冠状动脉钙化积分、血压变异性与不稳定型心绞痛的关系

目的探讨不稳定型心绞痛（UAP）患者冠状动脉钙化积分（CCS）与血压变异性（BPV）及冠状动脉病变严重程度的关系，并评价CCS与BPV对经皮冠状动脉腔内介入治疗（PCI）的UAP患者预后的预测价值。方法回顾性分析2009年6月至2011年6月在我院心内科住院首次接受冠状动脉造影（CAG）及PCI治疗的466例UAP患者，入选患者均在PCI术前接受320排螺旋CT心脏冠状动脉成像检查及24h动态血压监测（ABPM），分别测量CCS及血压变异系数（CV），入选病例按CCS分为CCS≤100，CCS101～400和CCS〉400三组，比较三组患者血压变异性及冠状动脉病变严重程度的差异，PCI术后对三组患者进行12个月的随访，记录术后死亡、非致命性心肌梗死、靶病变血运重建及再发心绞痛入院等主要心脏不良事件（MACE）发生情况。结果CCS〉400组患者24h收缩压变异系数（SBP-CV），24h舒张压变异系数（DBP．CV）高于其他两组（13．2±2．2vs．12．4±2．2vs．11．8±1．7；10．8±1．5vs．10．3±1．5vs．9．7±1．0，P〈0．05）；冠状动脉病变更为严重，表现为冠状动脉多支病变比例、B2／C型病变比例及冠状动脉病变Gensini积分均显著升高（47．6％vs．29．1％vs．18．3％；45．0％vs．27．3％vs．15．7％；56．8±16．9vs．52．8±13．6vs．36．7±17．1；P〈0．05）；并且CCS与SBP-CV呈正相关（r=0．322，P〈0．05）。随访12个月，Kaplan-Meier生存分析发现三组患者累积无MACE事件生存率差异有统计学意义（88．8％vs．84．2％vs．77．2％，Logrank8．044，P=0．005），在校正了年龄后，多因素Cox回归分析显示CCS〉400及SBP-CV是UAP患者PCI术后MACE发生的独立预测因子。CCS〉400组患者较CCS≤100组患者术后发生MACE的风险增加4．741倍（RR=4．741，P〈0．01）。结论CCS较高的UAP患者具有较高的血压变异性，并且冠状动脉病变更为严重，CCS及24hSBP．CV对接受PCI治疗的UAP患者的临床预后具有预测价值。

The relationship between coronary artery calcium score,blood pressure variability and unstable angina pectoris

Objective To investigate the relationship between coronary artery calcium score （CCS）, blood pressure variability（BPV） and unstable angina pectoris（UAP） patients and their predictive value for patient＇s prognosis. Methods 466 patients with UAP who underwent PCI for the first time from June 2009 to June 2011 were analyzed retrospectively. Patients received 320-slice multi-detector row computed tomography scanning examinations and ambulatory blood pressure monitoring （ABPM） before PCI, CCS and coefficient variation （CV） of blood pressure were measured. After PCI, patients were followed up for 12 months and major cardiac adverse events （MACE） were recorded. Results UA Patients were divided into three group according to their CCS levels： CCS≤ 100 group, CCS 101-400 group and CCS 〉400 group, patients in CCS 〉400 group had higher BPV and more serious coronary artery diseases than the other two groups. CCS was positive correlated with CV of systolic blood pressure （SBP-CV）（r=0.322, P〈0.05）. After 12 months of follow-up, Kaplan-Meier survival analysis showed patients of three groups had significantly different cumulative non-events survival rates（88.8% vs. 84.2% vs. 77.2%, Log rank 8.044, P=0.005）. Multivariate Cox regression analysis showed the risk of MACE in CCS〉 400 group increased 4.741 folds compared with CCS≤100 group（RR=4.471, P〈0.01）. Both CCS and SBP-CV were two strong independent predictors for prognosis of UAP patients undergoing PCI. Conclusion UAP patients with high CCS were associated with high BPV and serious coronary artery diseases, CCS and SBP-CVwere valuable in predicating the prognosis of UA patients undergoing PCI.