北京地区动脉粥样硬化性心脏病患者冠状动脉斑块稳定性影响因素研究

doi:10.12183/j.scjpm.2023.0838

摘要/Abstract

摘要： 目的探索北京地区冠状动脉粥样硬化性心脏病（简称冠心病）患者冠状动脉斑块稳定性影响因素。方法选取2019年1月至2021年12月首都医科大学附属北京世纪坛医院、火箭军特色医学中心及北京四季青医院收治的冠心病患者作为研究对象。根据光学相干断层成像技术（OCT）检查结果分析患者斑块特征并分为斑块不稳定组和斑块稳定组,采用单、多因素分析方法探讨冠心病患者冠状动脉斑块稳定性的影响因素。结果共纳入冠心病患者2 116例,其中男1 388例,女728例;年龄39~85岁,平均年龄（65.97±9.16）岁,≥60岁者1 429例,<60岁者687例;冠心病病程6~73个月,病程中位数为42个月。多因素logistic回归模型分析结果显示年龄（OR=7.178）、吸烟（OR=4.162）、血尿酸水平（OR=3.850）及低密度脂蛋白胆固醇（OR=3.228）、C反应蛋白（OR=4.577）、纤维蛋白原（OR=5.083）、同型半胱氨酸（OR=4.112）、胱抑素C水平（OR=3.124）、二级预防药物服用（OR=0.215）、低脂饮食干预（OR=0.274）、每周运动<3次（OR=3.983）、睡眠时间<6 h（OR=3.838）均为冠心病患者冠状动脉斑块稳定性的影响因素。结论冠心病患者冠状动脉斑块稳定性受到年龄、吸烟、血尿酸水平、二级预防药物服用状况、低脂饮食干预状况、运动状况、睡眠状况、血浆低密度脂蛋白、C反应蛋白、纤维蛋白原、同型半胱氨酸、胱抑素C水平等的影响。

关键词: 冠心病, 冠状动脉, 斑块, 稳定性, 影响因素

Abstract: Objective To investigate the influencing factors of coronary plaque stability in patients with coronary heart disease in Beijing. Methods The study subjects were patients with coronary heart disease admitted to Beijing Shijitan Hospital, Rocket Force Characteristic Medical Center, and Beijing Sijiqing Hospital from January 2019 to December 2021. According to the results of optical coherence tomography （OCT） examination, patients were divided into plaque unstable group and plaque stable group. Univariate and multivariate analysis methods were used to explore the influencing factors of coronary plaque stability in patients with coronary heart disease. Results A total of 2 116 patients with coronary heart disease were included, including 1 388 males and 728 females; aged 39-85 years, with an average age of （65.97 ± 9.16） years. There were 1 429 patients ≥ 60 years old and 687 patients<60 years old. The duration of coronary heart disease was 6-73 months, with a median duration of 42 months. The results of multivariate logistic regression analysis showed that age （OR=7.178）, smoking （OR=4.162）, blood uric acid level （OR=3.850）, LDL-C （OR=3.228）, C-reactive protein （OR=4.577）, fibrinogen （OR=5.083）, homocysteine （OR=4.112）, cystatin C level （OR=3.124）, secondary preventive drug use （OR=0.215）, low-fat diet intervention （OR=0.274）, weekly exercise<3 times （OR=3.983）, and sleep time<6 h （OR=3.838） were influencing factors for coronary plaque stability in patients with coronary heart disease. Conclusion The coronary plaque stability in patients with coronary heart disease is affected by their age, smoking, blood uric acid level, secondary preventive drug use, low-fat diet intervention, exercise, sleep, plasma low-density lipoprotein, C-reactive protein, fibrinogen, homocysteine, and cystatin C levels.

Key words: Coronary heart disease, Coronary artery, Plaque, Stability, Influencing factor

中图分类号:

R541.4

张楠, 张鸿丽, 刘小靖, 徐向向, 李俊新. 北京地区动脉粥样硬化性心脏病患者冠状动脉斑块稳定性影响因素研究[J]. 华南预防医学, 2023, 49(7): 838-842.

ZHANG Nan, ZHANG Hongli, LIU Xiaojing, XU Xiangxiang, LI Junxin. Study on influencing factors of coronary plaque stability in patients with coronary heart disease in Beijing[J]. South China Journal of Preventive Medicine, 2023, 49(7): 838-842.

