawa A,Otake H,Kawamori H,et al.Relationship among clinical characteristics,morphological culprit plaque features,and long-term prognosis in patients with acute coronary syndrome[J].Int J Cardiovasc Imaging,2021,37(10):2827-2837.DOI:10.1007/s 10554-021-02252-w.
• [43]Zuo W,Sun R,Zhang X,et al.The association between quantitative flow ratio and intravascular imaging-defined vulnerable plaque characteristics in patients with stable angina and non-ST-segment elevation acute coronary syndrome[J].Front Cardiovasc Med,2021,8:690262.DOI:10.33 8 9/fcvm.2021.690262.
• [44]Cao M,Zhao L,Ren X,et al.Pancoronary plaque characteristics in STEMI caused by culprit plaque erosion versus rupture:3-vessel OCT study[J].JACC Cardiovasc Imaging,2021,14(6):1235-1245,DOI:10.1016/j.jcmg.2020.07.047.
• [45]Yin Y,Fang C,Jiang S,et al.Culprit and non-culprit plaque characteristics with vs.without a healed phenotype in patients with acute myocardial infarction caused by plaque erosion-a 3-vessel OCT study[J].Circ J,2022,86(5):846-854.DOI:10.1253/circj.CJ-21-0635.
• [46]Ino Y,Takahata M,Kubo T,et al.Vascular response after everolimus-eluting stent in acute myocardial infarction caused by calcified nodule[J].Circ J,2022,86(9):1388-1396.DOI:10.1253/circj.CJ-21-1059.
• [47]Saiin K,Konishi T,Kazui S,et al.Association of coronary plaque morphology with inflammatory biomarkers and target lesion revascularization in patients with chronic coronary syndrome:an optical coherence tomography study[J].Am J Cardiovasc Dis,2023,13(5):309-319.
• [48]Zeng M,Zhao C,Bao X,et al.Clinical characteristics and prognosis of MINOCA caused by atherosclerotic and nonathero sclerotic mechanisms assessed by OCT[J].JACC Cardiovasc Imaging,2023,16(4):521-532.DOI:10.1016/j.jcmg.2022.10.023.
• [49]Yamamoto T,Kawamori H,Toba T,et al.Clinical impact of optical coherence tomography findings after drug-coated balloon treatment for patients with acute coronary syndromes[J].Int J Cardiol,2023,387:131149.DOI:10.1016/j.ijcard.2023.131149.
• [50]Wu X,Wu M,Huang H,et al.Comparative clinical implications of calcified versus non-calcified tissue protrusion after coronary stent implantation[J].Int J Gen Med,2023,16:5935-5946.DOI:10.2147/IJGM.S445493.
• [51]Kondo S,Mizukami T,Kobayashi N,et al.Diagnosis and prognostic value of the underlying cause of acute coronary syndrome in optical coherence tomography-guided emergency percutaneous coronary intervention[J].J Am Heart Assoc,2023,12(20):e030412.DOI:10.1161/JAHA.123.030412.
• [52]Sato T,Matsumura M,Yamamoto K,et al.Impact of eruptive vs noneruptive calcified nodule morphology on acute and longterm outcomes after stenting[J].JACC Cardiovasc Interv,2023,16(9):1024-1035.DOI:10.1016/j.jcin.2023.03.009.
• [53]Nozoe M,Nishioka S,Oi K,et al.Effects of patient background and treatment strategy on clinical outcomes after coronaryintervention for calcified nodule lesions[J].Circ Rep,2021,3(12):699-706.DOI:10.1253/circrep.CR-21-0129.
• [54]Virmani R,Kolodgie FD,Burke AP,et al.Lessons from sudden coronary death:a comprehensive morphological classification scheme for atherosclerotic lesions[J].Arterioscler Thro mb Vasc Biol,2000,20(5):1262-1275.DOI:10.1161/01.atv.20.5.1262.
• [55]Yahagi K,Davis HR,Arbustini E,et al.Sex differences in coronary artery disease:pathological observations[J].Atherosclerosis,2015,239(1):260-267.DOI:10.1016/j.athero sclerosis.2015.01.017.
• [56]Singh A,Tandon S,Tandon C.An update on vascular calcification and potential therapeutics[J].Mol Biol Rep,2021,48(1):887-896.DOI:10.1007/s11033-020-06086-y.
