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|本期目录/Table of Contents|

无冠脉钙化征象的HIV感染者应用可卡因及使用酶抑制剂对冠脉狭窄的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2009年第2期
页码:
215
栏目:
临床研究
出版日期:
2009-03-30

文章信息/Info

Title:
Protease inhibitor and long-term cocaine use are associated with coronary stenoses in HIV-infected individuals with no detectable coronary calcium
作者:
杜捷夫1; 孟庆义1; LAI Sheng-han 2
1.解放军总医院急诊科，北京 100853;2.Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD21205 USA.
Author(s):
DU Jie-fu1;  MENG Qing-yi1;  LAI Sheng-han2
1.Department of Emergency, PLA General Hospital, Beijing 100853, China; 2.Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD21205, USA
关键词:
冠状动脉钙化; HIV; 可卡因; 冠状动脉狭窄
Keywords:
coronary calcium;  HIV;  cocaine;  coronary stenosis
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 通过招募美国马里兰州巴尔第摩市年龄25~54岁的黑人青年有（无）HIV感染和（或）应用可卡因者使用酶抑制剂（PI）以及长期应用可卡因是否出现冠状动脉狭窄进行研究。方法 对在美国马里兰州巴尔第摩市招募的既往无心血管症状和传统心血管危险因素的109名年龄在25~54岁，有（无）HIV感染和（或）应用可卡因黑人青年，抽血检测血脂、血糖并应用64排多层CT对心脏及冠状动脉进行扫描，并采用Logistic回归模型对可能引起冠状动脉狭窄的因素进行分析。结果 109名被调查者的年龄为25~54岁，39名(35.8%)为女性；胆固醇水平为(4.01±0.88)mmol/L，CT检查见其中35例（32.1%）有冠状动脉钙化。74例CT检查未查见冠状动脉钙化，74例中有8例（11%）的被调查者冠状动脉狭窄>20%，其中5例（7%）冠状动脉狭窄≥50%；44例（59%）患者曾应用可卡因，应用过可卡因的患者中21例（28%）患者应用时间超过15年。109名被调查者，40例（36.7%）曾服用PI，在有和无冠状动脉斑块的被调查者中，血清高密度脂蛋白胆固醇（HDL）、吸食可卡因、年龄和服用PI有显著差异。应用Logistic回归模型分析发现使用PI和长期应用可卡因的时间是引起冠状动脉狭窄的独立相关因素。结论 在HIV感染患者中，长期应用可卡因及同时使用PI可能与非钙化的冠状动脉斑块独立相关。
Abstract:
AIM To investigate whether a coronary calcium score (CCS) of zero by computed tomography (CT) is associated with a low risk of a significant coronary arterial luminal narrowing. METHODS We performed contrast-enhanced coronary CT angiography (CTA) with a 64-sliced multidetector CT scanner in 109 Baltimore inner-city black adults aged 25 to 54 years who had a history of HIV infection, cocaine use, both, or neither, in order to determine the prevalence of noncalcified coronary plaques and stenoses. The subjects had no cardiovascular symptoms and were free of traditional risk factors for coronary artery disease (CAD). Thirty five subjects had coronary calcification. The remaining 74 participants without detectable coronary calcium were included in the analysis. RESULTS The mean age of the study population was (42.8±5.0) years and 39(35.8%) were females. The mean cholesterol level was (4.01±0.88) mmol/L. 11% of individuals without coronary calcification had coronary arterial luminal narrowing of >20%, and 7% had a stenosis ≥50%. Of the 74 participants, 59% were cocaine users, and 28% had used the drug for more than 15 years. 36.7% of the participants had taken PI. Among the variables examined, only serum HDL concentration, cocaine use, patient age, and protease inhibitors (PIs) use were significantly different between patients with and without coronary arterial stenoses. Logistic regression analyses revealed that the duration of PI use (OR=1.10) and prolonged (≥15 years) cocaine use (OR=29.6) were independently associated with the presence of coronary arterial stenoses. CONCLUSION In HIV infected patients, long-term use of cocaine and duration of combination antiretroviral therapy containing PIs may be independently associated with the presence of noncalcified coronary arterial plaques.

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备注/Memo

备注/Memo:
收稿日期：2008-9-19.基金项目：本研究受美国国立卫生研究院（NIH）RO1-DA12777,RO1-DA04334,RO1-DA12568研究资金资助 通讯作者：LAI Sheng-han(赖生汉)，教授，医学博士，主要从事心脏病理学研究Email:slai@jhmi.edu 作者简介：杜捷夫，副主任医师，医学博士，博士后Email:emergeneydu@126.com
更新日期/Last Update: 2009-04-16