冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系

doi:10.3969/j.issn.1004-583X.2022.02.004

摘要/Abstract

摘要：

目的探讨冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系。方法选取我院2016年3月-2021年3月220例冠心病患者作为研究对象,根据冠状动脉病变程度将患者分为轻、中度组(n=142)和重、极重度组(n=78)。收集两组入院时年龄、性别、身体质量指数(BMI)、糖尿病、高血压各项信息。测定两组入院1 d后叶酸(FA)、维生素B₁₂(VB₁₂)、总胆红素(TBIL)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平。采用手指复温试验测定患者外周微循环。对比两组基础资料、实验室指标及手指复温时间(RT),利用ROC曲线分析FA、VB₁₂、TBIL、TC、LDL-C、RT对冠心病患者重、极重度冠状动脉病变发生的预测价值,将有差异的单因素纳入Logistic模型,行量化赋值,明确冠心病患者重、极重度冠状动脉病变发生的危险因素。结果重、极重度组年龄≥60岁、高血压患者占比显著高于轻、中度组, FA、VB₁₂、TBIL水平显著低于轻、中度组, TC、LDL-C、RT显著高于轻、中度组,差异均有统计学意义(P<0.05)。FA、VB₁₂、TBIL、TC、LDL-C、RT预测冠心病患者重、极重度冠状动脉病变发生的曲线下面积分别为0.931、0.732、0.869、0.849、0.775、0.967,均P<0.05。经多因素Logistic回归分析证实,年龄≥60岁、高血压、FA≤6.555 μg/L、VB₁₂≤268.295 ng/L、TBIL≤10.015 μmol/L、TC≥5.015 mmol/L、LDL-C≥2.680 mmol/L、RT≥405.240 s是冠心病患者重、极重度冠状动脉病变发生的危险因素。结论年龄≥60岁、高血压患者发生重、极重度冠状动脉病变可能性较大,患者FA、VB₁₂、TBIL、TC、LDL-C水平及外周微循环与冠状动脉病变程度密切相关,可用于评估患者病情严重程度。

关键词: 冠心病, 临床特征, 外周微循环, 冠状动脉病变程度

Abstract:

Objective To explore the relationship between clinical features, peripheral microcirculatory and the severity of coronary artery disease (CAD) in patients with coronary heart disease (CHD).Methods Totally 220 CHD patients admitted to our hospital from March 2016 to March 2021 were assigned into mild and moderate group (n=142) and severe and extremely severe group (n=78). The data of age, gender, body mass index (BMI), diabetes mellitus (DM), and hypertension on admission were collected; the indicators of the two groups were measured on day 1 admission, including folic acid (FA), vitamin B₁₂ (VB₁₂), total bilirubin (TBIL), triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). The rewarming test of finger skin was used to measure peripheral microcirculatory; the predictive value of FA, VB₁₂, TBIL, TC, LDL-C, RT for severe and extremely severe CAD in CHD patients was analyzed according to receiver operating characteristic (ROC) curve by comparing the basic data, laboratory index, finger rewarming time (RT) of two groups. The different single factors were included in the Logistic model and quantified to determine the risk factors of severe and extremely severe CAD in CHD patients.Results Compared with mild and moderate group, the proportion of patients with age≥60 and hypertension in severe and extremely severe group was significantly increased; FA, VB₁₂ and TBIL in severe and extremely severe group were significantly decreased; TC, LDL-C and RT were obviously higher; and with statistically significant difference (P<0.05). The areas under curve (AUC) of FA, VB₁₂, TBIL, TC, LDL-C and RT in predicting in the pathogenesis of severe and extremely severe CAD in CHD patients were 0.931, 0.732, 0.869, 0.849, 0.775 and 0.967, respectively (all P<0.05). Multivariate Logistic regression analysis showed that the risk factors of severe and extremely severe CAD in CHD patients were age≥60 years old, hypertension, FA≤6.555 μg/L, VB₁₂≤268.295 ng/L, TBIL≤10.015 μmol/L, TC≥5.015 mmol/L, LDL-C≥2.680 mmol/L, RT≥405.240 s.Conclusion Patients with age≥60 years old and hypertension are more likely to have severe and extremely severe CAD. The levels of FA, VB₁₂, TBIL, TC, LDL-C and peripheral microcirculatory are closely correlated with severity of CAD, which can be used to evaluate the severity of patients.

Key words: coronary heart disease, clinical features, peripheral microcirculation, degree of coronary artery disease

中图分类号:

R541.4

段丽钦. 冠心病患者临床特征、外周微循环状态与冠状动脉病变程度的关系[J]. 临床荟萃, 2022, 37(2): 119-123.

