冠状动脉慢血流的临床预测指标与病理机制研究进展

doi:10.3969/j.issn.1004-583X.2026.06.014

摘要/Abstract

摘要：

冠状动脉慢血流(coronary slow flow,CSF)是一种以冠状动脉造影无显著狭窄(管腔狭窄≤40%),但心肌梗死溶栓试验血流分级≤2级为特征的微循环功能障碍性疾病。发病机制主要涉及内皮功能障碍、微血管病变、慢性炎症反应、血栓形成倾向及动脉粥样硬化等多种因素,目前尚不完全明确。本文从诊断方法、预测指标及病理生理机制三个维度深入探讨CSF的研究进展。旨在构建CSF的多维度评估体系,以实现对高危人群的早期识别;并着眼于未来整合多模态数据,建立预测模型,从而为精准干预提供支撑。

关键词: 冠状动脉慢血流, 内皮功能障碍, 炎症因子, 影像学方法, 预测模型

中图分类号:

程静文, 陈雪英, 刘旭, 高荣华. 冠状动脉慢血流的临床预测指标与病理机制研究进展[J]. 临床荟萃, 2026, 41(6): 562-567.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.06.014

https://www.lchc.cn/CN/Y2026/V41/I6/562

图/表 2

参考文献 60

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类别	具体指标	与CSF的关系	参考文献
临床	性别	男性患病风险约为女性的1.90~2.18倍	Sanghvi等^[18]、Chalikias等^[20]、 Huang等^[21]
	NGRP	与内皮功能障碍相关,削弱硝酸甘油的疗效	Fung等^[26]、Münzel等^[27]
	心电图	P波最大值、P波离散度、QT间期校正值等参数增大,但缺乏特异性,需结合其他指标	Mozafarybazargany等^[28]、杨帆等^[29]
生化	UAR	UAR>7.9时,AUC可达0.883(95%CI:0.840~0.927),敏感度为78.2%,特异度为88.2%	Zhang等^[30]
	NPAR	OR=1.915(95%CI:1.612~2.275);NPAR>17.39时敏感度可达90.6%	Zang等^[31]
	IBI	随血管受累范围扩大呈现升高的态势,IBI每增加1单位,CSF风险便会增加13.9%	Wen等^[32]
	NHHR	AUC=0.785,优于传统指标低密度脂蛋白胆固醇(AUC=0.578)	Yu等^[33]、Toprak等^[34]
影像学	IVUS	评估斑块组成、血管直径,预测机械性梗阻引起的术后CSF	Nakao等^[35]、Sakakura等^[36]
	OCT	识别TCFA,TCFA使CSF发生率升高(38% vs 11%)	Amano等^[37]
预测模型	Jiang Yu列线图	C-index=0.805,整合N末端脑钠肽前体、高密度脂蛋白胆固醇、血红蛋白、左前降支动脉直径、左回旋支动脉直径及右冠状动脉直径6个独立预测因子	Yu等^[39]
	C-ACS评分	AUC=0.707,适用于急诊风险评估	Xie等^[40]

类别	具体指标	与CSF的关系	参考文献
临床	性别	男性患病风险约为女性的1.90~2.18倍	Sanghvi等^[18]、Chalikias等^[20]、 Huang等^[21]
	NGRP	与内皮功能障碍相关,削弱硝酸甘油的疗效	Fung等^[26]、Münzel等^[27]
	心电图	P波最大值、P波离散度、QT间期校正值等参数增大,但缺乏特异性,需结合其他指标	Mozafarybazargany等^[28]、杨帆等^[29]
生化	UAR	UAR>7.9时,AUC可达0.883(95%CI:0.840~0.927),敏感度为78.2%,特异度为88.2%	Zhang等^[30]
	NPAR	OR=1.915(95%CI:1.612~2.275);NPAR>17.39时敏感度可达90.6%	Zang等^[31]
	IBI	随血管受累范围扩大呈现升高的态势,IBI每增加1单位,CSF风险便会增加13.9%	Wen等^[32]
	NHHR	AUC=0.785,优于传统指标低密度脂蛋白胆固醇(AUC=0.578)	Yu等^[33]、Toprak等^[34]
影像学	IVUS	评估斑块组成、血管直径,预测机械性梗阻引起的术后CSF	Nakao等^[35]、Sakakura等^[36]
	OCT	识别TCFA,TCFA使CSF发生率升高(38% vs 11%)	Amano等^[37]
预测模型	Jiang Yu列线图	C-index=0.805,整合N末端脑钠肽前体、高密度脂蛋白胆固醇、血红蛋白、左前降支动脉直径、左回旋支动脉直径及右冠状动脉直径6个独立预测因子	Yu等^[39]
	C-ACS评分	AUC=0.707,适用于急诊风险评估	Xie等^[40]

筛查分层级别	适用人群	筛查方案	核心评估目标
一级筛查	门诊体检的低危人群	采用无创、便捷的指标,包括年龄、性别、心电图参数完成基础风险评估,联合NPAR简易生化指标进行初筛	快速识别可疑CSF患者,兼顾筛查效率与临床经济性
二级筛查	一级筛查结果异常、合并血脂异常、肥胖等中危人群	在一级筛查基础上,追加UAR、NHHR复合指标,联合心肌声学造影、心脏磁共振无创影像学检查综合评估	进一步明确微循环损伤程度,排除假阳性病例,锁定确诊高危人群
三级筛查	二级筛查仍异常、拟行PCI、老年患者、合并糖尿病等高危人群	通过Jiang Yu列线图或C-ACS评分量化整体患病风险,联合IVUS/OCT评估血管结构与斑块特征	直接指导术中、术后个体化干预,降低不良事件发生率

筛查分层级别	适用人群	筛查方案	核心评估目标
一级筛查	门诊体检的低危人群	采用无创、便捷的指标,包括年龄、性别、心电图参数完成基础风险评估,联合NPAR简易生化指标进行初筛	快速识别可疑CSF患者,兼顾筛查效率与临床经济性
二级筛查	一级筛查结果异常、合并血脂异常、肥胖等中危人群	在一级筛查基础上,追加UAR、NHHR复合指标,联合心肌声学造影、心脏磁共振无创影像学检查综合评估	进一步明确微循环损伤程度,排除假阳性病例,锁定确诊高危人群
三级筛查	二级筛查仍异常、拟行PCI、老年患者、合并糖尿病等高危人群	通过Jiang Yu列线图或C-ACS评分量化整体患病风险,联合IVUS/OCT评估血管结构与斑块特征	直接指导术中、术后个体化干预,降低不良事件发生率

冠状动脉慢血流的临床预测指标与病理机制研究进展

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