冠状动脉慢血流现象临床危险因素及形态学研究

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±2.17)f l比(13.21±2.42)f l]与对照组相比更高,三酰甘油(3.05±1.37)mmol/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%CI 1.032~1.097,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cTFC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cTFC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cTFC密切相关。炎症可能是CSFP发生的关键机制。

Study on the clinical risk factors and morphology of coronary slow fl ow phenomenon

Objective To explore the clinical risk factors of coronary slow flow phenomenon(CSFP),and to know about the influence of coronary artery morphology on blood flow of thrombolysis in myocardial infarction(TIMI),so as to speculate the pathogenesis of CSFP.Methods A total of 256 patients without stenosis who successfully underwent coronary arteriography in Heart Center of the First Hospital of Lanzhou University from January 2017 to July 2019 were collected retrospectively.According to TIMI frame count,the patients with slow blood flow were selected as CSFP group(100 cases),while the patients with normal blood flow were selected as control group(156 cases),who were matched by age and sex.The clinical data and coronary angiogram data were collected.Binary logistic regression model was used to analyze the risk factors of CSFP,and Pearson correlation analysis was used to examine the correlation between coronary artery morphological parameters and corrected TIMI frame count(c TFC).Results(1)Univariate analysis found that homocysteine(22.07±7.27) mmol/L vs.(18.16±6.63)mmol/L],neutrophil percentage(44.40±15.60)% vs.(35.43±12.49)%],lymphocyte percentage3.65%(1.32%,24.65%)vs.1.80%(1.02%,6.22%)],mean platelet volume(MPV)(13.17±1.82)flvs.(12.20±1.57)fl],platelet distribution width(PWD)(14.17±2.17) flvs.(13.21±2.42) fl] in CSFP group were significantly higher than those in control group,triglyceride(3.05±1.37) mmol/L vs.(3.44±1.36)mmol/L],fibrinogen(2.65±0.68) g/L vs.(2.86±0.66) g/L] in CSFP group were significantly lower than those in control group.Meanwhile,compared with control group,intraoperative blood pressure in CSFP group was more lower,average coronary diameter was more larger,and average distal branch count was more less,the dif ferences were statistically significant(P<0.05).(2)Binary logistic regression model showed that homocysteine(OR 1.077,95%CI 1.034 to 1.123,P<0.001),lymphocyte percentage(OR 1.064,95%CI 1.032 to 1.097,P<0.001),PDW(OR 1.194,95%CI 1.051 to 1.356,P=0.006) and MPV(OR 1.338,95%CI1.127 to 1.588,P=0.001) were independent risk factors for predicting CSFP.(3)Correlation analysis showed that there was a significant positive correlation between mean coronary artery diameter and cTFC(r=0.583,P<0.05),the mean number of distal coronary branches was negatively correlated with the mean cTFC(r=-0.508,P<0.05).Conclusions Homocysteine,neutrophil percentage,PDW and MPV are independent risk factors for predicting CSPF.The mean coronary artery diameter and the number of distal branches are closely related to the mean coronary cTFC.Inflammation may be the key mechanism of CSFP.