Duan Liqin. Relationship between clinical features, peripheral microcirculatory and severity of coronary artery disease in patients with coronary heart disease[J]. Clinical Focus, 2022, 37(2): 119-123.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.02.004

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I2/119

图/表 5

参考文献 18

[1]	Lin TC, Lu TM, Huang FC, et al. Coronary artery bypass surgery versus percutaneous coronary intervention for left main coronary artery disease with chronic kidney disease[J]. Int Heart J, 2018,59(2):279-285. doi: 10.1536/ihj.17-260 URL
[2]	Wang X, Zhang Y, Dong Z, et al. Effect of continuous positive airway pressure on long-term cardiovascular outcomes in patients with coronary artery disease and obstructive sleep apnea: A systematic review and meta-analysis[J]. Respir Res, 2018,19(1):61. doi: 10.1186/s12931-018-0761-8 URL
[3]	郭晓鹃, 何平. 几种常见冠状动脉微循环病变的临床特点及机制研究进展[J]. 微循环学杂志, 2018,28(3):75-79.
[4]	颜红兵. 临床冠心病诊断与治疗指南[M]. 北京: 人民卫生出版社, 2010:5-26.
[5]	Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease[J]. Am J Cardiol, 1983,51(3):606. pmid: 6823874
[6]	Rigatelli G, Zuin M, Filippo G. Impact of isolated non-dominant hypoplastic right coronary artery disease on cardiovascular events and mortality rates in the elderly[J]. J Geriatr Cardiol, 2021,18(8):686-688. doi: 10.11909/j.issn.1671-5411.2021.08.007 pmid: 34527033
[7]	Deveci B, Gazi E. Relation between globulin, fibrinogen, and albumin with the presence and severity of coronary artery disease[J]. Angiology, 2021,72(2):174-180. doi: 10.1177/0003319720959985 URL
[8]	彭薇, 顾阳, 刘克琴. 冠心病发作及冠状动脉病变程度的相关危险因素分析[J]. 广西医科大学学报, 2018,35(8):1144-1147.
[9]	周春光, 冯霞, 罗勇. 中年男性冠心病的发生和冠状动脉病变程度与H型高血压的关系[J]. 广西医学, 2020,42(10):1248-1251.
[10]	刘莎莎, 邢智, 阿丽米拉·赛依提江, 等. 冠心病危险因素与冠状动脉病变的相关分析[J]. 新疆医科大学学报, 2018,41(10):1206-1209.
[11]	杨震, 宗文仓, 赵艳辉. 血脂异常与老年冠心病患者冠状动脉病变程度的相关性研究[J]. 医学信息, 2019,32(7):89-92.
[12]	黄卓山, 钟钧琳, 罗艳婷, 等. 冠心病患者LDL-C/HDL-C比值与冠状动脉病变严重程度的相关性[J]. 中山大学学报(医学科学版), 2018,39(2):303-308.
[13]	Zhang SY, Xuan C, Zhang XC, et al. Association between MTHFR gene common variants, serum homocysteine, and risk of early-onset coronary artery disease: A case-control study[J]. Biochem Genet, 2020,58(2):245-256. doi: 10.1007/s10528-019-09937-x URL
[14]	杨林飞, 陈敏, 张婷, 等. 同型半胱氨酸水平与高血压患者冠状动脉病变程度和性质的关系[J]. 中华高血压杂志, 2018,26(6):586-589.
[15]	周春娟, 毛文娟, 王瑜硕, 等. 冠心病患者血清脂蛋白, 血尿酸水平与冠状动脉狭窄程度的相关性[J]. 海南医学, 2019,30(24):3152-3155.
[16]	Xu C, Dong M, Deng Y, et al. Relation of direct, indirect and total bilirubin to adverse long-term outcomes among patients with acute coronary syndrome[J]. Am J Cardiol, 2019,123(8):1244-1248. doi: 10.1016/j.amjcard.2019.01.019 URL
[17]	夏华松, 吴延庆. 冠状动脉不同病变程度与外周微循环的相关性研究[J]. 临床心血管病杂志, 2019,35(2):123-126.
[18]	赵艳茹. 冠状动脉微循环障碍的机制及治疗再认识[J]. 心血管病学进展, 2018,39(6):1016-1020.

