剡冬冬,彭瑜,赵晶,张钲

• 1:兰州大学第一临床医学院
• 2:兰州大学第一医院心内科

摘要(Abstract)：

目的探寻冠状动脉慢血流现象(CSFP)的临床危险因素,了解冠状动脉形态对心肌梗死溶栓治疗试验(TIMI)血流的影响,推测CSFP的发病机制。方法回顾性收集2017年1月至2019年7月于兰州大学第一医院心脏中心行冠状动脉造影无狭窄病变的患者256例,根据TIMI血流帧数将其中血流减慢的患者设为CSFP组(100例),将血流正常患者设为对照组(156例),按年龄和性别匹配。收集患者临床数据和冠状动脉造影数据,采用二元logistic回归模型分析CSFP的危险因素,并采用Pearson相关分析检验冠状动脉形态学参数与平均校正的TIMI帧数(cTFC)的相关性。结果 CSFP组同型半胱氨酸[(22.07±7.27)mmol/L比(18.16±6.63)mmol/L]、中性粒细胞百分比[(44.40±15.60)%比(35.43±12.49)%]、淋巴细胞百分比[3.65%(1.32%,24.65%)比1.80%(1.02%,6.22%)]、平均血小板体积(MPV)[(13.17±1.82)fl比(12.20±1.57)fl]、血小板分布宽度(PDW)[(14.17±2.1 7)f l比(1 3.2 1±2.4 2)f l]与对照组相比更高,三酰甘油[(3.0 5±1.3 7)m m o l/L比(3.44±1.36)mmol/L]、纤维蛋白原[(2.65±0.68)g/L比(2.86±0.66)g/L]与对照组相比更低,术中血压更低,冠状动脉平均直径更大,平均远端分支数更少,差异均有统计学意义(均P<0.05)。二元logistic回归模型拟合显示:同型半胱氨酸(OR 1.077,95%CI 1.034～1.123,P<0.001)、中性粒细胞百分比(OR 1.064,95%CI1.032～1.097,P<0.001)、PDW(OR 1.194,95%CI 1.051～1.356,P=0.006)、MPV(OR 1.338,95%CI 1.127～1.588,P=0.001)是预测CSFP的独立危险因素。相关性分析显示,冠状动脉平均直径与平均c TFC呈显著正相关(r=0.583,P<0.05);冠状动脉平均远端分支数与平均c TFC呈显著负相关(r=-0.508,P<0.05)。结论同型半胱氨酸、中性粒细胞百分比、PDW和MPV是预测CSPF的独立危险因素。冠状动脉平均直径和远端分支数均与冠状动脉平均c TFC密切相关。炎症可能是CSFP发生的关键机制。

关键词(KeyWords)： 冠状动脉慢血流现象;临床危险因素;炎症;形态

Abstract:

Keywords:

基金项目(Foundation): 甘肃省心血管疾病重点实验室建设项目(1206RTSA025);; 兰州大学“中央高校基本科研业务费专项资金”重点研究基地建设项目(lzujbky-2019-kb17)

作者(Author): 剡冬冬,彭瑜,赵晶,张钲

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