Objective: To explore the relationship between coronary tortuosity and coronary microvascular disease (CMVD). Methods: Patients with typical angina symptoms and without serious coronary artery stenosis by coronary angiography were enrolled from June 2014 to December 2016, and CMVD was diagnosed by single photon emission tomography (SPECT). According to the SPECT results, patients were divided to the CMVD group and non-CMVD group. The baseline clinical characteristics, results of coronary angiography were compared between the two groups. The logistic analysis was used to analyze the relationship between coronary tortuosity and CMVD. Result: A total of 117 cases were enrolled, with 69 cases in the CMVD group and 48 cases in the non-CMVD group. No differences were found in gender distribution, age, hypertension, lipid abnormality, hyperuricemia and uses of statins between the two groups (all P>0.05). Incidence of diabetes (78.26%(54/69) vs. 35.42% (17/48) , P<0.05), hs-CRP ((4.29±2.15)mmol/L vs. (2.63±1.20)mmol/L, P<0.001), LDL-C ((2.98±0.96)mmol/L vs. (2.52±0.83)mmol/L, P=0.008) and homocysteine ((13.7±5.61)mmol/L vs. (11.5±4.38)mmol/L, P=0.025) levels were higher in the CMVD group than in the non-CMVD group. The data derived from echocardiographic examination were similar between the two groups. The Corrected TIMI frame counts were higher in the CMVD group than in non-CMVD group (LAD: 31.56±4.92 vs. 27.31±3.75, LCX: 29.47±4.18 vs. 26.62±3.19, RCA: 29.09±5.05 vs. 26.24±3.28, all P<0.001). The incidences of coronary atherosclerosis (76.81% (53/69) vs. 27.08% (13/48) , P<0.001) and coronary tortuosity ( (60.87% (42/69) vs. 33.33% (16/48) , P=0.035) were also higher in the CMVD group than in non-CMVD group. Logistic analysis found that coronary tortuosity (OR=6.111, 95%CI 2.707-13.794, P<0.001), diabetes (OR=6.565, 95%CI 2.883-14.948, P<0.001) and coronary atherosclerosis (OR=8.918, 95%CI 3.822-20.808, P<0.001) were independent risk factors of CMVD. Conclusion: Coronary tortuosity, diabetes and coronary atherosclerosis are related to CMVD in this patient cohort.
目的： 探讨冠状动脉迂曲与冠状动脉微血管病变（CMVD）之间的相关性。 方法： 选取2014年6月至2016年12月就诊河北医科大学第二医院心内科的有典型心绞痛症状，行冠状动脉造影未见冠状动脉明显狭窄患者。共入选患者117例，根据静息负荷心肌灌注显像结果，将患者分为CMVD组（69例）和非CMVD组（48例）。比较两组患者临床基线资料包括性别、年龄、既往病史、高敏C反应蛋白（hs-CRP）、B型利钠肽、肝肾功能及血脂等，超声心动图参数（左心室射血分数、室间隔和左心室后壁厚度、左心室舒张末内径等）及冠状动脉造影发现冠状动脉迂曲的情况。用logistic回归分析冠状动脉迂曲和CMVD发生的相关性。 结果： 两组患者在性别、年龄、高血压、血脂异常、高尿酸血症以及既往服用他汀类药物等差异均无统计学意义（P均>0.05），但CMVD组患者糖尿病发生率高于非CMVD组[78.26%（54/69）比35.42%（17/48），P<0.001]。CMVD组患者hs-CRP[（4.29±2.15）mmol/L比（2.63±1.20）mmol/L，P<0.001]、低密度脂蛋白胆固醇[（2.98±0.96）mmol/L比（2.52±0.83）mmol/L，P=0.008]和同型半胱氨酸水平[（13.7±5.61）mmol/L比（11.5±4.38）mmol/L，P=0.025]高于非CMVD组，两组患者总胆固醇和甘油三酯水平差异无统计学意义（P均>0.05）。两组患者超声心动图各参数差异无统计学意义（P均>0.05）。冠状动脉造影结果显示，CMVD组冠状动脉计帧数明显大于非CMVD组（左前降支：31.56±4.92比27.31±3.75，左回旋支：29.47±4.18比26.62±3.19，右冠状动脉：29.09±5.05比26.24±3.28，P均<0.001）。CMVD组患者冠状动脉迂曲[60.87%（42/69）比33.33%（16/48），P=0.035]和冠状动脉粥样硬化发生率[76.81%（53/69）比27.08%（13/48），P<0.001]均大于非CMVD组。logictic回归分析结显示，冠状动脉迂曲（OR=6.111，95%CI 2.707~13.794, P<0.001）、糖尿病（OR=6.565，95%CI 2.883~14.948，P<0.001）和冠状动脉粥样硬化（OR=8.918，95%CI 3.822~20.808,P<0.001）是CMVD发生的影响因素。 结论： 冠状动脉迂曲、糖尿病和冠状动脉粥样硬化是CMVD发生的影响因素，与CMVD的发生相关。.
Keywords: Coronary angiography; Coronary disease; Microvascular angina; Tomography, emission-computed, single-photon.