关键词: 冠状动脉疾病, 微血管性心绞痛, 平均冠状动脉近段内径, 冠状动脉迂曲, 冠状血管造影术, SYNTAX评分

Abstract: 　Background　Microvascular angina（MVA） is a disease that is easy to be ignored in the clinic.At present，there is no clear correlation evaluation index in routine coronary angiography，so it is unable to determine MVA quickly and accurately，and there is no relevant research at home and abroad.Objective　To explore the relationship between the luminal diameter and tortuosity of coronary artery and primary MVA.Methods　From January 2008 to September 2010，a total of 1 361 patients with angina pectoris and underwent coronary angiography were studied in Binzhou Medical University Hospital.The SYNCAX score of each patient was calculated according to the results of coronary angiography.The patients with a score greater than 0 were divided into coronary heart disease （CAD）group，and the patients with a score equal to 0 were divided into MVA group and non coronary heart disease （NCAD） group according clinical diagnosis.Baseline characteristics〔mean age，sex，past medical history，mean erythrocyte sedimentation rate（ESR），hemoglobin，neutrophil /lymphocyte ratio （NLR），blood lipid parameters，renal function parameters，bilirubin，mean luminal diameter of proximal coronary artery，and tortuosity of coronary artery〕 were compared across the three groups.Multivariate Logistic regression model was used to analyze the relationship of baseline characteristics with primary MVA.Results　There were significant differences between MVA group and CAD group in mean age，prevalence of hypertension，diabetes，and tortuosity of coronary artery，mean luminal diameter of proximal coronary artery，ESR，hemoglobin，NLR，TG，LDL-C，HDL-C，Cr and fasting blood glucose（P<0.05）.There were significant differences between MVA group and NCAD group in sex，prevalence of hypertension，diabetes，and tortuosity of coronary artery，smoking history distribution，mean age，mean luminal diameter of artery of proximal coronary，and hemoglobin （P<0.05）.Multivariate Logistic regression analysis showed that，compared with CAD group，mean luminal diameter of proximal coronary artery〔OR=8.279，95%CI（5.459，12.556），P<0.001〕，tortuosity of coronary artery〔OR=6.761，95%CI（3.755，12.174），P<0.001〕，hemoglobin〔OR=1.057，95%CI（1.031，1.083），P<0.001〕，female〔OR=3.019，95%CI（1.379，6.609），P=0.006〕，hypertension〔OR=0.194，95%CI（0.106，0.353），P<0.001〕，diabetes〔OR=0.105，95%CI（0.020，0.548），P=0.008〕and LDL-C 〔OR=0.617，95%CI（0.412，0.914），P=0.019〕 were independent influencing factors of primary MVA.Compared with the non-CAD group，mean luminal diameter of proximal coronary artery〔OR=9.246，95%CI （6.050，14.129），P<0.001〕 coronary artery tortuosity〔OR=4.105，95%CI（2.288，7.363），P<0.001〕，hemoglobin〔OR=1.042，95%CI （1.017，1.068），P=0.001〕，fasting blood glucose〔OR=1.214，95%CI（1.030，1.432），P=0.021〕，hypertension 〔OR=0.282，95%CI（0.154，0.517），P<0.001〕 and diabetes〔OR=0.138，95%CI（0.026，0.745），P=0.021〕 were independent influencing factors of primary MVA.Multivariate Logistic regression analysis showed that primary MVA〔OR=5.150，95%CI（3.366，7.881），P<0.001〕，female〔OR=1.460，95%CI（1.097，1.944），P=0.009〕，hypertension〔OR=1.564，95%CI（1.169，2.094），P=0.003〕 and elevated HDL-C〔OR=1.479，95%CI（1.067，2.050），P=0.019〕 were independent risk factors of tortuosity of coronary artery.Conclusion　Hypertension and diabetes are independently negatively correlated with primary MVA，while hemoglobin，mean luminal diameter of proximal coronary artery，and tortuosity of coronary artery are independently positively correlated with primary MVA.Increase of mean luminal diameter of proximal coronary artery and tortuosity of coronary artery may be secondary manifestations rather than the cause of primary MVA.

Key words: Coronary artery disease, Microvascular angina, Mean luminal diameter of proximal coronary artery, Tortuosity of coronary artery, Coronary angiography, SYNTAX score