冠状动脉完全闭塞病变侧支循环建立的影响因素和临床意义

Influencing factors and clinical significance of coronary collateral circulation in patients with one or more coronary artery occlusion

目的了解在完全闭塞病变的冠状动脉侧支循环(CCC)建立的影响因素和临床意义,为冠心病患者的临床治疗提供理论依据。方法选择冠状动脉造影证实有1支以上冠状动脉闭塞的冠心病患者96例,按有无CCC分为两组:CCC组(n=56)和无CCC组(n=40)。CCC积分采用Cohen和Rentrop法。造影采用右前斜30°摄影并计算左室射血分数(EF)。室壁运动记分按Cortina方法。所有随访均采用门诊和电话相结合,约半年一次,内容包括心脏事件、心功能情况和死亡。结果①CCC的建立与心绞痛病程有明显的正相关性(P<0.01);与每日吸烟量可能有负相关性(r=-1.721,P=0.093)。②CCC组与无CCC组相比,左室EF高(66.21±11.64)%和(42.78±11.02)%,心功能好(P<0.01);室壁运动积分低(8.18±1.68)分和(11.55±1.26)分,室壁运动障碍轻(P<0.01);室壁瘤的发生率低(3.6%和20.0%,χ2=5.10,P<0.05)。③随访84例(87.5%),平均15.6个月,无CCC组有2例因充血性心力衰竭死亡,CCC组无死亡。心功能CCC组明显好于无CCC组(P<0.01)。结论心绞痛病程与CCC有明显的正相关。CCC对左心室功能有显著的保护作用,并可以改善冠状动脉闭塞患者的远期预后。

Objective To explore the influencing elements of coronary collateral circulation （CCC）established in occluded coronary artery and its clinical significance,and to supply a theory foundation for clinical treatment of coronary heart disease. Methods Ninetysix consecutive patients, who were confirmed by coronary artery radiography with one or more occluded coronary artery, were divided into two groups ：CCC group （n = 56 ）and non-CCC group （n = 40 ）. CCC was scored by Cohen and Rentrop＇ s method. Ventricular radiography was adapted to the rigbt front slanting 30 degrees, and left ventricular ejection fraction（EF） was calculated. The wall motion score was scored by Cortina＇ s method. All subjects were followed up by regular outpatient visit or by phone. Results ①Establishment of CCC was positively correlated with duration of angina pectoris （P 〈 0.01 ）, but may be negatively correlated with smoking amount per day （ r = - 1.721, P = 0.093 ） ②Left ventricular EF was higher in CCC group than in non-CCC group [ （ 66.21 ± 11.64 ） % vs （42.78 ±11. 02） % ,P 〈 0.01 ）, and the wall motion score was lower（ 8.18 ±1.68 vs 11.55 ± 1.26,P 〈 0.01 ）, and the incidence of ventricular tumor was lower（ 3.6% vs 20.0% , Х^2 = 5.10, P 〈 0.05 ）. ③A total of 84 cases （ 87.5 % ） were followed up for 15.6 months. Two patients died from congestion heart failure in non-CCC group, but none died in CCC group. Cardiac function was better in CCC group than in non-CCC group（P 〈 0.01 ）. Conclusion Duration of angina pectoris shows a obviously positive correlation with establishment of CCC. Establishment of CCC could protect the left ventricle function, and improve the prognosis of patients with coronary artery occlusion.