霍黎明,彭欣,侯昌,刘健

• 1:北京大学人民医院心血管内科

摘要(Abstract)：

目的 探讨糖尿病合并非ST段抬高型急性冠状动脉综合征（NSTE-ACS）多支病变患者经皮冠状动脉介入治疗（PCI）后冠状动脉微循环功能障碍（CMD）的相关因素。方法 采用单中心回顾性研究设计，纳入2021年1月1日至2024年6月30日在北京大学人民医院接受PCI的242例糖尿病合并NSTE-ACS多支病变患者，收集基线资料、介入手术参数及实验室指标。基于术后即刻冠状动脉功能测量[基于计算流体力学的造影血流储备分数（caFFR）>0.80且基于冠状动脉造影的微循环阻力指数（caIMR）≥25]定义CMD，通过单因素及多因素Logistic回归分析CMD的危险因素。结果 242例患者中，49例（20.2%）术后诊断为患者水平CMD。CMD组血红蛋白含量水平显著高于非CMD组[136.00(130.00,150.00)g/L比130.00(119.00,145.00)g/L,P=0.012]，谷丙转氨酶水平亦较高[20.00(16.00,31.00)U/L比18.00(13.00,26.00)U/L,P=0.047]，而糖尿病病程、传统心血管风险标志物（高血压病、吸烟史、低密度脂蛋白胆固醇）、降糖药物种类及手术参数组间比较，差异均无统计学意义（均P>0.05）。单因素Logistic回归分析显示，血红蛋白含量（OR 1.025,95%CI 1.007～1.043,P=0.007）、尿素（OR 0.897,95%CI 0.791～1.108,P=0.091）与CMD显著相关或边际相关；多因素Logistic回归分析进一步证实血红蛋白含量为糖尿病合并NSTE-ACS多支病变患者PCI后CMD独立预测因子（OR 1.026,95%CI 1.007～1.045,P=0.006）。根据受试者工作特征曲线的Youden指数，血红蛋白含量诊断最佳截断值为131 g/L(Youden Index=0.238，敏感度69.4%，特异度54.4%)。结论 血红蛋白含量升高是糖尿病合并NSTE-ACS多支病变患者PCI术后CMD的独立危险因素。建议对术前血红蛋白含量≥131 g/L的患者强化术后微循环监测，并探索血液流变学干预策略。

关键词(KeyWords)： 糖尿病;冠心病;冠状动脉微循环功能障碍;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项项目(首发2024-2-4083);; 首都临床特色诊疗技术研究及转化应用项目(Z221100007422096);; 北京大学人民医院研究与发展基金项目(RDGS2022-08)

