冠状动脉慢性闭塞患者侧支循环形成的影响因素分析

Influence factors of formation of collateral circulation in patients with chronic occlusive coronary artery disease

目的研究冠状动脉慢性闭塞病变患者冠状动脉侧支循环形成的影响因素。方法选取冠状动脉造影结果显示至少1支主要冠状动脉血管为慢性闭塞病变的患者144例。根据Rentrop分级情况,0级和1级为受损侧支组(72例),2级和3级为充分侧支组(72例)。通过调查患者的血清学指标及HOMA模型评定患者胰岛素抵抗指数。结果冠状动脉受损侧支组患者体质量指数(BMI)[(24.2±3.4)kg/m^2比(26.1±5.9)kg/m^2,P=0.023]、总胆固醇(TC)[(5.37±1.35)mmol/L比(4.57±0.94)mmol/L,P=0.000]、载脂蛋白B(ApoB)[(1.20±0.37)mmol/L比(1.01±0.21)mmol/L,P=0.000]、脂蛋白a[(0.11±0.05)mg/L比(0.15±0.08)mg/L,P=0.001]、空腹胰岛素[(17.9±7.8)pmol/ml比(12.3±7.5)pmol/ml,P=0.014]、胰岛素抵抗指数(HOMA-IR)[(5.21±3.11)比(3.53±2.47),P=0.031]、β细胞功能指数(HOMA-β)[(179.9±82.0)比(107.8±77.9),P=0.002]、C反应蛋白(CRP)[(16.95±9.50)mg/L比(7.95±8.07)mg/L,P=0.038]显著高于充分侧支组;而载脂蛋白A-Ⅰ(Apo A-Ⅰ)[(1.34±0.18)mmol/L比(1.42±0.20)mmol/L,P=0.010]、胰岛素敏感性指数(ISI)[(-4.41±0.78)比(-4.12±0.75),P=0.024]显著低于充分侧支组。双变量相关分析显示,侧支循环形成与BMI、TC、Apo B、脂蛋白a、空腹胰岛素、HOMA-IR、HOMA-β、CRP成正相关(P<0.05),而与Apo A-I、ISI负相关(P<0.05)。logistic回归分析显示,在校正体重、Apo A-I、HOMA-β因素后,脂蛋白a(OR 7.575,P=0.009)、TC(OR 2.154,P=0.001)是冠状动脉侧支循环形成的独立影响因素。结论肥胖、CRP及HOMA-IR与冠状动脉侧支循环形成可能有关,TC、脂蛋白a可以作为预测慢性闭塞患者侧支循环形成的独立危险因素。

Objective To study the possible influencing factors in the formation of coronary collateral circulation in patients with chronic total occlusion（ CTO）. Methods Patients were enrolled having at least 1 major coronary artery angiography revealed as CTO of 144 patients. According to the Rentrop classification,patients with grade 0 and grade 1 filling were catogorized as insufficient collateral circulation group（ n = 72） and patients with grade 2 and grade 3 filling as collateral circulation group（ n = 72）. Serum biomarkers and insulin-resistance by HOMA model were also studied in all patients. Results In the insufficient collateral circulation,BMI,TC,Apo B,lipoprotein a,fasting insulin HOMA-IR,HOMA- beta,CRP was significantly higher than the well collateral circulation group and Apo A-Ⅰ,ISI lower than the well collateral group（ all P〈0. 05）. Bivariate correlation alaysis showed. Rentrop score,BMI,TC,Apo B,lipoprotein a,fasting insulin,HOMA-IR,HOMA- beta and CRP are positively correlated to the formation of collateral circulation（ P〈0. 05）; Apo A-Ⅰ and ISI were negatively correlated（ P〈0. 05）. Logistic regression analysis after calibration with weight,Apo A-Ⅰ and HOMA-beta factors,lipoprotein a（ OR7. 575,P = 0. 009）,TC（ OR 2. 154,P = 0. 001） were found to be the independent factors of coronary collateral circulation formation. Conclusions TC, lipoprotein a, obesity, CRP, and HOMA-IR are correlated with the formation of coronary collateral circulation and may predict formation of collateral circulation in patients with CTO.