冠状动脉迂曲与冠状动脉微循环的关系研究
发布时间：2018-07-20 18:51
【摘要】：目的:观察冠状动脉迂曲(coronary tortuosity,CT)对冠状动脉微循环(coronary microvascular)造成的影响,探讨冠状动脉迂曲与冠状动脉微血管病变(coronary microvascular disease)之间的相关性。方法:选取2015年3月至2016年12月就诊河北医科大学第二医院心内五科的有典型心绞痛症状,行冠状动脉造影未见冠脉明显狭窄患者55例,对上述患者进行冠状动脉造影评价,其中冠状动脉迂曲的患者35例,非冠状动脉迂曲的患者20例。同时收集所有上述住院患者资料包括患者主诉,现病史,性别,年龄,入院时的血压,血尿酸,血脂,和左室射血分数(LVEF),室壁运动积分指数,心脏大小,室壁厚度,BNP,心电图检查,家族史,糖尿病史,吸烟史,饮酒史,及有无心肌梗死或溶栓病史,患者基础用药情况。入选标准:1.患者入院时有典型心绞痛症状2.行冠状动脉脉造影检查,冠脉未见明显狭窄(冠状动脉狭窄程度20%)3.行ECT检查符合冠状动脉微血管病变诊断标准排除标准:1.冠状动脉狭窄程度≥20%。2.影响室壁运动或心脏射血功能的其它心肌疾病如应激性心肌病(Takotsubo心肌病)、肥厚性心肌病、扩张型心肌病、心肌炎、心肌致密化不全、心肌淀粉样变性;3.严重心律失常如永久性心房纤颤、反复发作控制不佳的室性心律失常;4.心源性休克:SBP≤90mmHg持续30min以上,外周血管收缩的表现如面色苍白、出汗、尿量减少(20ml/h)、脉搏细速或需要行主动脉内气囊反搏术;5.严重的心脏瓣膜疾病包括心脏瓣膜中-重度狭窄或大量反流;6.高药物过敏体质;7.需要机械通气者;8.严重肝肾功能不全者(转氨酶大于正常上限2倍,血肌酐2.5mg/dl);9.存在自身免疫性疾病、严重创伤、出血性疾病、合并肿瘤者;10、患者或患者家属拒绝参加本项研究者。把上述纳入标准的55例患者分别行单光子发射断层扫描(SPECT)检查,利用99m-锝为示踪剂,分别记录心肌静息及负荷状态下的节段性心肌灌注减低,灌注缺损及灌注再分布征象,以心肌血流反向分布作为冠状动脉微血管病变的诊断标准[43 44]。最终得到冠状动脉微血管病变患者33例,非冠状动脉微血管病变患者22例,对以上两组患者进行统计学分析,研究冠状动脉迂曲与冠状动脉微血管病变的相关性,探讨二者的病理生理学机制及诊断、治疗。所有数据均应用spss21.0软件进行统计学处理,以在两组进行比较前应用二元logistic回归对上述数据进行多因素分析,以p0.05为差别有统计学意义。结果:1两组患者基线资料比较实验组与对照组在性别、年龄、吸烟方面差异无统计学意义(p0.05),实验组与对照组在高血压、糖尿病、冠状动脉粥样硬化方面有统计学意义(p0.05)。2两组患者生化指标的比较实验组与对照组超敏反应蛋白(2.20±1.63vs.4.15±4.29,p=0.000)、低密度脂蛋白(2.66±0.98vs.2.69±0.69,p=0.092)、甘油三酯(1.62±0.62vs.1.55±0.62,p=0.978)、总胆固醇(3.90±1.41vs.4.66±0.80,p=0.001)两组患者在低密度脂蛋白、甘油三酯方面无统计学意义(p0.05);两组患者在超敏反应蛋白及总胆固醇方面有统计学意义(p0.05)。3两组患者冠状动脉迂曲参数的比较实验组与对照组行pearson卡方检验(卡方值11.786df=1,p0.01)差别有统计学意义,见表1。4多因素logistic回归分析结果二分类logictic回归分析结果显示,性别(or=0.28,p=0.029),冠状动脉迂曲(or=62.59,p=0.004),高血压(or=11.064,p=0.096),冠状动脉粥样硬化(or=15.405,p=0.043),超敏反应蛋白(or=0.616,p=0.41),总胆固醇(or=0.202,p=0.010),糖尿病(or=8.320,p=0.43)。其中超敏反应蛋白p0.05,or1差别无统计学意义,糖尿病or1为暴露因素但p0.05差别无统计学意义,超敏反应蛋白p0.05但or1为非暴露因素,冠状动脉迂曲、高血压、性别、冠状动脉粥样硬化or1,p0.05差别有统计学意义。冠状动脉迂曲为冠状动脉微血管病变的独立危险因素。患者出院后随访3个月,观察到对照组患者均未出现急性心肌梗死等mace事件,实验组院外2个月后有1例患者出现急性心肌梗死,两组间差异无统计学意义(p0.05)结论:1冠状动脉迂曲与冠状动脉微循环相关2冠状动脉迂曲可能影响冠状动脉微循环障碍的产生和发展
[Abstract]:Objective: To observe the effect of coronary tortuosity (CT) on coronary microcirculation (coronary microvascular) and to explore the correlation between coronary artery tortuosity and coronary arteria microvascular disease (coronary microvascular disease). Methods: to choose the second hospital of Hebei Medical University from March 2015 to December 2016. There were 55 cases of typical angina pectoris in five families with coronary angiography and coronary arteriography, including 35 cases of coronary artery tortuosity and 20 cases of non coronary tortuosity. Age, blood pressure, blood uric acid, blood lipid, and left ventricular ejection fraction (LVEF), wall motion integral index, heart size, wall thickness, BNP, electrocardiogram, family history, diabetes history, smoking history, drinking history, and the history of myocardial infarction or thrombolytic, and the basic medication of patients. The standard of admission was 1. patients with typical angina symptoms 2 Coronary arteriography, no obvious stenosis (20% of coronary stenosis), 3. lines of ECT examination were in line with the criteria for diagnostic criteria for coronary arteriopathy: 1. other myocardial diseases, such as stress cardiomyopathy (Takotsubo cardiomyopathy), affecting ventricular wall movement or cardiac ejection, were more than 20%.2. in coronary artery stenosis. Hypertrophic cardiomyopathy, dilated cardiomyopathy, myocarditis, myocardial densification, myocardial amyloidosis, 3. severe arrhythmias such as permanent atrial fibrillation, recurrent ventricular arrhythmia, 4. cardiogenic shock: SBP < 90mmHg continuous 30min, and peripheral vasoconstriction such as paleness, sweating, and reduced urine (20ml/h), 5. severe heart valve diseases include moderate to severe stenosis or massive reflux, 6. high drug allergies, 7. mechanical ventilation, 8. severe liver and renal insufficiency (2 times the normal upper limit, serum creatinine 2.5mg/dl); 9. with autoimmune diseases, and severe invasive disease. 10, patients or patients' families refused to participate in the study. 