项目	轻、中度组 (n=142)	重、极重度组 (n=78)	t/χ²值	P值
年龄[例(%)]
<60岁 ≥60岁	88(61.97) 54(38.03)	29(37.18) 49(62.82)	12.429	0.000
性别[例(%)]
男女	77(54.23) 65(45.77)	43(55.13) 35(44.87)	0.017	0.898
BMI(kg/m²)	24.21±3.54	24.68±3.51	0.945	0.346
糖尿病[例(%)]
是否	37(26.06) 105(73.94)	25(32.05) 53(67.95)	0.894	0.344
高血压[例(%)]
是否	61(42.96) 81(57.04)	46(58.97) 32(41.03)	5.170	0.023
FA(μg/L)	7.86±2.15	5.15±1.64	9.688	0.000
VB₁₂(ng/L)	289.42±67.67	256.86±68.51	3.399	0.001
TBIL(μmol/L)	11.84±3.14	8.67±2.31	7.825	0.000
TG(mmol/L)	2.35±0.54	2.43±0.57	1.031	0.304
TC(mmol/L)	4.38±1.01	5.15±1.13	5.184	0.000
HDL-C(mmol/L)	1.31±0.32	1.28±0.34	1.491	0.137
LDL-C(mmol/L)	2.48±0.52	2.87±0.57	5.142	0.000
RT(s)	361.45±43.85	432.15±50.42	10.840	0.000

项目	轻、中度组 (n=142)	重、极重度组 (n=78)	t/χ²值	P值
年龄[例(%)]
<60岁 ≥60岁	88(61.97) 54(38.03)	29(37.18) 49(62.82)	12.429	0.000
性别[例(%)]
男女	77(54.23) 65(45.77)	43(55.13) 35(44.87)	0.017	0.898
BMI(kg/m²)	24.21±3.54	24.68±3.51	0.945	0.346
糖尿病[例(%)]
是否	37(26.06) 105(73.94)	25(32.05) 53(67.95)	0.894	0.344
高血压[例(%)]
是否	61(42.96) 81(57.04)	46(58.97) 32(41.03)	5.170	0.023
FA(μg/L)	7.86±2.15	5.15±1.64	9.688	0.000
VB₁₂(ng/L)	289.42±67.67	256.86±68.51	3.399	0.001
TBIL(μmol/L)	11.84±3.14	8.67±2.31	7.825	0.000
TG(mmol/L)	2.35±0.54	2.43±0.57	1.031	0.304
TC(mmol/L)	4.38±1.01	5.15±1.13	5.184	0.000
HDL-C(mmol/L)	1.31±0.32	1.28±0.34	1.491	0.137
LDL-C(mmol/L)	2.48±0.52	2.87±0.57	5.142	0.000
RT(s)	361.45±43.85	432.15±50.42	10.840	0.000

指标	曲线下面积	标准误	95%可信任区间	最佳截断值	敏感度	特异度
FA	0.931	0.016	0.900~0.962	6.555	0.754	0.987
VB₁₂	0.732	0.034	0.665~0.799	268.295	0.655	0.590
TBIL	0.869	0.024	0.822~0.916	10.015	0.739	0.832
TC	0.849	0.027	0.796~0.902	5.015	0.679	0.789
LDL-C	0.775	0.031	0.713~0.837	2.680	0.756	0.669
RT	0.967	0.023	0.846~0.937	405.240	0.692	0.944

指标	曲线下面积	标准误	95%可信任区间	最佳截断值	敏感度	特异度
FA	0.931	0.016	0.900~0.962	6.555	0.754	0.987
VB₁₂	0.732	0.034	0.665~0.799	268.295	0.655	0.590
TBIL	0.869	0.024	0.822~0.916	10.015	0.739	0.832
TC	0.849	0.027	0.796~0.902	5.015	0.679	0.789
LDL-C	0.775	0.031	0.713~0.837	2.680	0.756	0.669
RT	0.967	0.023	0.846~0.937	405.240	0.692	0.944

变量		量化赋值
年龄	X1	≥60岁=1, <60岁=0
高血压	X2	是=1,否=0
FA	X3	≤6.555 μg/L=1,>6.555 μg/L=0
VB₁₂	X4	≤268.295 ng/L=1,>268.295 ng/L=0
TBIL	X5	≤10.015 μmol/L=1,>10.015 μmol/L=0
TC	X6	≥5.015 mmol/L=1,<5.015 mmol/L=0
LDL-C	X7	≥2.680 mmol/L=1,<2.680 mmol/L=0
RT	X8	≥405.240 s=1,<405.240 s=0
冠状动脉病变程度	Y	重、极重度=1,轻、中度=0