【摘要】：目的:觀察冠狀動脈迂曲(coronary tortuosity,CT)對冠狀動脈微循環(huán)(coronary microvascular)造成的影響,探討冠狀動脈迂曲與冠狀動脈微血管病變(coronary microvascular disease)之間的相關(guān)性。方法:選取2015年3月至2016年12月就診河北醫(yī)科大學(xué)第二醫(yī)院心內(nèi)五科的有典型心絞痛癥狀,行冠狀動脈造影未見冠脈明顯狹窄患者55例,對上述患者進(jìn)行冠狀動脈造影評價(jià),其中冠狀動脈迂曲的患者35例,非冠狀動脈迂曲的患者20例。同時收集所有上述住院患者資料包括患者主訴,現(xiàn)病史,性別,年齡,入院時的血壓,血尿酸,血脂,和左室射血分?jǐn)?shù)(LVEF),室壁運(yùn)動積分指數(shù),心臟大小,室壁厚度,BNP,心電圖檢查,家族史,糖尿病史,吸煙史,飲酒史,及有無心肌梗死或溶栓病史,患者基礎(chǔ)用藥情況。入選標(biāo)準(zhǔn):1.患者入院時有典型心絞痛癥狀2.行冠狀動脈脈造影檢查,冠脈未見明顯狹窄(冠狀動脈狹窄程度20%)3.行ECT檢查符合冠狀動脈微血管病變診斷標(biāo)準(zhǔn)排除標(biāo)準(zhǔn):1.冠狀動脈狹窄程度≥20%。2.影響室壁運(yùn)動或心臟射血功能的其它心肌疾病如應(yīng)激性心肌病(Takotsubo心肌病)、肥厚性心肌病、擴(kuò)張型心肌病、心肌炎、心肌致密化不全、心肌淀粉樣變性;3.嚴(yán)重心律失常如永久性心房纖顫、反復(fù)發(fā)作控制不佳的室性心律失常;4.心源性休克:SBP≤90mmHg持續(xù)30min以上,外周血管收縮的表現(xiàn)如面色蒼白、出汗、尿量減少(20ml/h)、脈搏細(xì)速或需要行主動脈內(nèi)氣囊反搏術(shù);5.嚴(yán)重的心臟瓣膜疾病包括心臟瓣膜中-重度狹窄或大量反流;6.高藥物過敏體質(zhì);7.需要機(jī)械通氣者;8.嚴(yán)重肝腎功能不全者(轉(zhuǎn)氨酶大于正常上限2倍,血肌酐2.5mg/dl);9.存在自身免疫性疾病、嚴(yán)重創(chuàng)傷、出血性疾病、合并腫瘤者;10、患者或患者家屬拒絕參加本項(xiàng)研究者。把上述納入標(biāo)準(zhǔn)的55例患者分別行單光子發(fā)射斷層掃描(SPECT)檢查,利用99m-锝為示蹤劑,分別記錄心肌靜息及負(fù)荷狀態(tài)下的節(jié)段性心肌灌注減低,灌注缺損及灌注再分布征象,以心肌血流反向分布作為冠狀動脈微血管病變的診斷標(biāo)準(zhǔn)[43 44]。最終得到冠狀動脈微血管病變患者33例,非冠狀動脈微血管病變患者22例,對以上兩組患者進(jìn)行統(tǒng)計(jì)學(xué)分析,研究冠狀動脈迂曲與冠狀動脈微血管病變的相關(guān)性,探討二者的病理生理學(xué)機(jī)制及診斷、治療。所有數(shù)據(jù)均應(yīng)用spss21.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,以在兩組進(jìn)行比較前應(yīng)用二元logistic回歸對上述數(shù)據(jù)進(jìn)行多因素分析,以p0.05為差別有統(tǒng)計(jì)學(xué)意義。結(jié)果:1兩組患者基線資料比較實(shí)驗(yàn)組與對照組在性別、年齡、吸煙方面差異無統(tǒng)計(jì)學(xué)意義(p0.05),實(shí)驗(yàn)組與對照組在高血壓、糖尿病、冠狀動脈粥樣硬化方面有統(tǒng)計(jì)學(xué)意義(p0.05)。2兩組患者生化指標(biāo)的比較實(shí)驗(yàn)組與對照組超敏反應(yīng)蛋白(2.20±1.63vs.4.15±4.29,p=0.000)、低密度脂蛋白(2.66±0.98vs.2.69±0.69,p=0.092)、甘油三酯(1.62±0.62vs.1.55±0.62,p=0.978)、總膽固醇(3.90±1.41vs.4.66±0.80,p=0.001)兩組患者在低密度脂蛋白、甘油三酯方面無統(tǒng)計(jì)學(xué)意義(p0.05);兩組患者在超敏反應(yīng)蛋白及總膽固醇方面有統(tǒng)計(jì)學(xué)意義(p0.05)。3兩組患者冠狀動脈迂曲參數(shù)的比較實(shí)驗(yàn)組與對照組行pearson卡方檢驗(yàn)(卡方值11.786df=1,p0.01)差別有統(tǒng)計(jì)學(xué)意義,見表1。4多因素logistic回歸分析結(jié)果二分類logictic回歸分析結(jié)果顯示,性別(or=0.28,p=0.029),冠狀動脈迂曲(or=62.59,p=0.004),高血壓(or=11.064,p=0.096),冠狀動脈粥樣硬化(or=15.405,p=0.043),超敏反應(yīng)蛋白(or=0.616,p=0.41),總膽固醇(or=0.202,p=0.010),糖尿病(or=8.320,p=0.43)。其中超敏反應(yīng)蛋白p0.05,or1差別無統(tǒng)計(jì)學(xué)意義,糖尿病or1為暴露因素但p0.05差別無統(tǒng)計(jì)學(xué)意義,超敏反應(yīng)蛋白p0.05但or1為非暴露因素,冠狀動脈迂曲、高血壓、性別、冠狀動脈粥樣硬化or1,p0.05差別有統(tǒng)計(jì)學(xué)意義。冠狀動脈迂曲為冠狀動脈微血管病變的獨(dú)立危險(xiǎn)因素�；颊叱鲈汉箅S訪3個月,觀察到對照組患者均未出現(xiàn)急性心肌梗死等mace事件,實(shí)驗(yàn)組院外2個月后有1例患者出現(xiàn)急性心肌梗死,兩組間差異無統(tǒng)計(jì)學(xué)意義(p0.05)結(jié)論:1冠狀動脈迂曲與冠狀動脈微循環(huán)相關(guān)2冠狀動脈迂曲可能影響冠狀動脈微循環(huán)障礙的產(chǎn)生和發(fā)展
[Abstract]:Objective: To observe the effect of coronary tortuosity (CT) on coronary microcirculation (coronary microvascular) and to explore the correlation between coronary artery tortuosity and coronary arteria microvascular disease (coronary microvascular disease). Methods: to choose the second hospital of Hebei Medical University from March 2015 to December 2016. There were 55 cases of typical angina pectoris in five families with coronary angiography and coronary arteriography, including 35 cases of coronary artery tortuosity and 20 cases of non coronary tortuosity. Age, blood pressure, blood uric acid, blood lipid, and left ventricular ejection fraction (LVEF), wall motion integral index, heart size, wall thickness, BNP, electrocardiogram, family history, diabetes history, smoking history, drinking history, and the history of myocardial infarction or thrombolytic, and the basic medication of patients. The standard of admission was 1. patients with typical angina symptoms 2 Coronary arteriography, no obvious stenosis (20% of coronary stenosis), 3. lines of ECT examination were in line with the criteria for diagnostic criteria for coronary arteriopathy: 1. other myocardial diseases, such as stress cardiomyopathy (Takotsubo cardiomyopathy), affecting ventricular wall