规律运动与急性冠状动脉综合征患者侧支循环形成的关系

The relationship of regular exercise and coronary collateral of patients with acute coronary syndrome

目的 探讨急性冠状动脉综合征（ACS）患者发病前规律运动与冠状动脉侧支循环的关系.方法 选择2012年5-10月入院确诊为ACS并经冠状动脉造影检查为严重冠状动脉病变的239例患者为研究对象,按是否规律运动分为规律运动组102例与无规律运动组137例,收集分析冠状动脉造影及其他相关指标结果,并进行冠状动脉病变Gemini积分和侧支循环Rentmp分级,比较两组间冠状动脉侧支循环情况,同时对其他临床和实验室特征进行比较,采用多元logistic回归分析与侧支循环形成的关联因素.结果 规律运动组侧支循环形成比例[41.2％ （42/102）]高于无规律运动组[24.1％（33/137）],差异有统计学意义（x2=7.929,P=0.005）;规律运动组lg（Gensini评分）为（1.89±0.18）分,非规律运动组为（1.94±0.19）分,差异有统计学意义（t=2.003,P=0.046）;两组左心室射血分数分别为57.0％ （52.0％,60.0％）、50.0％ （45.0％,57.0％）,差异有统计学意义（Z=-5.152,P=0.000）.多因素Logistic回归分析显示,规律运动（OR=3.423,95％ CI：1.790～6.548）、糖尿病（OR=0.451,95％CI：0.212 ～0.962）、B型脑钠肽（OR=2.412,95％ CI：1.271 ～4.578）、非ST段抬高型ACS（OR=2.383,95％ CI：1.185～4.791）、胸痛史（OR =2.207,95％ CI：1.175～4.145）、Gensini评分（OR=1.538,95％ CI：1.141～2.073）是侧支循环建立的影响因素（P均＜0.05）.调整其他影响因素后,与无规律运动比较,规律运动的患者更容易形成冠状动脉侧支循环（OR=3.423,95％ CI：1.790～6.548,P＜0.001）.结论 对于ACS患者,规律运动有利于侧支循环的形成.

Objective To investigate the relationship between regular exercise habit and coronary collaterals of patients with acute coronary syndrome （ACS）.Methods TWo hundred and thirty-night patients diagnosed ACS and operated coronary angiography （CAG） showing severe coronary stenosis were enrolled hospitalized from May 2012 to October 2012.They were divided into regular exercise group （n =102） and irregular exercise group（n =137） according to the exercise frequency.The information of the general data,the information of CAG and other relevant index were collected.The coronary artery score was recorded according to the Censini and the coronary collateral class was made according to the Rentrop.Other characters in clinical and laboratory were recorded.Multi-factor regression analysis was used to analysis the influence factors of coronary collateral.Results The proportion of coronary collaterals （41.2％ （42/102）） in the regular exercise group was higher than that in the irregular exercise group （24.1％ （33/137））,and the difference was statistically significant（x2 =7.929,P =0.005）.Lg（Gensini score） was （1.89 ± 0.18） the and （1.94 ± 0.19） in the regular exercise group,The left ventricular ejection fraction was 57.0％ （52.0％,60.0％） in the regular exercise group and 50.0％ （45.0％,57.0％） in the irregular exercise group,and the difference was statistically significant （Z =-5.152,P =0.000）.Multi-factor regression analysis showed that regular exercise （OR =3.423,95％ CI：1.790-4.578）,diabetes mellitus （OR =0.451,95％ CI：0.212-0.962）,B-type natriuretic peptide （OR =2.412,95 ％ CI：1.271-4.578）,non-ST-segment elevation ACS （OR =2.383,95％ CI：1.185-4.791）,chest pain history （OR =2.207,95％ CI：1.175-4.145）,Gensini score （OR =1.538,95％ CI：1.141-2.073） were independent influence factors of coronary collateral（P ＜ 0.05）.After adjusting other factors,the patients with regular exercise had better coronary collaterals than that with irregular exercise （OR=3.423,95％CI：1.790-6.548,P ＜0.001）.Conclusion The regular exercise can promote coronary collateral emergence for the patients with ACS.