冠状动脉侧支循环某些相关因素的临床研究

Relationship between some relative fectors and coronary artery collateral circulation

目的研究冠状动脉侧支循环在冠状动脉完全闭塞与次全闭塞血管病变中的形成情况,观察心肌梗死病史、心肌肥厚及糖尿病对侧支循环形成的影响以及侧支循环对心肌的保护作用。方法回顾分析了我院一年内409例经冠状动脉造影证实的冠状动脉完全或次全闭塞患者,先按有无心肌梗死病史将患者分为两组,对照分析侧支循环形成的良好率,及心功能相关因素方面的差异。再按有无心肌肥厚、有无糖尿病病史分别分为两组,观察其对侧支循环形成的影响。结果冠状动脉完全与次全闭塞对比侧支循环形成的良好率有显著差异。有心肌梗死与无心肌梗死病史两组侧支循环形成的良好率比较无显著差异。两组的左心室舒张末期内径、左心室射血分数、室壁运动异常发生率及室壁瘤形成均有显著差异。而有心肌梗死病史者侧支循环良好组与不良组比较左心室舒张末期内径、左心室射血分数无差异。有无心肌肥厚对侧支循环形成良好率无差异。有糖尿病史者侧支循环血流良好率明显高于无糖尿病史者,且有显著差异。结论冠状动脉侧支循环的开放依赖于冠状动脉血管的完全或次全闭塞。冠状动脉缓慢闭塞下形成的侧支循环对心肌、心功能有保护作用。糖尿病有利于侧支循环的发展。

Objective To study the coronary collateral circulation in patients with completely occluded or subtotal occlusion. To observe the effect of diabetes mellitus, left ventricle hypertrophy and history of myocardial infarction on the coronary collateral circulation, and its protective on the myocardium and heart function. Methods Coronary angiography of 409 patients with coronary artery completely occluded or subtotal occlusion were retrospectively analyzed for the formation of coronary collateral circulation. The patients were divided into two groups based on with or without myocardial infarction, and four groups on diabetes mdlitus and left ventricle hypertrophy. The incidence of well-developed collateral vessels was contrastively analyzed, and the effect of diabetes mellitus and left ventricle hypertrophy on the development of coronary collateral circulation was studied. Results The incidence of well-devdoped collateral vessels was significantly different between patients with completely occluded and subtotal occlusion, and there was no significantly different between patients with or without myocardial infarction, but their LVEF, LVD and incidence of abnormal movement regions of the left ventricle and ventricular aneurysm were significantly different. In patients with myocardial infarction, there was no significantly different between patients with heart function. Conclusion Coronary collaterals depend on patients with completely or subtotal occlusion. The incidence of well-developed collateral can preserve left ventricular function when coronary artery occluded chronically. Diabetes mellitus is helpful to coronary collateral.