作者(Author): 霍黎明,彭欣,侯昌,刘健

参考文献(References)：

• [1] Safiri S, Karamzad N, Singh K, et al. Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990-2019[J]. Eur J Prev Cardiol, 2022, 29(2):420-431.DOI:10.1093/eurjpc/zwab213.
• [2]刘明波，何新叶，杨晓红，等.《中国心血管健康与疾病报告2023》概要（心血管疾病流行及介入诊疗状况）[J].中国介入心脏病学杂志，2024,32(10):541-550. DOI:10.3969/j.issn.1004-8812.2024.10.001.
• [3]苏州工业园区东方华夏心血管健康研究院，国家放射与治疗临床医学研究中心胸痛中心专家委员会.《胸痛中心质控报告（2023）》概要[J].中国介入心脏病学杂志，2024, 32(11):618-625. DOI:10.3969/j.issn.1004-8812.2024.11.002.
• [4]中华医学会心血管病学分会，中华心血管病杂志编辑委员会.经皮冠状动脉介入治疗指南（2025）[J].中华心血管病杂志，2025, 53(7):717-745. DOI:10.3760/cma.j.cn112148-20250422-00302.
• [5] Chen W, Ni M, Huang H, et al. Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases(2023 Edition)[J]. MedComm(2020), 2023, 4(6):e438. DOI:10.1002/mco2.438.
• [6] Marano P, Wei J, Merz CNB. Coronary microvascular dysfunction:what clinicians and investigators should know[J]. Curr Atheroscler Rep, 2023,25(8):435-446. DOI:10.1007/s11883-023-01116-z.
• [7]张津，龚艳君，郑博.冠状动脉微循环障碍评估现状及进展[J].中国介入心脏病学杂志，2023, 31(10):770-774.DOI:10.3969/j.issn.1004-8812.2023.10.008.
• [8] Hou C, Guo M, Ma Y, et al. The coronary angiographyderived index of microcirculatory resistance predicts left ventricular performance recovery in patients with ST-segment elevation myocardial infarction[J]. J Interv Cardiol, 2022,2022:9794919. DOI:10.1155/2022/9794919.
• [9] Jespersen L, Hvelplund A, Abildstr?m SZ, et al. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events[J]. Eur Heart J, 2012, 33(6):734-744. DOI:10.1093/eurheartj/ehr331.
• [10] Li K, Liu S, Wang J, et al. Analysis of metabolic risk factors for microcirculation disorders post-percutaneous coronary intervention and predictive model construction:a study on patients with unstable angina[J]. Rev Cardiovasc Med,2025, 26(1):25739. DOI:10.31083/rcm25739.
• [11] Stampouloglou PK, Anastasiou A, Bletsa E, et al. Diabetes mellitus in acute coronary syndrome[J]. Life(Basel),2023, 13(11):2226. DOI:10.3390/life13112226.
• [12] Niewiara?，Kleczyński P, Guzik B, et al. Impaired coronary flow reserve in patients with poor type 2 diabetes control:Preliminary results from prospective microvascular dysfunction registry[J]. Cardiol J, 2024, 31(2):185-192. DOI:10.5603/CJ.a2022.0100.
• [13] Chen D, Zhang Y, Yidilisi A, et al. Combined risk estimates of diabetes and coronary angiography-derived index of microcirculatory resistance in patients with non-ST elevation myocardial infarction[J]. Cardiovasc Diabetol, 2024, 23(1):300. DOI:10.1186/s12933-024-02400-1.
• [14]车丕序.冠心病伴糖尿病患者的临床与预后[J].中国介入心脏病学杂志，1995,(3):129.
• [15]中华医学会心血管病学分会，中华心血管病杂志编辑委员会.非ST段抬高型急性冠脉综合征诊断和治疗指南（2024）[J].中华心血管病杂志，2024,52(6):615-646. DOI:10.3760/cma.j.cn112148-20240107-00014.
• [16] Huang D, Gong Y, Fan Y, et al. Coronary angiographyderived index for assessing microcirculatory resistance in patients with non-obstructed vessels:the FLASH IMR study[J]. Am Heart J, 2023, 263:56-63. DOI:10.1016/j.ahj.2023.03.016.
• [17] Nangaku M, Eckardt KU. Hypoxia and the HIF system in kidney disease[J]. J Mol Med(Berl), 2007, 85(12):1325-1330. DOI:10.1007/s00109-007-0278-y.
• [18] PraticóD, Pasin M, Barry OP, et al. Iron-dependent human platelet activation and hydroxyl radical formation:involvement of protein kinase C[J]. Circulation, 1999, 99(24):3118-3124. DOI:10.1161/01.cir.99.24.3118.
• [19] Paquette M, Bernard S, Baass A. Hemoglobin concentration,hematocrit and red blood cell count predict major adverse cardiovascular events in patients with familial hypercholesterolemia[J]. Atherosclerosis, 2021, 335:41-46. DOI:10.1016/j.atherosclerosis.2021.09.015.
• [20] Lee G, Choi S, Kim K, et al. Association of hemoglobin concentration and its change with cardiovascular and all-cause mortality[J]. J Am Heart Assoc, 2018, 7(3):e007723.DOI:10.1161/jaha.117.007723.
• [21] Chilingaryan Z, Deshmukh T, Leung HHL, et al. Erythrocyte interaction with neutrophil extracellular traps in coronary artery thrombosis following myocardial infarction[J]. Pathology,2022, 54(1):87-94. DOI:10.1016/j.pathol.2021.05.099.
• [22] He H, Pan L, Liu F, et al. Linear and non-linear relationships between red blood cell indices and cardiovascular risk factors:findings from the China National Health Survey[J]. BMC Public Health, 2024, 24(1):3451. DOI:10.1186/s12889-024-20988-7.
• [23] Bil J,Pietraszek N, Gil RJ, et al. Complete blood count-derived indices as prognostic factors of 5-year outcomes in patients with confi rmed coronary microvascular spasm[J]. Front Cardiovasc Med, 2022, 9:933374. DOI:10.3389/fcvm.2022.933374.
• [24] Takei Y, Tomiyama H, Tanaka N, et al. Association between insulin resistance, oxidative stress, sympathetic activity and coronary microvascular function in patients with early stage impaired glucose metabolism[J]. Circ J, 2022, 86(5):866-873. DOI:10.1253/circj.CJ-21-0549.