2025 年第 10 期 第 20 卷

早发冠心病患者罪犯病变处巨噬细胞聚集的影响因素分析

Influencing factors of macrophage accumulation in culprit lesions in patients with premature coronary atherosclerotic heart disease

作者：侯方杰1耿强1丁允淇2马颖1许耀文1骆效青1高杰1孙晓薇1宋慧1张康1王正忠1邵一兵1

英文作者：Hou Fangjie1， Geng Qiang1， Ding Yunqi2， Ma Ying1， Xu Yaowen1， Luo Xiaoqing1， Gao Jie1 Sun Xiaowei1， Song Hui1， Zhang Kang1， Wang Zhengzhong1 Shao Yibing1

单位：1康复大学青岛医院山东省青岛市市立医院心内科，青岛266011；2北京理工大学珠海学院，珠海519088

英文单位：1Department of Cardiology， Qingdao Hospital of University of Health and Rehabilitation Sciences Qingdao Municipal Hospital Shandong Province Qingdao 266011， China； 2Beijing Institute of Technology Zhuhai Zhuhai 519088 China

关键词：早发冠心病；巨噬细胞聚集；光学相干断层成像

英文关键词：Prematurecoronaryatheroscleroticheartdisease;Macrophageaccumulation;Opticalcoherencetomography

• 摘要：

• 目的 探讨早发冠心病（冠状动脉粥样硬化性心脏病）患者罪犯病变处巨噬细胞聚集的影响因素。方法 回顾性纳入2021年10月至2024年10月于山东省青岛市市立医院接受冠状动脉造影及光学相干断层成像（OCT）检查的143例早发冠心病患者(≤45岁)。采用单因素和多因素Logistic回归方法分析早发冠心病患者OCT下巨噬细胞聚集的独立预测因子。结果 本研究纳入的143例接受OCT检查的早发冠心病患者中罪犯病变处巨噬细胞聚集83例（58.0%）。罪犯病变处巨噬细胞聚集的正性影响因素包括吸烟（P=0.002）、高血压病（P＜0.001）、高胆固醇血症（P=0.003），负性影响因素包括服用阿司匹林（P=0.024）、他汀类药物（P=0.007）。将单因素分析中P＜0.1的因素纳入多因素分析。调整其他危险因素后，高血压病（比值比=4.555，95%置信区间：2.058～10.084，P＜0.001）、吸烟（比值比=3.479，95%置信区间：1.537～7.873，P=0.003）和高胆固醇血症（比值比=5.364，95%置信区间：1.634～17.608，P=0.006）仍然是早发冠心病患者巨噬细胞聚集的独立预测因子，而糖尿病虽差异无统计学意义，但有相关趋势（P=0.057）。结论 高血压病、吸烟及高胆固醇血症均是早发冠心病患者罪犯病变处巨噬细胞聚集的独立预测因子。

• Objective To investigate the influencing factors of macrophage accumulation in culprit lesions in patients with premature coronary atherosclerotic heart disease. Methods A total of 143 patients (≤45 years old) with premature coronary atherosclerotic heart disease who underwent coronary angiography and optical coherence tomography (OCT) in Qingdao Municipal Hospital, Shandong Province from October 2021 to October 2024 were retrospectively enrolled. Univariate and multivariate Logistic regression methods  were used to analyze the independent predictors of macrophage accumulation under OCT in patients with premature coronary atherosclerotic heart disease. Results Among 143 patients with premature coronary atherosclerotic heart disease who underwent OCT examination, macrophage accumulation was found in 83 (58.0%) culprit lesions. The positive influencing factors of macrophage aggregation in culprits lesions included smoking (P=0.002), hypertension (P＜0.001) and hypercholesterolemia (P=0.003), and the negative influencing factors included aspirin (P=0.024) and statins (P=0.007). Factors with P＜0.1 in univariate analysis were included in multivariate analysis. After adjusting for other risk factors, hypertension(odds ratio=4.555, 95% confidence interval: 2.058-10.084, P＜0.001), smoking (odds ratio=3.479，95% confidence interval: 1.537-7.873, P=0.003) and hypercholesterolemia(odds ratio=5.364，95% confidence interval:1.634-17.608, P=0.006) were still independent predictors of macrophage accumulation in patients with premature coronary atherosclerotic heart disease, while diabetes had a related trend although the difference was not statistically significant(P=0.057). Conclusion Hypertension, smoking and hypercholesterolemia are independent predictors of macrophage accumulation in culprit lesions in patients with premature coronary atherosclerotic heart disease.