• [57]Madhavan MV,Tarigopula M,Mintz GS,et al.Coronary artery calcification:pathogenesis and prognostic implications[J].J Am Coll Cardiol,2014,63(17):1703-1714.DOI:10.1016/j.jacc.2014.01.017.
• [58]Otsuka F.Yasuda S,Noguchi T,et al.Pathology of coronary atherosclerosis and thrombosis[J].Cardiovasc Diagn Ther,2016,6(4):396-408.DOI:10.21037/cdt.2016.06.01.
• [59]中华医学会心血管病学分会介入心脏病学组,心血管病影像学组.光学相干断层成像技术在冠心病介入诊疗领域的应用中国专家建议[J].中华心血管病杂志,2017,45(1):5-12.DOI:10.3760/cma.j.issn.0253-3758.2017.01.003.
• [60]哈力木拉提·买买提,艾克力亚尔·艾尼瓦尔,凯赛尔江·卡地尔,等.深度学习在冠状动脉内光学相干断层成像的研究进展[J].中国介入心脏病学杂志,2024,32(3):154-158.DOI:10.3969/j.issn.1004-8812.2024.03.005.
• [61]Shaikh K,Nakanishi R,Kim N,et al.Coronary artery calcification and ethnicity[J].J Cardiovasc Comput Tomogr,2019,13(6):353-359.DOI:10.1016/j.jcct.2018.10.002.
• [62]Nakamura S,Ishibashi-Ueda H,Niizuma S,et al.Coronary calcification in patients with chonic kidney disease and coronary artery disease[J].Clin J Am Soc Nephrol,2009,4(12):1892-1900.DOI:10.2215/CJN.04320709.
• [63]Giachelli CM.Mechanisms of vascular calcification in uremia[J].Semin Nephrol,2004,24(5):401-402.DOI:10.1016/j.semnephrol.2004.06.005.
• [64]Goodman WG.Recent developments in the management of secondary hyperparathyroidism[J].Kidney Int,2001,59(3):1187-1201.DOI:10.1046/j.1523-1755.2001.0590031187.x.
• [65]Sarnak MJ,Amann K,Bangalore S,et al.Chronic kidney disease and coronary artery disease:JACC state-of-the-art review[J].JAm Coll Cardiol,2019,74(14):1823-1838.DOI:10.1016/j.jacc.2019.08.1017.
• [66]Yahagi K,Kolodgie FD,Lutter C,et al.Pathology of human coronary and carotid artery atherosclerosis and vascular calcification in diabetes mellitus[J].Arterioscler Thromb Vasc Biol,2017,37(2):191-204.DOI:10.1161/ATVBAHA.116.306256.
• [67]Nakahara T,Dweck MR,Narula N,et al.Coronary artery calcification:from mechanism to molecular imaging[J].JACC Cardiovasc Imaging,2017,10(5):582-593.DOI:10.1016/j.jcmg.2017.03.005.
• [68]Rattazzi M,Bertacco E,Puato M,et al.Hypertension and vascular calcification:a vicious cycle?[J].J Hypertens,2012,30(10):1885-1893.DOI:10.1097/HJH.0b013e328356c257.
• [69]Kalra SS,Shanahan CM.Vascular calcification and hypertension:cause and effect[J].Ann Med,2012,44(Suppl 1):S85-S92.DOI:10.3109/07853890.2012.660498.
• [70]Kovacic JC,Lee P,Baber U,et al.Inverse relationship between body mass index and coronary artery calcification in patients with clinically significant coronary lesions[J].Atherosclerosis,2012,221(1):176-182.DOI:10.1016/j.atherosclerosis.2011.11.020.
• [71]Chaikriangkrai K,Kassi M,Khaleel B ala S,e t a l.Athero sclerosis burden in patients with acute chest pain:obesity paradox[J].ISRN Obes,2014,2014:634717.DOI:10.1155/2014/634717.
• [72]Reis JP,Loria CM,Lewis CE,et al.Association between duration of overall and abdominal obesity beginning in young adulthood and coronary artery calcification in middle age[J].JAMA,2013,310(3):280-288.DOI:10.1001/jama.2013.7833.
• [73]Altintas S,van Workum S,Kok M,et al.BMI is not independently associated with coronary artery calcification in a large single-center CT cohort[J].Obes Sci Pract,2022,9(2):172-178.DOI:10.1002/osp4.636.
