Exploring the clinical value of pulmonary function assessment in coronary heart disease and the severity of coronary artery lesions
探讨肺功能评估在冠心病及冠状动脉病变严重程度中的临床价值

摘要

目的 探讨肺功能与冠心病（coronary artery disease, CAD）患者及冠状动脉病变严重程度的相关性，识别新的、简便的风险标志物。方法 随机选取我院行冠状动脉造影的患者279例，分为对照组156例、CAD组123例。依据Gensini评分系统对冠状动脉狭窄严重情况进行评估。入选研究对象行血常规、心肌酶、血脂分析检测及肺功能、超声心动图检查。采用Logistic回归分析CAD的相关危险因素。结果 CAD组用力肺活量（forced vital capacity, FVC）明显低于对照组[2.72（2.00, 3.40）L vs 3.13（2.40, 3.80）L]，CAD组第1秒用力呼气容积（forced expiratory volume in one second, FEV1）明显低于对照组[2.05（1.40, 2.60）L/s vs 2.36（1.70, 2.90）L/s]。多因素Logistic回归分析：FVC下降与CAD存在相关性，FVC下降是CAD发病的危险因素（OR=3.88，95%CI: 1.270-11.876，P=0.017），Spearman相关性分析：Gensini评分与高血压（r=0.263，P＜0.001）、2型糖尿病（r=0.233，P＜0.001）、吸烟史（r=0.265，P＜0.001）、饮酒史（r=0.322，P＜0.001）、甘油三酯（triglyceride，TG）（r=0.308，P＜0.001）呈正相关；与性别（r= -0.164，P=0.006）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-C）（r= -0.135，P=0.033）、FVC（r= -0.223，P＜0.001）、FEV1（r= -0.313，P＜0.001）呈负相关（P均＜0.05）；通过调整性别、高血压、2型糖尿病、吸烟史、饮酒史、TG、HDL-C因数后，偏相关性分析显示FVC与Gensini评分呈负相关（r=-0.301，P＜0.001），最大自主通气量与Gensini评分呈负相关（r=-0.164，P=0.013）。结论FVC下降不仅是冠心病的独立危险因素，还与冠状动脉狭窄严重的程度呈明显相关。

Abstract

Objective To explore the correlation between pulmonary function and patients with coronary artery disease (CAD) as well as the severity of coronary artery lesions, aiming to identify new and simple risk markers.
Methods A total of 279 patients who underwent coronary angiography in our hospital were randomly selected and divided into a control group (n=156) and a CAD group (n=123). The severity of coronary artery stenosis was assessed using the Gensini score system. All enrolled subjects underwent routine blood tests, myocardial enzyme tests, blood lipid analysis, pulmonary function tests, and echocardiography. Logistic regression analysis was used to analyze the related risk factors for CAD.
Results The forced vital capacity (FVC) in the CAD group was significantly lower than that in the control group [2.72 (2.00, 3.40) L vs 3.13 (2.40, 3.80) L], and the forced expiratory volume in one second (FEV1) in the CAD group was significantly lower than that in the control group [2.05 (1.40, 2.60) L/s vs 2.36 (1.70, 2.90) L/s]. Multivariate logistic regression analysis showed that decreased FVC was correlated with the presence of CAD and was a risk factor for CAD (OR=3.88, 95% CI: 1.270-11.876, P=0.017). Spearman correlation analysis revealed that the Gensini score was positively correlated with hypertension (r=0.263, P<0.001), type 2 diabetes (r=0.233, P<0.001), smoking history (r=0.265, P<0.001), alcohol consumption history (r=0.322, P<0.001), and triglyceride (TG) levels (r=0.308, P<0.001). It was negatively correlated with gender (r=-0.164, P=0.006), high-density lipoprotein cholesterol (HDL-C) levels (r=-0.135, P=0.033), FVC (r=-0.223, P<0.001), and FEV1 (r=-0.313, P<0.001) (all P<0.05). After adjusting for factors including gender, hypertension, type 2 diabetes, smoking history, alcohol consumption history, TG, and HDL-C, partial correlation analysis showed that FVC was negatively correlated with the Gensini score (r=-0.301, P<0.001), and maximum voluntary ventilation was also negatively correlated with the Gensini score (r=-0.164, P=0.013).
Conclusion   Decreased FVC is not only an independent risk factor for CAD but is also significantly correlated with the severity of coronary artery stenosis.