关键词: 冠心病, 斑块稳定性, 膳食营养素, 光学相干断层成像技术, 影响因素分析

Abstract: Background　Coronary artery disease（CAD） is a major chronic disease threatening Chinese residents' health. Rational intake of dietary nutrients is of vital importance to the prevention and treatment of CAD. Recently，robust evidence has indicated that coronary atherosclerotic vulnerable plaque is associated with an increased risk of disease progression. However，to the best of our knowledge，no previous study has evaluated the impact of dietary factors on coronary plaque vulnerability. Objective　To investigate dietary nutrients intake and its association with coronary plaque vulnerability in CAD patients. Methods　A total of 314 patients who were diagnosed with CAD by coronary angiography from September 2018 to March 2019 were invited to complete the Semi-Quantitative Food Frequency Questionnaire（SQFFQ）. The Nutrition Calculator V2.7.3 was used to calculate daily intakes of 22 nutrients. Vulnerability of the coronary plaque was assessed by optical coherence tomography. Results　The average intake of dietary fiber，folate，vitamin C and sodium in CAD patients was（17.21±6.59） g/d，（94.07±50.88）μg/d，（142.54±62.39）mg/d and（4.00±1.16）g/d，respectively. Logistic regression analysis indicated that high vitamin C intake was associated with reduced risk of lipid plaque〔OR=0.994，95%CI（0.990，0.998），P=0.003〕，thin-cap fibroatheroma（TCFA）〔OR=0.988，95%CI（0.981，0.994），P<0.001〕 and thrombus〔OR=0.988，95%CI（0.983，0.994），P<0.001〕；high dietary fiber intake was associated with reduced risk of macrophage infiltration〔OR= 0.955，95%CI（0.920，0.992），P=0.016〕and TCFA〔OR=0.934，95%CI（0.900，0.970），P<0.001〕；high folate intake was associated with reduced TCFA〔OR=0.986，95%CI（0.978，0.993），P<0.001〕 and plaque rupture〔OR=0.991，95%CI（0.985，0.997），P=0.005〕. However，high sodium intake was associated with increased risk of lipid plaque〔OR=1.597，95%CI（1.243，2.052），P<0.001〕，TCFA〔OR=1.617，95%CI（1.258，2.079），P<0.001〕，plaque rupture〔OR=1.359，95%CI（1.082，1.708），P=0.008〕 and thrombus〔OR=1.476，95%CI（1.077，2.022），P=0.015〕. Conclusion　In these CAD patients，the intake of dietary fiber and vitamin was insufficient，but sodium intake exceeded the standard seriously，indicating that their dietary composition is unreasonable. The intakes of vitamin C，dietary fiber，folate and sodium are closely associated with coronary plaque vulnerability. Therefore，dietary and nutrition guidance may be a good intervention to prevent the development and delay the progression of CAD.

Key words: Coronary artery disease, Plaque vulnerability, Dietary nutrients, Optical coherence tomography, Root cause analysis