冠状动脉慢性完全闭塞病变侧支循环形成特点及影响因素探讨

摘要

Objective To evaluate the significance of coronary collateral circulation in patients with chronic total occluded (CIO) coronary artery disease and factors influencing collateral channel development Methods We identified 1485 patients with total occluded coronary artery from January 2004 to December 2008 in Zhongshan hospital. Among them, 638 patients were diagnosed as the CTO. All patients were categorized into two groups according to the condition of collateral circulation. Results Compared with patients with good collateral circulation, patients with poor collateral were older (63.6 ± 10.7 yrs old vs. 66. 5 ±11.2 yrs old, t = 3. 638 , P < 0. 05 ) , had history of heavy smoking (44. 1% vs. 59. 5% ,χ2 = 15. 277,P<0. 01) and acute myocardial infarction (32.8% vs. 39. 5% ,χ2 = 2. 043, P < 0. 05 ) , higher level of blood glucose [(5.51 ±1.38) mmol/1. Vs. (6.67 ±1.41) mmol/L, t=2.299, P < 0. 05 ] and Uric Acid [ (355. 79 ± 92. 69) mmol/L vs. (370. 94 ± 94. 81 ) mmol/L, t = 2. 697, P < 0. 05 ]. And the angiography revealed that oslial occlusion ( 29. 8% vs. 20. 7% ,%2 = 6. 927, P < 0. 01 ) and excessive tortuosity (19. 1% vs. 26. 2% ,χ2 = 4. 551 , P < 0. 05 ) were more common. A multiple logistic regression analysis revealed that history of heavy smoking ( OR:0. 191 , P < 0. 05, 95% CI:0. 052 - 0. 699) and high level of blood glucose (OR:0. 377,P<0. 05, 95%CI:0. 092-0. 989) were independent predictors of poor condition of coronary collateral circulation. Conclusions History of heavy smoking and high level of blood glucose were independent predictors of poor coronary collateral circulation while other factors like angina time and myocardial infarction were not supported to have definite influence.%目的 评价冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)侧支循环的形成情况,对影响侧支循环建立的因素进行探讨.方法 连续搜集2004年1月至2008年12月上海市中山医院1485例冠状动脉造影提示完全闭塞病变并确认为CTO(闭塞时间＞3个月)病变者638例,根据冠状动脉造影结果采用Rentrop法评价侧支循环的开放情况,将侧支循环积分2、3级判断为侧支循环良好,侧支循环积分0、1级判断为侧支循环不良；对两组患者在临床影响因素、病变影像特征、介入治疗资料等进行分析.结果 两组患者年龄(63.6±10.7)岁比(66.5±11.2)岁,t=3.638,P＜0.05;合并既往明确心肌梗死史(32.8％比39.5％,x2 =2.043,P＜0.05)；中重度吸烟史44.1％比59.5％x2=15.277,P＜0.01;高尿酸水平(355.79±92.69)mmol/L比(370.94±94.81)mmol/L,t=2.697,P＜0.05及空腹血糖水平升高(5.51±1.38) mmol/L比(6.67±1.41) mmol/L,t =2.299,P＜0.05;开口闭塞病变29.8％比20.7％,x2=6.927,P＜0.01及病变近端中重度迂曲者19.1％比26.2％,x2=4.551,P＜0.05,多出现侧支循环不良；经多元回归分析,既往有中重度吸烟史(OR:0.191,P＜0.05,95％ CI:0.052 ～0.699)、空腹血糖水平升高(OR:0.377,P＜0.05,95％ CI:0.092～0.989)为CTO病变侧支循环形成不良的独立预测因素；而闭塞血管及位置、心绞痛病程、既往心梗史等方面差异无统计学意义.结论 本研究显示中重度吸烟史、空腹血糖水平升高对于CTO病变侧支循环形成具有独立的负向预测作用,而心绞痛病程、心肌梗死等因素对其无明确影响作用.