冠状动脉迂曲的临床特点与冠状动脉粥样硬化相关性分析

Clinical Features of Coronary Tortuous and the Correlation Analysis between Coronary Tortuous and Coronary Atherosclerosis

摘要: 目的：探究冠状动脉迂曲(CAT)患者的临床特点、危险因素，并研究其与冠状动脉粥样硬化的相关性。方法：采用回顾性方法选取2020年6月~2023年2月于青岛大学附属医院心内科性行冠状动脉造影术的患者，按照CAT的标准定义将患者分为CAT组与对照组，统计两组患者的基本临床特征，包括性别、年龄、体重、身高、BMI、既往史(高血压病史、糖尿病病史、吸烟史)、实验室指标(低密度脂蛋白、高密度脂蛋白、甘油三酯、脂蛋白A、空腹血糖、糖化血红蛋白、尿酸)，通过统计学方法比较两组之间的差异，并运用logistic回归分析探讨CAT的独立危险因素；分析冠状动脉是否迂曲以及迂曲程度与冠状动脉狭窄严重程度的相关性。结果：CAT组在女性比例(54.84% vs 20.59%, P = 0.000)、高血压患病率(83.87% vs 57.35%, P = 0.001)、收缩压(141.94 ± 17.55 vs 133.90 ± 14.58, P = 0.005)、舒张压(79.90 ± 9.51 vs 76.41 ± 9.50, P = 0.038)、高密度脂蛋白(1.37 ± 0.27 vs 1.26 ± 0.28, P = 0.019)显著高于对照组，而身高(163.92 ± 8.11 vs 169.13 ± 7.80, P = 0.000)、吸烟比例(22.58% vs 52.94%, P = 0.000)显著低于对照组，二元logistic回归分析结果表明高血压是CAT的独立危险因素(OR 3.420, 95% CI (1.401~8.353), P = 0.007)。CAT最常累及左前降支，其次为左回旋支，右冠状动脉合并CAT最为少见，CAT累及双支较为常见，累及三支罕见。冠状动脉是否迂曲(P = 0.708)及迂曲的严重程度(P = 0.452)与冠状动脉狭窄的严重程度之间无明确关联。CAT组与非迂曲组在冠状动脉严重狭窄比例、合并心肌梗死比例无统计学差异。结论：性别、身高、血压、吸烟、高密度脂蛋白可能与冠状动脉迂曲发生相关；而高血压是CAT的独立危险因素；CAT与冠状动脉狭窄严重程度之间无明显关系。

Abstract: Objective: To explore the clinical characteristics and risk factors of patients with coronary artery tortuosity (CAT), and to study its correlation with coronary atherosclerosis. Methods: Patients who underwent coronary angiography in the Department of Cardiology, Affiliated Hospital of Qingdao University from June 2020 to February 2023 were selected retrospectively. According to the stand-ard definition of CAT, the patients were divided into CAT group and control group, and the basic clinical characteristics of the patients in the two groups were analyzed. Gender, age, weight, height, BMI, previous history (history of hypertension, diabetes, smoking), laboratory indicators (low-density lipoprotein, high-density lipoprotein, triglyceride, lipoprotein A, fasting blood glucose, glycosylated hemoglobin, uric acid) were included. The differences between the two groups were compared by statistical methods, and the independent risk factors of CAT were analyzed by logistic regression analysis. The correlation between whether the coronary artery is tortuous or the degree of tortuous and the severity of coronary artery stenosis was analyzed. Results: In CAT group, the ra-tio of female (54.84% vs 20.59%, P = 0.000), prevalence of hypertension (83.87% vs 57.35%, P = 0.001), systolic blood pressure (141.94 ± 17.55 vs 133.90 ± 14.58, P = 0.005), diastolic blood pres-sure (79.90 ± 9.51 vs 76.41 ± 9.50, P = 0.038), high-density lipoprotein (1.37 ± 0.27 vs 1.26 ± 0.28, P = 0.019) were significantly higher than those in the control group. Height (163.92 ± 8.11 vs 169.13 ± 7.80, P = 0.000) and the proportion of smoking (22.58% vs 52.94%, P = 0.000) were sig-nificantly lower than those of the control group. The results of binary logistic regression analysis showed that hypertension was an independent risk factor for CAT (OR 3.420, 95% CI (1.401~8.353), P = 0.007). LCX was most frequently involved in CAT, followed by LCX. CAT combined with RCA was the rarest. CAT involved two branches was more common, and CAT involved three branches was ra-re. There was no clear association between coronary artery tortuosity (P = 0.708) or severity of tor-tuosity (P = 0.452) and severity of coronary artery stenosis. There was no significant difference in the proportion of severe coronary artery stenosis and myocardial infarction between CAT group and non-tortuous group. Conclusion: Gender, height, blood pressure, smoking and high-density lipopro-tein may be related to the occurrence of coronary artery tortuosity. Hypertension was an inde-pendent risk factor for CAT. There was no significant relationship between CAT and the severity of coronary artery stenosis.