55 patients who were included in the standard were examined by single photon emission tomography (SPECT), and 99m- technetium was used as a tracer to record decreased segmental myocardial perfusion, perfusion defect and reperfusion in cardiac resting and load state, respectively. 33 cases of coronary arteria microangiopathy and 22 cases of non coronary arteria microangiopathy were obtained by [43 44].. The correlation between coronary artery circuitous and coronary arteria microvascular lesions was investigated. To discuss the pathophysiological mechanism and diagnosis and treatment of the two, all the data were statistically treated with spss21.0 software to analyze the above data by two yuan logistic regression before the comparison of the two groups. The difference was statistically significant with the difference of P0.05. Results: the baseline data of the 1 two groups were compared with the control group. There was no significant difference in smoking, age and smoking (P0.05). There was a significant difference between the experimental group and the control group in hypertension, diabetes, and coronary atherosclerosis (P0.05) the biochemical indexes in group.2 two were compared with those in the control group (2.20 + 1.63vs.4.15 + 4.29, p=0.000), and low density lipoprotein (2.66 + 0.98vs.2.69). + 0.69, p=0.092), triglyceride (1.62 + 0.62vs.1.55 + 0.62, p=0.978), total cholesterol (3.90 + 1.41vs.4.66 + 0.80, p=0.001) two groups had no statistical significance in low density lipoprotein and triglyceride (P0.05). The two groups were statistically significant in hypersensitivity reaction protein and total cholesterol (P0.05) group.3 two. The comparison between the experimental group and the control group was statistically significant in the Pearson chi square test (11.786df=1, P0.01). See table 1.4 multiple factor Logistic regression analysis results and two classified LOGICTIC regression analysis results showed that sex (or=0.28, p=0.029), coronary artery circuitous (or=62.59, p=0.004), hypertension (or=11.064, p=0.096), coronary atherosclerosis Or=15.405 (p=0.043), hypersensitive reaction protein (or=0.616, p=0.41), total cholesterol (or=0.202, p=0.010), diabetes (or=8.320, p=0.43). There is no statistical difference between the hypersensitive reaction protein P0.05, or1, and the or1 is the exposure factor, but the P0.05 difference is not statistically significant. Or1, P0.05, coronary arteriosclerosis was an independent risk factor for coronary arteriopathy. The patients were followed up for 3 months after discharge. No acute myocardial infarction, such as mace events were observed in the control group, and 1 patients in the experimental group were anxious after 2 months. There was no statistically significant difference between the two groups (P0.05): 1 the correlation between coronary artery circuitous and coronary microcirculation 2 coronary arteries may affect the production and development of coronary microcirculation disorders.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.3
本文编号：2134436
[Abstract]:Objective: To observe the effect of coronary tortuosity (CT) on coronary microcirculation (coronary microvascular) and to explore the correlation between coronary artery tortuosity and coronary arteria microvascular disease (coronary microvascular disease). Methods: to choose the second hospital of Hebei Medical University from March 2015 to December 2016. There were 55 cases of typical angina pectoris in five families with coronary angiography and coronary arteriography, including 35 cases of coronary artery tortuosity and 20 cases of non coronary tortuosity. Age, blood pressure, blood uric acid, blood lipid, and left ventricular ejection fraction (LVEF), wall motion integral index, heart size, wall thickness, BNP, electrocardiogram, family history, diabetes history, smoking history, drinking history, and the history of myocardial infarction or thrombolytic, and the basic medication of patients. The standard of admission was 1. patients with typical angina symptoms 2 Coronary arteriography, no obvious stenosis (20% of coronary stenosis), 3. lines of ECT examination were in line with the criteria for