2020 年第 3 期 第 15 卷

基于光学相干断层扫描评价吸烟对老年患者冠状动脉斑块的影响

Effect of smoking on coronary artery plaque measured by optical coherence tomography in elderly patients

作者：姚威1陈妍2刘泽森3张婷玉1孟康1

英文作者：

单位：1首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所100029；2天津医科大学总医院心内科300052；3首都医科大学附属北京潞河医院心内科101100

英文单位：

关键词：冠状动脉粥样硬化性心脏病；吸烟；光学相干断层扫描；冠状动脉斑块

英文关键词：

• 摘要：

• 【摘要】目的    应用光学相干断层扫描（OCT）探讨吸烟对于老年患者冠状动脉粥样硬化斑块的影响。方法    选取2015年1月至2017年11月因胸痛就诊于首都医科大学附属北京安贞医院的老年患者62例。根据是否吸烟分为吸烟组（20例）和非吸烟组（42例）。以冠状动脉造影及OCT影像检查评价冠状动脉斑块特征，进行组间比较。结果    吸烟组患者有更高的空腹血糖、血尿酸、同型半胱氨酸水平；吸烟组脂质斑块、易损斑块比例更高［60.0%（12/20）比21.4%（9/42）、40.0%（8/20）比11.9%（5/42）］，纤维帽厚度更薄［（92±36）μm比（124±46）μm］，且有更多的巨噬细胞浸润［65.0%（13/20）比26.2%（11/42）］，巨噬细胞多分布于距离管腔较近的位置（＜50 μm）［45.0%（9/20）比7.1%（3/42）］，与非吸烟组比较差异均有统计学意义（均P＜0.05）。结论    吸烟者冠状动脉斑块稳定性欠佳。

• 【Abstract】Objective    To investigate the effect of smoking on coronary artery plaque measured by optical coherence tomography（OCT） in elderly patients. Methods    A total of 62 elderly patients with chest pain who visited Beijing Anzhen Hospital, Capital Medical University from January 2015 to November 2017 were enrolled. The patients were divided into smoking group（20 cases） and non-smoking group（42 cases）. Characteristics of coronary artery plaques were measured by coronary angiography and OCT. Results    Compared with non-smokers, levels of fasting blood glucose, blood uric acid and homocysteine were higher, rates of lipid plaque and vulnerable plaque were higher［60.0%（12/20） vs 21.4%（9/42）, 40.0%（8/20） vs 11.9%（5/42）］, fibrous cap of plaque was thinner［（92±36）μm vs （124±46）μm］ in the smoking group（all P＜0.05）. In addition, smokers were more likely to have macrophage infiltration［65.0%（13/20） vs 26.2%（11/42）］ and macrophage cells were gathered closer to the surface of lumen（＜50 μm）［45.0%（9/20） vs 7.1%（3/42）］（both P＜0.05）. Conclusion    There is a trend of poor stability of coronary plaques in current smokers.