吸烟与冠状动脉的狭窄程度

背景:吸烟是心血管病发病的重要因素之一,其发心血管疾病的确切机机制及吸烟量和心血管危险之间是否存在线性关系有待研究。目的:分析吸烟与冠状动脉粥样硬化程度的关系。设计:回顾性调查及对比实验。单位:南京医科大学第一附属医院。对象:选择2004-04/2005-04在南京医科大学第一附属医院心内科收治的500例疑似及确诊冠心病的患者,纳入标准:①患者既往有胸痛病史或/及有心电图缺血性改变者。②经冠状动脉造影确诊或疑似冠心病。排除标准:①变异性心绞痛。②手术前2周内有感染、心力衰竭(急性心肌梗死后Killp分级II级以上)。③肝功能异常、血管疾病(需强的松治疗的大动脉炎)。④家族性高胆固醇血症、甲状腺功能异常、肾上腺功能失常。纳入患者中,男370例,年龄42～76岁,平均(61±11)岁;女130例,年龄45～75岁,平均(61±12)岁。本实验经南京医科大学第一附属医院伦理委员会批准,并经每位患者签署同意书。方法:①对纳入500例疑似及确诊冠心病患者进行吸烟习惯调查,依据吸烟与否将患者分为吸烟组(n=254)和不吸烟两组(n=246)。②对所有患者进行人体测量(体质量指数与收缩压、舒张压的测量),检测患者的外周血中白细胞计数(包括白细胞总数、中性粒细胞计数、嗜酸性粒细胞计数、淋巴细胞计数、单核细胞计数和嗜碱性粒细胞计数)。③应用国际上通行的Gensini’s评分系统(基于这样一个假设,即冠心病严重程度是狭窄血管功能改变及其累及灌注心肌范围共同作用的结果,冠脉管腔直径明显减小比远端损伤得分更高)对冠状动脉造影检查的结果进行评价。④对吸烟组患者吸烟量和Gensini’s评分、人体测量、白细胞计数的Spearman相关分析。主要观察指标:①两组患者体质量指数、收缩压、舒张压、白细胞计数、Gensini’s评分结果。②吸烟组患者吸烟量和Gensini’s评分、人体测量、白细胞计数的Spearman相关分析结果。结果:①吸烟组患者外周血中白细胞总数、中性粒细胞计数、单核细胞计数水平与Gensini’s评分明显高于非吸烟组患者(P<0.05～0.01)。②Spearman相关分析结果显示吸烟组患者的吸烟总数、外周血中白细胞总数、中性粒细胞计数、单核细胞计数水平与Gensini’s评分显著相关(r=0.109,0.100,0.135,0.139,P<0.05～0.01)。结论:吸烟与冠状动脉粥样硬化程度显著相关,并且炎症反应可能是这种相关关系的机制之一。

Smoking and severity of coronary stenosis

BACKGROUND: Smoking is an important cause of cardiovascular disease, its definite mechanism in inducing cardiovascular disease is still unclear, and whether there is linear correlation between the amount of cigarette smoking and cardiovascular risk still needs to be investigated.OBJECTIVE: To analyze the association between cigarette smoking and the severity of coronary atherosclerosis.DESIGN: A retrospective investigation and comparative study.SETTING: The First Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: Totally 500 consecutive patients, who underwent coronary angiography for suspected or known coronary atherosclerosis, were selected from the First Affiliated Hospital of Nanjing Medical University from April 2004 to April 2005. The inclusive criteria included patients with history of chest pain and/or ischemic changes of electrocardiography (ECG), and those with suspected or known coronary artery disease by coronary angiography. Patients with spastic angina pectoris (acetylcholine-positive) were excluded. Patients with infectious processes within 2 weeks before catheterization, heart failure (Killip Class≥ 2 after acute myocardial infarction), hepatic dysfunction, vascular disease (aortitis should be treated with prednisolone), familial hypercholesterolemia, thyroid dysfunction, or adrenal dysfunction were also excluded. There were 370 males aged 42-76years with an average of (61±11) years and 130 females aged 45-75 years with an average of (61±12) years. There were no significant differences in the sex, age and general information among all the patients. This study was approved by the ethics committee of the First Affiliated Hospital of Nanjing Medical University and informed consent was obtained from each patient.METHODS: ① According to the smoking habit, 500 patients with suspected or known coronary artery disease were divided into smoking group (n=254) and non-smoking group (n=246). ② All the patients received anthropometric measurements including body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Blood samples were drawn from every patient at admission to the detect the leukocyte counts in peripheral blood, including total leukocyte count, neutrophil count, eosinophil count, lymphocyte count, monocyte count and basophil count. ③ The severity of coronary atherosclerosis was defined by the Gensini score system, based on the hypothesis that the severity of coronary artery disease should be considered as a consequence of the functional significance of the vascular narrowing and the extent of the area perfused by the involved vessel or vessels. In this scoring system, a greater reduction of the lumen diameter was assigned a higher score than a distal lesion. ④The association of smoking amount with Gensini score, anthropometric measurements and leukocyte count were studies with the Spearman correlation analysis.MAIN OUTCOME MEASURES: ① Results of BMI, SBP, DBP, leukocyte count and Gensini score; ② Results of the Spearman correlation analysis on the association of smoking amount with Gensini score, anthropometric measurements and leukocyte count.RESULTS: ① The total leukocyte count, neutrophil count, monocyte count in peripheral blood and Gensini score were significantly higher in the smoking group than in the non-smoking group.② The Spearman correlation analysis indicated that the amount of cigarette smoking was significantly associated with the total cigarettes smoked, total leukocyte count,neutrophil count, monocyte count and Gensini score (r=0.109, 0.100,0.135, 0.139, P ＜ 0.05-0.01).CONCLUSION: Smoking is significantly associated with the severity of coronary atherosclerosis, and the inflammatory response may be part of the mechanisms underlying the association between coronary artery disease and cigarette smoking.