diagnostic criteria for coronary arteriopathy: 1. other myocardial diseases, such as stress cardiomyopathy (Takotsubo cardiomyopathy), affecting ventricular wall movement or cardiac ejection, were more than 20%.2. in coronary artery stenosis. Hypertrophic cardiomyopathy, dilated cardiomyopathy, myocarditis, myocardial densification, myocardial amyloidosis, 3. severe arrhythmias such as permanent atrial fibrillation, recurrent ventricular arrhythmia, 4. cardiogenic shock: SBP < 90mmHg continuous 30min, and peripheral vasoconstriction such as paleness, sweating, and reduced urine (20ml/h), 5. severe heart valve diseases include moderate to severe stenosis or massive reflux, 6. high drug allergies, 7. mechanical ventilation, 8. severe liver and renal insufficiency (2 times the normal upper limit, serum creatinine 2.5mg/dl); 9. with autoimmune diseases, and severe invasive disease. 10, patients or patients' families refused to participate in the study. 55 patients who were included in the standard were examined by single photon emission tomography (SPECT), and 99m- technetium was used as a tracer to record decreased segmental myocardial perfusion, perfusion defect and reperfusion in cardiac resting and load state, respectively. 33 cases of coronary arteria microangiopathy and 22 cases of non coronary arteria microangiopathy were obtained by [43 44].. The correlation between coronary artery circuitous and coronary arteria microvascular lesions was investigated. To discuss the pathophysiological mechanism and diagnosis and treatment of the two, all the data were statistically treated with spss21.0 software to analyze the above data by two yuan logistic regression before the comparison of the two groups. The difference was statistically significant with the difference of P0.05. Results: the baseline data of the 1 two groups were compared with the control group. There was no significant difference in smoking, age and smoking (P0.05). There was a significant difference between the experimental group and the control group in hypertension, diabetes, and coronary atherosclerosis (P0.05) the biochemical indexes in group.2 two were compared with those in the control group (2.20 + 1.63vs.4.15 + 4.29, p=0.000), and low density lipoprotein (2.66 + 0.98vs.2.69). + 0.69, p=0.092), triglyceride (1.62 + 0.62vs.1.55 + 0.62, p=0.978), total cholesterol (3.90 + 1.41vs.4.66 + 0.80, p=0.001) two groups had no statistical significance in low density lipoprotein and triglyceride (P0.05). The two groups were statistically significant in hypersensitivity reaction protein and total cholesterol (P0.05) group.3 two. The comparison between the experimental group and the control group was statistically significant in the Pearson chi square test (11.786df=1, P0.01). See table 1.4 multiple factor Logistic regression analysis results and two classified LOGICTIC regression analysis results showed that sex (or=0.28, p=0.029), coronary artery circuitous (or=62.59, p=0.004), hypertension (or=11.064, p=0.096), coronary atherosclerosis Or=15.405 (p=0.043), hypersensitive reaction protein (or=0.616, p=0.41), total cholesterol (or=0.202, p=0.010), diabetes (or=8.320, p=0.43). There is no statistical difference between the hypersensitive reaction protein P0.05, or1, and the or1 is the exposure factor, but the P0.05 difference is not statistically significant. Or1, P0.05, coronary arteriosclerosis was an independent risk factor for coronary arteriopathy. The patients were followed up for 3 months after discharge. No acute myocardial infarction, such as mace events were observed in the control group, and 1 patients in the experimental group were anxious after 2 months. There was no statistically significant difference between the two groups (P0.05): 1 the correlation between coronary artery circuitous and coronary microcirculation 2 coronary arteries may affect the production and development of coronary microcirculation disorders.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R543.3
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相关期刊论文 前4条
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