Effect of mild coronary stenosis on coronary flow reserve in patients with chest pain and non-obstructive coronary artery disease
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摘要: 目的 探讨冠状动脉(冠脉)轻度狭窄对非阻塞性冠脉胸痛患者冠脉血流储备(CFR)的影响。方法 回顾性分析340例由影像学检查明确冠脉狭窄<50%的胸痛患者，并行三磷酸腺苷负荷下经胸多普勒超声测定左前降支的CFR。根据CFR结果将患者分为CFR<2.5组(84例)和CFR≥2.5组(256例)，比较两组患者的临床资料、冠脉轻度狭窄比例及超声心动图参数，并分析CFR下降的影响因素。结果 单因素分析显示，CFR<2.5组年龄、收缩压、女性比例、高血压病史比例、冠脉轻度狭窄比例均高于CFR≥2.5组(均P<0.05)，BMI、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)值均低于CFR≥2.5组(均P<0.05)。Logistic回归分析结果显示，冠脉轻度狭窄(OR=1.995，95%CI：1.060~3.755，P=0.032)、年龄(OR=1.085，95%CI：1.047~1.124，P<0.01)、收缩压(OR=1.020，95%CI：1.000~1.040，P=0.048)均是CFR降低的独立影响因素。结论 冠脉轻度狭窄、年龄及收缩压是非阻塞性冠脉胸痛患者CFR下降的独立影响因素。Abstract: Objective To study the effect of mild coronary stenosis on coronary flow reserve(CFR) in patients with chest pain and non-obstructive coronary artery disease.Methods A retrospective study was conducted in 340 patients with chest pain whose coronary stenosis was less than 50% confirmed by imaging, and the CFR of the left anterior descending branch was measured by the transthoracic Doppler echocardiography under adenosine triphosphate stress. According to the result of the CFR, the patients were divided into groups with CFR<2.5(n=84) and CFR≥2.5(n=256). The clinical data, coronary stenosis degree, and echocardiographic parameters were compared between the two groups, and the factors associated with the decrease in CFR were analyzed.Results Univariate analysis showed that the age, systolic blood pressure, the percentage of female sex, the history of hypertension, and the proportion of mild coronary stenosis in the group with CFR<2.5 were higher than those in the group with CFR≥2.5(all P<0.05), while BMI, low-density lipoprotein cholesterol(LDL-C), and triglycerides(TG) levels in the group with CFR<2.5 were significantly lower than those in the group with CFR≥2.5(all P<0.05). Logistic regression analysis showed that coronary artery stenosis(OR=1.995, 95%CI: 1.060-3.755, P=0.032), age(OR=1.085, 95%CI: 1.047-1.124, P<0.01), systolic blood pressure(OR=1.020, 95%CI: 1.000-1.040, P=0.048) were independently associated with the decrease of CFR.Conclusion Mild coronary stenosis, age, and systolic blood pressure were independently associated with the decrease of CFR in patients with chest pain and non-obstructive coronary artery disease.
