吸烟对冠状动脉微循环阻力的影响研究
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摘要
目的探讨吸烟对冠状动脉微循环阻力的影响。方法选取2015年5月至2018年5月,温州医科大学附属第二医院行冠状动脉造影术并行冠状动脉内压力导丝测定的患者104例,其中吸烟者56例和无吸烟者48例,分为观察组和对照组。检测两组患者的血浆高敏C反应蛋白(hs-CRP)等生化指标,釆用压力导丝检测患者冠状动脉开口压力及狭窄段以远压力,冠状动脉血流储备,血流储备分数和冠状动脉循环阻力指数。结果观察组充血状态下冠状动脉微循环阻力指数高于对照组,差异有统计学意义(t=-5.946,P=0.000),血流储备分数值低于对照组,差异有统计学意义(t=2.021,P=0.046)。多元回归分析结果分析显示吸烟(95%CI:1.14～5.26,P=0.003);hs-CRP水平(95%CI:1.62～3.27,P<0.01)是微循环阻力指数的独立预测因子。结论吸烟者较无吸烟者更易导致冠状动脉微循环阻力升高。吸烟与hs-CRP是冠状动脉微循环阻力指数升高的独立危险因素。
Objective To observe the effects of smoking on the microcirculation resistance of coronary artery. Methods A retrospective analysis was performed on data of 104 patients underwent coronary angiography and pressure guide wire examination in the Second Affiliated Hospital of Wenzhou Medical University from May 2015 to May 2018, Patients were divided into observation group(56 smokers) and control group(48 nonsmokers).Serum levels of high-sensitivity c-reactive protein(hs-CRP) and other biochemical markers were determined in the two groups.Pressure of coronary artery opening(Pa) and distal end of stenosis(Pd), coronary artery blood flow reserve(CFR), fractional flow reserve(FFR) and index of microcirculation resistance(IMR) were measured by pressure guide wire. Results The IMR value of coronary artery in the observation group was significantly higher than that in the control group(t=-5.946, P=0.000), while the FFR value was significantly lower(t=2.021, P=0.046).Multiple regression analysis showed that cigarette smoking(95%CI:1.14-5.26, P=0.003) and hs-CRP level(95% CI:1.62-3.27, P<0.01) were independent predictor for the increase of IMR of coronary arteries. Conclusions Smokers are more likely to have increased coronary microcirculation resistance compared to nonsmokers.Cigarette smoking and hs-CRP are independent risk factors for the increase of coronary microcirculation resistance index.
Objective To observe the effects of smoking on the microcirculation resistance of coronary artery. Methods A retrospective analysis was performed on data of 104 patients underwent coronary angiography and pressure guide wire examination in the Second Affiliated Hospital of Wenzhou Medical University from May 2015 to May 2018, Patients were divided into observation group(56 smokers) and control group(48 nonsmokers).Serum levels of high-sensitivity c-reactive protein(hs-CRP) and other biochemical markers were determined in the two groups.Pressure of coronary artery opening(Pa) and distal end of stenosis(Pd), coronary artery blood flow reserve(CFR), fractional flow reserve(FFR) and index of microcirculation resistance(IMR) were measured by pressure guide wire. Results The IMR value of coronary artery in the observation group was significantly higher than that in the control group(t=-5.946, P=0.000), while the FFR value was significantly lower(t=2.021, P=0.046).Multiple regression analysis showed that cigarette smoking(95%CI:1.14-5.26, P=0.003) and hs-CRP level(95% CI:1.62-3.27, P<0.01) were independent predictor for the increase of IMR of coronary arteries. Conclusions Smokers are more likely to have increased coronary microcirculation resistance compared to nonsmokers.Cigarette smoking and hs-CRP are independent risk factors for the increase of coronary microcirculation resistance index.
引文
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[2] Guerra-Silva NM,Santucci FS,Moreira RC,et al.Coronary disease risk assessment in men:comparison between ASCVD risk versus Framingham[J].Int J Cardiol,2017,228:481-487.
[3] 姜垣,刘黎香.全面无烟是全民健康的保障[J].中华流行病学杂志,2017,38(5):565-566.
[4] Baldassarre D,Castelnuovo S,Frigerio B et al.Effects of timing and extent of smoking,type of cigarettes,and concomitant risk factors on the association between smoking and subclinical atherosclerosis[J].Stroke,2009,40(6):1991-1998.
[5] Bakris G,Sarafidis P,Agarwal R,et al.Review of blood pressure control rates and outcomes [J].J Am Soc Hypertens,2014,8(2):127-141.
[6] 龙英全,钟秋安,潘姣姣,等.吸烟对男性人群体质指数与血压关系的影响[J].中华疾病控制杂志,2015,19(3):218-221.
[7] 卢周舟,童嘉毅.冠状动脉微循环障碍的检测与治疗[J].东南大学学报,2015,34(4):657-660.
[8] Lanza GA,Crea F.Primary coronary microvascular dysfunction:clinical presentation,pathophysiology,and management[J].Circulation,2010,121(21):2317-2325.
[9] Fearon WF,Low AF,Yong AS,et al.Prognostic value of the index of microcirculatory resistance measured after primary percutaneous coronary intervention[J].Circ J,2013,127(24):2436-2441.
[10] Yuhei K,William FF.Invasive coronary microcirculation assessment current status of index of microcirculatory resistance[J].Circ J,2014,78(5):1021-1028.
[11] 解翠,吕慧,高奋,等.冠状动脉慢血流性心绞痛危险因素初步分析[J].中国介入心脏病学杂志,2015,23(4):213-216.
[12] Cong L,Pu Z,Yangjing X,et al.Impact of hyperhomocysteinemia on coronary microcirculation in patients referred for elective coronary angiography[J].Int J Clin Exp Med,2017,10(7):10625-10633.
[13] 吕涛.吸烟冠心病病人的冠脉造影分析[J].赤峰学院学报,2015,31(6):80-81.
[14] 吴永辉,吴立华,任凤学.冠状动脉慢血流现象相关危险因素的分析[J].北京医学,2014,36(5):347-349.
[15] Fineschi M,Bravi A,Gori T.The "slow coronary flow" phenomenon:evidence of preserved coronary flow reserve despite increased resting microvascular resistances[J].Int J Cardiol,2008,127(3):358-361.
[16] Rooks C,Faber T,Votaw J,et al.Effects of smoking on coronary microcirculatory function:a twin study[J].Atherosclerosis,2011,215(2):500-506.
[17] 刘巍,高雅楠,侯方杰,等.光学相干断层成像下吸烟对年轻急性冠状动脉综合征患者斑块特征的影响[J].中国介入心脏病学杂志2018,26(5):241-245.
[18] Tanriverdi H,Evrenngul H,Kuru O,et al.Cigarette smoking induced oxidative stress may impair endothelial function and coronary blood flow in angiographically nomal coronary arteties[J].Circ J,2006,70(5):593-599.
[19] Hawkins BM,Stavrakis S,Rousan TA,et al.Coronary slow flow-prevalence and clinical correlations[J].Circ J,2012,76(4):936-942.
[20] Madak N,Nazli Y,Mergen H,et al.Acute phase reactants in patiens with coronary slow flow phenomenon[J].Anadolu Kardiyol Derg,2010,10(5):416-420.
[21] 许明,高莉莉,李志军.高敏C反应蛋白在冠状动脉慢血流患者中的应用[J].医学信息,2016,29(30):40-41.