血流储备分数、血同型半胱氨酸在冠状动脉粥样硬化性心脏病中的临床应用

Clinical Application of Blood Flow Reserve Fraction and Blood Homocysteine in Coronary Atherosclerotic Heart Disease

摘要: 冠状动脉粥样硬化性心脏病(coronary heart disease, CAD)简称冠心病，是由于冠状动脉血管发生粥样硬化病变，导致管腔狭窄、痉挛或阻塞，从而导致心肌缺血、缺氧甚至坏死的心脏疾病，是动脉粥样硬化所致器官病变中最为常见的类型。冠状动脉疾病的传统危险因素包括吸烟、高血压、高脂血症、糖尿病和家族史，高同型半胱氨酸血症(hyperhomocysteinemia)已被认为是动脉粥样硬化和血管疾病的新的可改变危险因素。有研究表明HHcy血症可能促使机体冠状动脉微循环功能明显障碍。冠状动脉造影(coronary angiography, CAG)长期以来作为诊断冠心病的“金标准”，有助于人们通过影像技术方法对冠状动脉解剖学情况有直观的认识。血流储备分数(fractional flow reserve, FFR)技术作为一项有创性测定血管血流功能学指标，判断该血管所供给区域是否合并心肌缺血，合理指导冠心病的介入治疗有着重要的意义。有研究表明，HHCy血症能促使机体冠状动脉微循环功能明显障碍，从而导致FFR值的下降。现主要对冠心病患者中血清同型半胱氨酸及有创血流储备分数的研究进展及临床应用加以综述。

Abstract: Coronary atherosclerotic heart disease (CAD), referred to as coronary heart disease, is a heart disease in which atherosclerotic lesions occur in coronary arteries, leading to lumen narrowing, spasm, or obstruction, which results in myocardial ischemia, hypoxia, and even necrosis, and it is the most common type of atherosclerosis-induced organ disease. Traditional risk factors for coronary artery disease include smoking, hypertension, hyperlipidemia, diabetes mellitus, and family history. Hyperhomocysteinemia (HHcy) has been recognized as a new modifiable risk factor for atherosclerosis and vascular disease. It has been shown that HHcymia can contribute to significant dysfunction of the coronary microcirculation. Coronary angiography (CAG) has long been used as the “gold standard” for the diagnosis of coronary artery disease, which helps people visualize the anatomy of coronary arteries through imaging techniques. As an invasive measure of vascular flow function, fractional flow reserve (FFR) technique is of great significance in determining whether myocardial ischemia is combined in the area supplied by the vessel, and in rationally guiding the interventional therapy of coronary heart disease. HHCyemia can promote the function of coronary microcirculation to be significantly impaired. The research progress and clinical application of serum homocysteine and invasive flow reserve fraction in patients with coronary artery disease are summarized.