摘要
目的:探讨冠状动脉慢血流(coronary slow flow,CSF)现象的临床危险因素及炎症反应在其发病机制中的可能作用。方法:采用校正的心肌梗死溶栓治疗(thrombolysis in myocardial infarction,TIMI)临床试验血流帧数(corrected TIMI frame count,CTFC)评价冠状动脉血流情况。入选我院2016年1月至2016年12月择期行冠状动脉造影(coronary angiography,CAG)并证实CSF的患者96例为CSF组,入选同期行CAG证实血流完全正常的患者106例为非慢血流(nonCSF,NCSF)组。比较两组患者的临床特点、生化指标及相关炎症因子(包括外周静脉血及冠状动脉血)之间的差异,炎症因子包括:白细胞介素-6(interleukin-6,IL-6)、超敏C反应蛋白(hypersensitive C reactive protein,hsCRP)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)。同时进行单因素及多因素Logistic回归分析,分析CSF的危险因素及其与炎症反应的相关性。结果:CSF组冠状动脉三分支的CTFC值均显著高于NCSF组(前降支:32.3±3.7 vs 17.8±2.1;回旋支:34.5±3.9vs 23.1±2.8;右冠状动脉:34.9±4.3 vs 21.4±3.2,P均<0.01),且右冠状动脉为CSF最常见的受累冠脉(83.3%)。单因素分析发现:CSF组患者体质指数,糖尿病比例,尿酸,冠状动脉血IL-6、hsCRP,外周静脉血及冠状动脉血MMP-9均显著高于NCSF组(P<0.05或0.01)。Logistic回归分析发现:体质指数(OR=1.313,95%CI 1.026~1.654,P=0.034)、糖尿病(OR=1.604,95%CI 1.198~2.466,P=0.006)、高尿酸水平(OR=1.036,95%CI 1.006~1.102,P=0.027)、外周静脉血MMP-9(OR=2.279,95%CI 1.478~4.022,P=0.004)、受累冠状动脉血MMP-9(OR=3.145,95%CI 2.011~5.023,P=0.000)是发生CSF的独立危险因素。结论:体质指数、糖尿病、尿酸是CSF发生的独立危险因素;与全身炎症反应相比,受累冠脉局部炎症反应与CSF更相关;炎症因子MMP-9在CSF的病理生理过程中发挥重要作用。
Objective:To explore the risk factors of coronary slow flow(CSF)and the role of inflammatory response on its pathogenesis.Methods:The CSF was evaluated by corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC).Totally 96 cases with CSF(CSF group)and 106 cases with normal flow(NCSF group)were selected from patients undergoing coronary angiography(CAG)in our hospital from January 2016 to December 2016.Single and multi-variable logistic regression analysis was used to assess the relationship between CSF and clinical characteristics,baseline biochemistry and related inflammation factors(both in peripheral venous blood and in coronary arterial blood)including interleukin-6(IL-6),hypersensitive C reactive protein(hsCRP)and matrix metalloproteinase-9(MMP-9).Results:The CTFC values of three branches of coronary arteria in CSF group were all significantly higher than those in control group(left anterior descending:32.3±3.7 vs 17.8±2.1,left circumflex branch:34.5±3.9 vs 23.1±2.8,right coronary artery:34.9±4.3 vs 21.4±3.2,all P<0.01).The most common coronary artery involved by CSF was right coronary artery(83.3%).Single factor analysis found that the body mass index,diabetes ratio,uric acid,IL-6,hsCRP in coronary arterial blood,MMP-9 in both peripheral venous and coronary arterial blood in CSF group were significantly higher than those in NCSF group(P<0.05 or 0.01).Logistic regression analysis found that body mass index(OR=1.313,95%CI 1.026-1.654,P=0.034),diabetes(OR=1.604,95%CI 1.198-2.466,P=0.006),uric acid(OR=1.036,95%CI 1.006-1.102,P=0.027),MMP-9 in peripheral venous blood(OR=2.279,95%CI 1.478-4.022,P=0.004),MMP-9 in involved coronary arterial blood(OR=3.145,95%CI 2.011-5.023,P=0.000)were independent risk factors of CSF.Conclusions:Body mass index,diabetes,and uric acid are independent risk factors of CSF.Compared with the systemic inflammatory response,local inflammatory response of the involved coronary arteries is more relevant to CSF.MMP-9 plays an important role in the pathogenesis of CSF.
作者
严健华
孙英刚
陈漫天
唐勇
孟舒
张亚臣
张燚
YAN Jian-hua;SUN Ying-gang;CHEN Man-tian;TANG Yong;MENG Shu;ZHANG Ya-chen;ZHANG Yan(Department of Cardiology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)
出处
《中国临床医学》
2018年第2期194-198,共5页
Chinese Journal of Clinical Medicine
