作者：巩杨超，刘成峰，王西强，刘仲伟，姜馨

单位：

1.西安医学院2.延安大学3.陕西省人民医院心血管内科

Units：

1.Xi'an Medical University, Xi'an 710068, China2.Yan'an University, Yan'an 716000, China3.Cardiovascular Internal Medicine, Shaanxi Provincial People's Hospital, Xi'an 710068, China

关键词：

冠心病; 游离三碘甲状腺原氨酸; 斑块易损性; 多支病变;

Keywords：

Coronary disease; Free triiodothyronine; Plaque vulnerability; Multi-branch lesions

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.084

Funds：

陕西省重点研发计划项目（2019ZDLSF01-01-01）；

摘要：

目的 探讨游离三碘甲状腺原氨酸（FT3）水平与稳定性冠心病（SCAD）患者冠状动脉斑块易损性及多支病变的关系。方法 选取2021年11月至2022年6月于陕西省人民医院心血管内科住院治疗的SCAD患者86例为研究对象。收集患者的临床资料，采用血管内超声（IVUS）测量脂质池面积、纤维帽厚度、外弹力膜（EEM）面积、斑块面积、斑块负荷、斑块长度，根据冠状动脉造影（CAG）检查结果将冠状动脉病变分为单支病变和多支病变。FT3水平与脂质池面积的相关性分析采用Pearson相关分析；SCAD患者发生多支病变的影响因素分析采用单因素、多因素Logistic回归分析；采用ROC曲线分析FT3水平对SCAD患者发生多支病变的评估价值。结果 86例SCAD患者的FT3水平为2.68～6.05 pmol/L，中位数为4.54 pmol/L，根据FT3水平中位数将患者分为低FT3组（FT3≤4.54 pmol/L,n=43）和高FT3组（FT3>4.54 pmol/L,n=43）。两组脂质池面积、多支病变发生率比较，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，SCAD患者FT3水平与脂质池面积呈负相关（r=-0.707,P<0.001）。多因素Logistic回归分析结果显示，FT3水平、斑块长度是SCAD患者发生多支病变的独立影响因素（P<0.05）。ROC曲线分析结果显示，FT3水平评估SCAD患者发生多支病变的曲线下面积为0.720[95%CI(0.611,0.829),P<0.001]，Youden指数最大值为0.359，最佳截断值为4.65 pmol/L，灵敏度为71.2%，特异度为64.7%。结论 FT3水平与SCAD患者冠状动脉斑块易损性呈负相关，FT3水平是SCAD患者发生多支病变的独立影响因素，且对其具有中等评估价值。

Abstract：

Objective To investigate the correlation between free triiodothyronine (FT3) levels and coronaryatherosclerotic plaque vulnerability and multi-branch lesions in patients with stable coronary artery disease (SCAD) . MethodsA total of 86 patients with SCAD who were hospitalized in the Cardiovascular Internal Medicine of Shaanxi Provincial People'sHospital from November 2021 to June 2022 were selected as the research subjects. The clinical data of the patients were collected,the lipid pool area, plaque fibrous cap thickness, external elastic membrane (EEM) area, plaque area, plaque load and plaquelength were measured by intravascular ultrasound (IVUS) . Coronary artery lesions were divided into single-vessel lesion andmulti-branch lesions according to the coronary angiography (CAG) results. Pearson correlation analysis was used to analyze thecorrelation between FT3 level and lipid pool area. Univariate and multivariate Logistic regression analysis was used to explorethe influencing factors of multi-branch lesions in patients with SCAD. ROC curve was used to analysis the value of FT3 levelin evaluating multi-branch lesions in patients with SCAD. Results FT3 levels of 86 SCAD patients ranged from 2.68 to 6.05pmol/L, with a median of 4.54 pmol/L. Patients were divided into low FT3 group (FT3 ≤ 4.54 pmol/L, n=43) and high FT3 group (FT3> 4.54 pmol/L, n=43) according to the median FT3 level. There was statistically significant differences in the lipid pool area andthe incidence of multi-branch lesions between the two groups (P < 0.05) . The results of Pearson correlation analysis showed that FT3 level was negatively correlated with lipid pool area in SCAD patients (r=-0.707, P < 0.001) . Multivariate Logistic regressionanalysis showed that FT3 level and plaque length were the independent influencing factors of multi-branch lesions in patientswith SCAD (P < 0.05) . ROC curve analysis showed that the area under the curve of FT3 level in evaluating multi-branch lesionsin patients with SCAD was 0.720 [95%CI (0.611, 0.829) , P < 0.001] , the maximum value of the Youden index was 0.359, theoptimal cut-off value was 4.65 pmol/L, the sensitivity was 71.2%, and the specificity was 64.7%. Conclusion The FT3 levelis negatively correlated with coronary atherosclerotic plaque vulnerability in patients with SCAD. FT3 level is the independentinfluencing factor of multi-branch lesions in patients with SCAD and has medium evaluation value.

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