movement or cardiac ejection, were more than 20%.2. in coronary artery stenosis. Hypertrophic cardiomyopathy, dilated cardiomyopathy, myocarditis, myocardial densification, myocardial amyloidosis, 3. severe arrhythmias such as permanent atrial fibrillation, recurrent ventricular arrhythmia, 4. cardiogenic shock: SBP < 90mmHg continuous 30min, and peripheral vasoconstriction such as paleness, sweating, and reduced urine (20ml/h), 5. severe heart valve diseases include moderate to severe stenosis or massive reflux, 6. high drug allergies, 7. mechanical ventilation, 8. severe liver and renal insufficiency (2 times the normal upper limit, serum creatinine 2.5mg/dl); 9. with autoimmune diseases, and severe invasive disease. 10, patients or patients' families refused to participate in the study. 55 patients who were included in the standard were examined by single photon emission tomography (SPECT), and 99m- technetium was used as a tracer to record decreased segmental myocardial perfusion, perfusion defect and reperfusion in cardiac resting and load state, respectively. 33 cases of coronary arteria microangiopathy and 22 cases of non coronary arteria microangiopathy were obtained by [43 44].. The correlation between coronary artery circuitous and coronary arteria microvascular lesions was investigated. To discuss the pathophysiological mechanism and diagnosis and treatment of the two, all the data were statistically treated with spss21.0 software to analyze the above data by two yuan logistic regression before the comparison of the two groups. The difference was statistically significant with the difference of P0.05. Results: the baseline data of the 1 two groups were compared with the control group. There was no significant difference in smoking, age and smoking (P0.05). There was a significant difference between the experimental group and the control group in hypertension, diabetes, and coronary atherosclerosis (P0.05) the biochemical indexes in group.2 two were compared with those in the control group (2.20 + 1.63vs.4.15 + 4.29, p=0.000), and low density lipoprotein (2.66 + 0.98vs.2.69). + 0.69, p=0.092), triglyceride (1.62 + 0.62vs.1.55 + 0.62, p=0.978), total cholesterol (3.90 + 1.41vs.4.66 + 0.80, p=0.001) two groups had no statistical significance in low density lipoprotein and triglyceride (P0.05). The two groups were statistically significant in hypersensitivity reaction protein and total cholesterol (P0.05) group.3 two. The comparison between the experimental group and the control group was statistically significant in the Pearson chi square test (11.786df=1, P0.01). See table 1.4 multiple factor Logistic regression analysis results and two classified LOGICTIC regression analysis results showed that sex (or=0.28, p=0.029), coronary artery circuitous (or=62.59, p=0.004), hypertension (or=11.064, p=0.096), coronary atherosclerosis Or=15.405 (p=0.043), hypersensitive reaction protein (or=0.616, p=0.41), total cholesterol (or=0.202, p=0.010), diabetes (or=8.320, p=0.43). There is no statistical difference between the hypersensitive reaction protein P0.05, or1, and the or1 is the exposure factor, but the P0.05 difference is not statistically significant. Or1, P0.05, coronary arteriosclerosis was an independent risk factor for coronary arteriopathy. The patients were followed up for 3 months after discharge. No acute myocardial infarction, such as mace events were observed in the control group, and 1 patients in the experimental group were anxious after 2 months. There was no statistically significant difference between the two groups (P0.05): 1 the correlation between coronary artery circuitous and coronary microcirculation 2 coronary arteries may affect the production and development of coronary microcirculation disorders.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.3

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