冠状动脉微循环阻力指数与传统心血管危险因素、 Hcy 及LP-PLA2 的相关性研究

Correlational study between index of microcirculatory resistance and coronary risk factors, homocysteine and lipoprotein associated phospholipase

摘要:

目的 探讨冠状动脉（冠脉）微循环障碍与LP-PLA2、Hcy 的相关性，以及其发生、发展的相关危 险因素。方法 63 例冠脉造影显示临界病变（狭窄40%~70%，且测量冠脉血流储备分数（FFR）>0.8），冠脉造 影术后测量前降支微循环阻力指数（IMR）值，以IMR 中位数为界分为IMR 正常组（<21.3 u）和IMR 升高组 （≥ 21.3 u）。分别记录和测定两组一般资料、相关生化指标、心血管疾病危险因素和血浆脂蛋白相关磷脂酶A2 （LP-PLA2）及同型半胱氨酸（Hcy）值，分析各指标与IMR 的关系。结果 63 例患者完成IMR 测量，IMR 范围： 6.5~42.3 u，中位数：21.3 u，与正常组比较，IMR 升高组HDL-C 和CFR 更低，而Hcy 和年龄较高（P <0.05）； IMR 值与Hcy、年龄及LDL-C（r =0.263）呈正相关（P <0.05），与CFR、HDL-C 呈负相关（P <0.05），与LPLPA2 水平无相关性（P >0.05）；多因素logistic 回归分析显示，年龄、Hcy 是IMR 升高的危险因素（P <0.05）， HDL-C、CFR 是IMR 升高的保护因素（P <0.05）。结论 ① FFR>0.8 的冠脉临界病变中，CFR 可作为评估冠 脉微循环的指标；②年龄和Hcy 是冠脉微循环障碍的危险因素，CFR 和HDL-C 是冠脉微循环的保护因素； ③年龄的增长、HDL-C 水平的降低和Hcy 可能参与冠脉微循环障碍的病理过程，导致IMR 值升高。

Abstract:

Objective To investigate clinical application and risk factors of index of microcirculatory resistance (IMR). Methods A total of 63 patients who were admitted into our hospital from August 2014 to April 2017 were involved in this study. All patients manifested with syndrome of myocardial ischemia but artery angiography suggested intermediate coronary arterial lesions (stenosis between 40%-70%) and FFR > 0.8. IMR and CFR was measured in target coronary artery and all patients were divided into 2 groups based on IMR: normal group in which patients had IMR < 21.3 u, and abnormal group in which patients had IMR > 21.3 u. The general and clinical information as well as levels of LP-PLA2 and Hcy were recorded. Results IMR ranged from 6.5 to 42.3 U. Patients in abnormal group showed decreased levels of HDL-C and CFR while increased levels of Hcy and age when compared with those in normal group [(1.21 ± 0.33) mmol/L vs (1.51 ± 0.33) mmol/L, P < 0.05; (2.20 ± 0.49) vs (2.71 ± 0.52), P < 0.05; (17.33 ± 3.67) μmol/L vs (14.74 ± 4.50) μmol/L, P < 0.05; (66.0 ± 9.67) yrs vs (58.0 ± 8.05) yrs, P < 0.05]. IMR was positively related to Hcy (r = 0.510, P < 0.05), age (r = 0.376, P < 0.05), and LDL-C (r = 0.263, P < 0.05) while negatively related to CFR (r = -0.520, P < 0.05) and HDL-C (r = -0.559, P < 0.05). No obvious correlation between IMR and LP-PLA2, male history, history of diabetes mellitus, smoking history, HbA1c, BMI, FBG, TC or TG was identified (P > 0.05). Multivariable logistic regression analysis showed that age [O^R = 1.090, (95% Cl: 1.012, 1.173), P = 0.023] and Hcy [O^R= 1.016, (95% Cl 0.841, 1.228), P = 0.027] were independent risk factors of IMR. HDL-C [O^R = 0.095, (95% Cl: 0.015, 0.614), P = 0.013] and CFR [O^R = 0.201, (95% Cl: 0.048, 0.848), P = 0.029] were independent protective factors of IMR. Conclusion CFR may be an indicator of coronary microcirculation dysfunction when FFR > 0.8; Hcy and age are independent risk factors while HDL-C levels and CFR are independent protective factors of coronary microcirculation dysfunction.