冠状动脉慢性完全闭塞病变侧支循环的形成特征及影响因素分析

Analysis of the Clinical Significance and Influencing Factors of Coronary Collateral Circulation in Patients with Chronic Total Occluded Coronary Artery Disease

目的研究冠状动脉慢性完全闭塞病变(CTO)侧支循环的形成情况,探讨侧支循环建立的影响因素。方法选取我院2013年10月—2014年12月收治的356例冠状动脉造影提示完全闭塞病变并经临床确诊为CTO患者157例,根据冠状动脉造影结果,采用Rentrop法将患者分为侧支循环不良组和侧支循环良好组,对两组患者临床基线资料、病变影像特征等进行对比分析。结果侧支循环良好组与侧支循环不良组相比:患者更年轻(P<0.05);合并既往明确心肌梗死史患者比例较低(P<0.05);中重度吸烟史患者比例较低(P<0.01);尿酸水平和空腹血糖水平均较低(P均<0.05);病变近端中重度迂曲及开口闭塞病变患者比例均较小(P均<0.05)。经Logistic回归分析发现,中重度吸烟史和空腹血糖水平升高为CTO病变侧支循环形成不良的独立预测因素(P均<0.05)。结论本研究显示中重度吸烟史及空腹血糖水平升高为CTO病变侧支循环形成的独立负向预测因素。

OBJECTIVE To study the clinical significance of coronary collateral circulation in patients with chronic total occluded（CTO） coronary artery disease and factors influencing the development of collateral channel.METHODS 356 patients with total occluded coronary artery from Oct.2013 to Dec.2014 in our hospital were selected.157 patients were diagnosed as the CTO.According to the results of coronary angiography,patients were divided into two groups by Rentrop method,namely unsatisfactory collateral circulation group and satisfactory collateral circulation group.The clinical data and pathological features of the patients were compared.RESULTS Compared with patients in unsatisfactory collateral circulation group：patients in satisfactory collateral circulation group were younger（P〈0.05）,the proportion of patients with previous myocardial infarction patients was lower（P〈0.05）,the proportion of patients with moderate and severe smoking history was lower（P〈0.01）,uric acid levels and fasting plasma glucose levels of patients were lower（both P〈0.05）,the proportion of patients with ostial occlusion and excessive tortuosity were lower（both P〈0.05）.Logistic regression analysis revealed that history of moderate to severe smoking and high level of blood glucose were independent predictors of poor condition of coronary collateral circulation（both P〈0.05）.CONCLUSIONS History of moderate to severe smoking and high level of blood glucose were independent predictors of poor coronary collateral circulation.