参考文献

[1] Nicholls SJ, Kataoka Y, Nissen SE, et al.Effect of evolocumab on coronary plaque phenotype and burden in statin-treated patients following myocardial infarction[J]. JACC Cardiovasc Imaging, 2022, 15(7):1308-1321.
[2] Wallentin L, Eriksson N, Olszowka M, et al.Plasma proteins associated with cardiovascular death in patients with chronic coronary heart disease: A retrospective study[J]. PLoS Med, 2021, 8(1):e1003513.
[3] Vergallo R, Porto I, D'Amario D, et al. Coronary atherosclerotic phenotype and plaque healing in patients with recurrent acute coronary syndromes compared with patients with long-term clinical stability: An in vivo optical coherence tomography study[J]. JAMA Cardiol, 2019, 4(4):321-329.
[4] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 慢性稳定性心绞痛诊断与治疗指南[J]. 中华心血管病杂志,2007,35(3):195-206.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J]. 中华心血管病杂志,2007,35(4):295-304.
[6] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会. 2010年急性ST段抬高型心肌梗死诊断和治疗指南[J]. 中国实用乡村医生杂志,2013,20(4):9-16.
[7] 冯晔娇,林平,赵振娟,等.急性冠脉综合征患者生活事件与冠状动脉粥样硬化斑块稳定性的相关性研究:抑郁的中介作用[J].中国全科医学,2020,23(29):3667-3674.
[8] 王玮琪,林平,王旖旎,等.膳食营养素对冠心病患者冠状动脉斑块稳定性的影响研究[J].中国全科医学,2020,23(34):4349-4355.
[9] 陈运起,郑伟民.老年冠状动脉不同病变程度患者治疗后斑块稳定性的临床分析[J].中华老年心脑血管病杂志,2020,22(11):1209-1211.
[10] 郑琦,段继坤,杨帆,等.应用光学相干断层扫描技术探究点状钙化特征与斑块稳定性的关系[J].临床心血管病杂志,2021,37(12):1117-1120.
[11] Koay YC, Chen YC, Wali JA,et al.Plasma levels of trimethylamine-N-oxide can be increased with ‘healthy' and ‘unhealthy' diets and do not correlate with the extent of atherosclerosis but with plaque instability[J]. Cardiovasc Res, 2021, 117(2):435-449.
[12] 秦慧兵,张保朝,张小林,等.血清MCP-1、HMGB1、APN、oxLDL水平与老年脑梗死病情及颈动脉粥样硬化关系[J].华南预防医学,2020,46(1):72-75.
[13] Niccoli G.Air pollution and coronary plaque vulnerability and instability: An optical coherence tomography study[J]. JACC Cardiovasc Imaging, 2022, 15(2):325-342.
[14] Okada K, Hibi K, Honda Y, et al.Association between abdominal fat distribution and coronary plaque instability in patients with acute coronary syndrome[J]. Nutr Metab Cardiovasc Dis, 2020, 30(7):1169-1178.
[15] Galiuto L, Leccisotti L, Locorotondo G, et al.Coronary plaque instability assessed by positron emission tomography and optical coherence tomography[J]. Ann Nucl Med, 2021, 35(10):1136-1146.
[16] 蒋薇,闵祖良,刘杰杰,等. 老年冠状动脉粥样硬化性心脏病患者TBIL、HCY、Hs-CRP、UA水平与冠状动脉不稳定性斑块形成风险的关系[J]. 中国急救复苏与灾害医学杂志,2022,17(3):304-308.
[17] 张倩,袁静,徐小英,等. 血清TBIL、 Hcy、 hs-CRP、 UA水平与老年冠心病病人冠状动脉不稳定性斑块形成间的关系[J]. 实用老年医学,2022,36(1):77-80.
[18] 毛海慧,刘亚斌,魏渠成,等. 血清铁蛋白及高敏C反应蛋白与冠状动脉粥样硬化斑块稳定性的关系[J]. 心电与循环,2020,39(6):560-565.
[19] 白莎,杨爽,郝春艳. 血尿酸与动脉粥样硬化斑块相关性的研究进展[J]. 广西医学,2021,43(4):495-497,505.
[20] 吴长明,陈群,沈丽丽,等. 血清胆红素、尿酸水平与冠状动脉易损斑块的相关性分析[J]. 中国现代医生,2011,49(22):59-60,81.
[21] 周靖. 影响颈动脉粥样硬化患者斑块稳定性的危险因素分析[J]. 现代医学与健康研究(电子版),2022,6(3):115-117.
[22] 韩沙如拉,杨志甫,袁瑞,等. 影响急性脑梗死患者颈动脉斑块稳定性的危险因素分析[J]. 包头医学院学报,2022,38(6):7-11.