摘要
目的探讨低氧血症对我国西藏高原地区藏族冠状动脉慢血流(CSF)患者的影响。方法选择2018年3月至2019年3月山南市人民医院拟诊冠心病并行冠状动脉造影检查的藏族患者145例,入院后行血常规、血生化、血气分析及颈动脉彩色多普勒超声和超声心动图等检查,分析患者的一般情况、化验检查及冠状动脉造影特点。根据冠状动脉血流TIMI帧数(TFC)分为CSF组(TFC>27帧,67例)和对照组(TFC<27帧,78例)。利用logistic回归分析法分析影响CSF的危险因素,采用Pearson相关性分析动脉氧分压(PO2)水平与CSF患者TFC的相关性,绘制受试者工作特征(ROC)曲线,计算曲线下面积评估动脉PO2水平的预测效力。结果与对照组比较,CSF组患者的体质指数、糖尿病病史、吸烟、红细胞计数(RBC)、中性粒细胞与淋巴细胞比值(NLR)、红细胞分布宽度(RWD)、血红蛋白、胱抑素C、同型半胱氨酸、尿酸、高敏C反应蛋白、PO2、肺动脉压及颈动脉内膜中层厚度等差异均有统计学意义(均为P<0.05)。进一步行多因素logistic回归分析发现,吸烟(OR=2.974,P=0.001)、RBC、NLR和RWD升高(OR=4.093,P=0.010;OR=3.717,P=0.013;OR=2.233,P=0.017)和PO2降低(OR=2.693,P=0.004)是患者发生CSF的独立相关因素。将CSF患者的PO2水平与TFC进行Pearson相关性分析显示,PO2与TFC呈负相关(r=-0.497,P<0.001)。应用ROC曲线分析PO2水平对CSF的诊断价值,显示ROC曲线下面积为0.758(95%CI:0.661~0.856,P<0.001),当PO2界值为47.62 mmHg时,灵敏度89.5%,特异度79.6%。结论我国西藏高原地区低氧环境造成PO2降低,RBC增多、RWD升高等因素是CSF发生的重要危险因素,PO2水平对CSF具有一定的诊断价值。
Objective To investigate the effects of hypoxemia on coronary slow flow(CSF)in Tibetan patients in Tibet Plateau of China.Methods A total of 145 patients with coronary heart disease and underwent coronary angiography were selected in this study.Routine blood biochemistry and blood routine examination were performed after admission.Blood gas analysis,carotid color doppler ultrasound and cardiac ultrasound were used to further analyze the clinical characteristics of the patients.According to the coronary artery TIMI frame count(TFC),the patients was divided into CSF group(TFC>27 frames,67 cases)and control group(TFC<27 frames,78 cases).Logistic regression analysis was used to analyze the risk factors affecting CSF,and Pearson correlation was used to analyze the correlation between arterial PO2 level and TFC of CSF patients.Receiver operating characteristic(ROC)curve was drawn and the area under the curve was calculated to evaluate the predictive effect of arterial PO2 level.Results The comparison between CSF group and control group showed that body mass index(BMI),diabetes mellitus,smoking,red blood cell(RBC)count,neutrophil-lymphocyte ratio(NLR),red blood cell distribution width(RWD),haemoglobin(Hb),cystatin C(Cys-C),homocysteine(Hcy),uric acid(UA),hypersensitive C-reactive protein(hs-CRP),PO2,systolic pulmonary artery pressure(SPAP)and carotid intima-media thickness(CIMT)showed significant differences(all P<0.05).Further multivariate logistic regression analysis showed that smoking(OR=2.974,P=0.001)and RBC(OR=4.093,P=0.010),NLR(OR=3.717,P=0.013),RWD(OR=2.233,P=0.017),PO2(OR=2.693,P=0.004)were independent factors related to CSF in Tibetan patients.The correlation analysis between PO2 level and TFC in CSF group showed that the level of PO2 was negatively correlated with TFC(r=-0.497,P<0.001).The diagnostic value of PO2 level in patients with CSF was analyzed by ROC curve.The results showed that the area under ROC curve was 0.758(95%CI:0.661-0.856,P<0.001),the sensitivity was 89.5%and the specificity was 79.6%.Concl
作者
姚彦鹏
余小华
毛启兄
白马康珠
匡涛
梁有峰
Yao Yanpeng;Yu Xiaohua;Mao Qixiong;Baima Kangzhu;Kuang Tao;Liang Youfeng(Department of Cardiology,Shannan People s Hospital,Shannan 865000,China;Department of Cardiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中国心血管杂志》
2020年第2期146-150,共5页
Chinese Journal of Cardiovascular Medicine