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Key words:
- chest pain /
- coronary stenosis /
- coronary flow reserve /
- echocardiography
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表 1 两组患者临床资料比较
Table 1. Clinical data
例(%), X±S, M(P25, P75) 项目 CFR<2.5组(84例) CFR≥2.5组(256例) t/χ2/Z值 P值 女性 62(73.81) 148(57.81) 6.854 0.009 年龄/岁 66.06±7.61 58.65±9.52 6.484 <0.001 BMI/(kg/m2) 24.61±3.36 25.67±3.34 -2.595 0.010 心率/(次/min) 65.86±10.38 65.71±9.16 0.126 0.900 血压/mmHg 收缩压 136.51±13.83 130.11±16.34 3.230 0.001 舒张压 74.92±8.40 75.80±10.22 -0.714 0.476 既往史 高血压病史 61(72.62) 145(56.64) 6.762 0.009 吸烟史 14(16.67) 58(22.66) 2.472 0.291 糖尿病史 19(22.62) 48(18.75) 0.598 0.439 生化指标 TC/(mmol/L) 4.22±0.84 4.45±0.97 -1.922 0.055 HDL-C/(mmol/L) 1.19±0.29 1.14±0.26 1.807 0.072 LDL-C/(mmol/L) 2.41±0.70 2.63±0.83 -2.198 0.029 TG/(mmol/L) 1.26(0.88，1.77) 1.47(1.10，2.09) -2.491 0.013 空腹血糖/(mmol/L) 5.52±1.41 5.53±1.52 -0.085 0.932 
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表 2 两组患者超声心动图参数比较
Table 2. Echocardiographic parameters
X±S, M(P25, P75) 项目 CFR<2.5组(84例) CFR≥2.5组(256例) t/Z值 P值 LAD/mm 33.86±4.20 34.19±4.04 -0.643 0.521 LVEDD/mm 44.58±7.43 44.59±8.07 -0.010 0.992 LVMI/(g/m2) 72.98(61.49，84.07) 72.35(62.69，83.59) -0.034 0.973 LVEF/% 71.00(66.00，74.00) 71.00(66.00，74.00) -0.137 0.891 E/E’ 7.75(5.98，8.73) 7.00(5.70，8.50) -1.532 0.126 1 mmHg=0.133 kPa。
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表 3 按年龄分层后两组患者超声心动图参数比较
Table 3. Echocardiographic parameters in patients stratified by age
X±S, M(P25, P75) 项目 CFR<2.5组(84例) CFR≥2.5组(256例) t/Z值 P值 年龄<60岁(151例) LAD/mm 32.91±3.95 34.22±4.29 -1.227 0.222 LVEDD/mm 44.20±10.05 44.47±8.49 -0.124 0.902 LVMI/(g/m2) 72.14(54.35，88.87) 71.78(61.52，71.78) -0.287 0.774 LVEF/% 70.50(61.75，73.25) 71.00(65.75，74.00) -0.466 0.641 E/E’ 7.00(5.60，8.80) 7.00(5.53，8.40) -0.471 0.638 年龄≥60岁(189例) LAD/mm 34.15±4.29 34.16±3.78 -0.021 0.983 LVEDD/mm 44.69±6.61 44.72±7.64 -0.026 0.979 LVMI/(g/m2) 73.27(64.57，73.27) 72.82(65.01，72.82) -0.308 0.758 LVEF/% 71.00(67.00，74.00) 71.00(67.75，75.00) -0.335 0.737 E/E’ 7.80(6.00，8.70) 7.00(5.80，8.80) -1.136 0.256
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表 4 两组患者冠脉狭窄情况比较
Table 4. The degree of coronary artery stenosis
例(%) 项目 CFR<2.5组(84例) CFR≥2.5组(256例) χ2值 P值 冠脉轻度狭窄 27(32.14) 39(15.23) 11.559 0.001 左前降支轻度狭窄 22(81.48) 31(79.49) 0.040 0.841
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表 5 非阻塞性冠脉胸痛患者CFR下降的影响因素
Table 5. The influencing factors of CFR decrease in patients with non-obstructive coronary chest pain
影响因素 β SE Wald P OR 95%CI 性别(女性) 0.406 0.316 1.654 0.198 1.501 0.808~2.789 年龄 0.081 0.018 20.608 < 0.010 1.085 1.047~1.124 BMI -0.066 0.044 2.214 0.137 0.936 0.859~1.021 收缩压 0.020 0.010 3.918 0.048 1.020 1.000~1.040 LDL-C -0.254 0.185 1.885 0.170 0.776 0.540~1.115 TG -0.277 0.170 2.647 0.104 0.758 0.543~1.058 冠脉轻度狭窄 0.691 0.323 4.576 0.032 1.995 1.060~3.755
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