女性慢性完全闭塞病变患者的临床和影像学特点

张 剑; 韩雅玲; 荆全民; 王效增; 马颖艳; 王 耿; 刘海伟

摘要: 目的:通过同期男女冠心病慢性完全闭塞（CTO）患者的比较分析女性CTO病变的临床和影像学特点。方法：1989年6月~2005年12月诊断冠心病的患者，入院后行常规实验室生化检查及X线胸片、心脏超声等临床辅助检查，并行冠状动脉造影及左室造影检查。入选有1支或1支以上CTO病变的患者进入本研究，按性别分为女性组（n=334）和男性组(n=1 382)。结果：与男性组比较，在临床资料方面，女性组年龄大［(64±8)岁 vs.(60±11)岁，P<0.01］，高血压病比例高(65.6% vs. 53.3%,P<0.01)，而女性组体质量低［(65±10)kg vs.(75±10)kg,P<0.01)、吸烟比例低(11.1% vs.46.7%,P<0.01)、饮酒比例低(2.4% vs. 26.6%,P<0.01)、心肌梗死比例低(38.0% vs. 52.7%，P<0.01)，在心绞痛、心律失常、心力衰竭、糖尿病、脑血管病的比例均无统计学差异。实验室检查资料方面，女性组三酰甘油（TG）高［(2.3±2.0)mmol/L vs.(2.0±1.5)mmol/L,P<0.01)、总胆固醇（TC）高［(5.4±1.3)mmol/L vs.(5.0±2.4)mmol/L,P<0.01］、高密度脂蛋白胆固醇（HDL-C）高［(1.4±0.5)mmol/L vs.(1.3±0.4)mmol/L,P<0.01 ］、空腹血糖（FPG）高［(6.1±1.7)mmol/L vs.(5.9±1.7)mmol/L，P<0.05］和纤维蛋白原（Fib）水平高［(4.1±1.3)g/L vs.(3.9±1.4)g/L,P<0.05 ］，而尿素氮低（BUN）［(5.6±2.4)mmol/L vs.(5.9±2.0)mmol/L,P<0.05］、血清肌酐（Cr）低［(81±31)μmol/L vs.(95±33)μmol/L,P<0.01］。心脏超声左室内径小［ (48±6)mm vs.(51±6)mm,P<0.01］，左室射血分数（LVEF）偏高［(0.64±0.10) vs.(0.63±0.11),P<0.05］。冠状动脉造影资料比较显示，两组在冠状动脉优势型、单支血管病变、多支血管病变、CTO血管分布、侧支循环0级、Ⅰ级、Ⅱ级、Ⅲ级比例及造影并发症发生中均无统计学差异。结论：女性CTO患者中代谢指标异常较为突出，且年龄较高，但女性CTO患者病变复杂程度与男性并无显著差异。

Abstract: AIM:To analyze the characteristics of female patients with chronic total occlusion (CTO) lesions by comparing clinical and angiographic features of male and female CTO patients undergoing coronary angiography. METHODS: A total of 1 716 CTO patients confirmed by coronary angiography between June 1989 and December 2005 were divided into two groups according to gender and data were retrospectively analyzed. After admission, patients underwent routine laboratory tests, X-rays, ultrasound cardiography, and coronary and left ventricle angiography. Coronary stenosis >50% was taken as a positive result, and coronary stenosis 100% or close to 100% with TIMI blood flow 0-1 grade as CTO lesions. RESULTS: Of the 1 716 CTO patients confirmed by coronary angiography, 334 were female (19.5%) and 1 382 male (80.5%). The mean age in the group of females was higher than in the male group ［(64±8) years vs. (60±11) years, P<0.01］. The rates of hypertension (65.6% vs. 53.3%) in the female group was higher than in the group of males, but the body mass index ［(65±10) kg vs. (75±10) kg, P<0.01］, smoking rates (11.1% vs. 46.7%, P<0.01), alcohol consumption (2.4% vs. 26.6%, P<0.01) and old myocardial infarction (38.0% vs. 52.7%, P<0.01) in the female group were lower than those in the group of males. The mean levels of triglycerides (TG) ［(2.3±2.0) mmol/L vs. (2.0±1.5) mmol/L, P<0.01］, total cholesterol (TC) ［(5.4±1.3) mmol/L vs. (5.0±2.4) mmol/L, P<0.01］, high-density lipoprotein cholesterol (HDL-C) ［(1.4±0.5) mmol/L vs. (1.3±0.4) mmol/L, P<0.01］, fasting plasma glucose (FPG) ［(6.1±1.7) mmol/L vs. (5.9±1.7) mmol/L, P<0.05］, fibrinogen (Fib) ［(4.1±1.3) g/L vs. (3.9±1.4) g/L, P<0.05］ and ejection fraction (EF) value ［(0.64±0.10) vs. (0.63±0.11), P<0.05］ in the group of females were higher than in the group of males, but mean levels of BUN ［(5.6±2.4) mmol/L vs. (5.9±2.0) mmol/L, P<0.05］ and creatinine (Cr) ［(81±31) μmol/L vs. (95±33) μmol/L, P<0.01］ in the female group were lower than those in the male group. No significant differences were observed between groups in rates of type of coronary dominance, single-vessel disease, multivessel disease, CTO distribution (LM, LAD, LCX or RCA) and collateral circulation, and angiographic complications. CONCLUSION: The rate of hypertension and some metabolic indexes including TG, TC, FPG and Fib in female CTO patients are higher than those in CTO patients. CTO female patients are older in age but their CTO is not more complex than in male CTO patients.

女性慢性完全闭塞病变患者的临床和影像学特点

Clinical and angiographic characteristics of chronic total occlusion in female patients