• [74]Welsh A,Hammad M,Pi?a IL,et al.Obesity and cardiovascular health[J].Eur J Prev Cardiol,2024,31(8):1026-1035.DOI:10.1093/eurjpc/zwae025.
• [75]Wang ZX,Luo ZW,Li FX,et al.Aged bone matrix-derived extracellular vesicles as a messenger for calcification paradox[J].Nat Commun,2022,13(1):1453.DOI:10.1038/s41467-022-29191-x.
• [76]Teichtahl AJ,Wluka AE,Wijethilake P,et al.Wolff's law in action:a mechanism for early knee osteoarthritis[J].Arthritis Res Ther,2015,17(1):207.DOI:10.1186/s13075-015-0738-7.
• [77]Broussard DL,Magnus JH.Risk assessment and screening for low bone mineral density in a multi-ethnic population of women and men:does one approach fit all?[J].Osteoporos Int,2004,15(5):349-360.DOI:10.1007/s00198-003-1549-2.
• [78]Persy V,D'Haese P.Vascular calcification and bone disease:the calcification paradox[J].Trends Mol Med,2009,15(9):405-416.DOI:10.1016/j.molmed.2009.07.001.
• [79]Niwczyk O,Grymowicz M,Szczesnowicz A,et al.Bones and hormones:interaction between hormones of the hypothalamus,pituitary,adipose tissue and bone[J].Int J Mol Sci,2023,24(7):6840.DOI:10.3390/ijms24076840.
• [80]Elmariah S,Delaney JA,O'Brien KD,et al.Bisphosphonate use and prevalence of valvular and vascular calcification in women MESA(the Multi-Ethnic Study of Atherosclerosis)[J].J Am Coll Cardiol,2010,56(21):1752-1759.DOI:10.1016/j.jacc.2010.05.050.
• [81]De Lorenzo A,Pellegrini M,Gualtieri P,et al.The association between obesity and reduced weight-adjusted bone mineral content in older adults:a new paradigm that contrasts with the obesity paradox[J].Nutrients,2024,16(3):352.DOI:10.3390/nu16030352.
• [82]Lee H,Park HE,Yoon JW,et al.Clinical significance of body fat distribution in coronary artery calcification progression in Korean population[J].Diabetes Metab J,2021,45(2):219-230.DOI:10.4093/dmj.2019.0161.
• [83]Kang YM,Jung CH,Cho YK,et al.Fatty liver disease determines the progression of coronary artery calcification in a metabolically healthy obese population[J].PLoS One,2017,12(4):e0175762.DOI:10.1371/journal.pone.0175762.
• [84]Chung GE,Park HE,Lee H,et al.Sarcopenic obesity is significantly associated with coronary artery calcification[J].Front Med(Lausanne),2021,8:651961.DOI:10.3389/fmed.2021.651961.
• [85]Petsophonsakul P,Burgmaier M,Willems B,et al.Nicotine promotes vascular calcification via intracellular Ca2+-mediated,Nox5-induced oxidative stress,and extracellular vesicle release in vascular smooth muscle cells[J].Cardiovasc Res,2022,118(9):2196-2210.DOI:10.1093/cvr/cvab244.
• [86]Lloyd A,Steele L,Fotheringham J,et al.Pronounced increase in risk of acute ST-segment elevation myocardial infarction in younger smokers[J].Heart,2017,103(8):586-591.DOI:10.113 6/heartjnl-2016-3095 95.
• [87]Hu G,Zhou M,Liu J,et al.Smoking and provision of smoking cessation interventions among inpatients with acute coronary syndrome in China:findings from the improving care for cardiovascular disease in China-acute coronary syndrome project[J].Glob Heart,2020,15(1):72.DOI:10.5334/gh.784.
• [88]Kronmal RA,McClelland RL,Detrano R,et al.Risk factors for the progression of coronary artery calcification in asymptomatic subjects:results from the Multi-Ethnic Study of Atherosclerosis(MESA)[J].Circulation,2007,115(21):2722-2730.DOI:10.1161/CIRCULATIONAHA.106.674143.
• [89]刘巍,高雅楠,侯方杰,等.光学相干断层成像下吸烟对年轻急性冠状动脉综合征患者斑块特征的影响[J].中国介入心脏病学杂志,2018,26(5):241-246.DOI:10.3969/j.issn.1004-8812.2018.05.001.
• [90]Schmermund A,Ba