经皮冠状动脉介入再通对冠状动脉慢性完全闭塞性病变患者左室心肌重塑的影响

Influence of revascularization of percutaneous coronary intervention on left ventricular myocardial remodeling in patients with chronic total occlusion of coronary artery

目的探究经皮冠状动脉(冠脉)介入再通对冠状动脉慢性完全闭塞性病变患者左室心肌重塑的影响。方法纳入自2015年9月~2017年6月于湖北医药学院附属人民医院心内科住院患者,确诊为冠状动脉慢性完全闭塞(CTO)病变同时接受经皮冠状动脉介入术(PCI)再通成功的患者62例,对其进行为期一年的随访,采集纳入对象的一般资料及再通前后的心脏彩超及血清学数据,应用SPSS 20.0软件对数据进行统计分析。结果与基线水平相比,再通后1年患者体内N-末端脑钠肽前体(NT-pro BNP)[(295.25±468.90)pg/ml vs.(492.90±840.25)pg/ml,P=0.001]、低密度脂蛋白(LDL)[(1.94±0.65)mmol/L vs.(2.41±0.93)mmol/L,P<0.001]、三酰甘油(TG)[(1.33±1.02)mmol/L vs.(1.52±1.02)mmol/L,P=0.018]、总胆固醇(TC)[(3.25±0.79)mmol/L vs.(4.15±1.12)mmol/L,P<0.001]水平较前明显降低,其差距均具有统计学意义;与基线水平相比,再通1年后单支血管病变亚组NT-pro BNP明显低于多支血管病变亚组[(254.9±381.6)pg/ml vs.(515.2±600.5)pg/ml,P=0.027]、无侧枝循环亚组NT-pro BNP值明显低于有侧枝循环亚组[(210.65±279.05)pg/ml vs.(457.65±559.48)pg/ml,P=0.040]。结论 PCI再通可明显改善冠状动脉CTO患者左室心肌重塑,提高患者心功能;单支血管病变、无侧枝循环的冠状动脉CTO病变患者更能从CTO-PCI中获益。

Objective To discuss the influence of revascularization by percutaneous coronary intervention（PCI） on left ventricular myocardial remodeling in patients with chronic total occlusion（CTO） of coronary artery. MethodsThe inpatients were chosen from Department of Cardiology of People＇s Hospital affiliated to Hubei University of Medicine from Sept. 2015 to June 2017, among them 62 were diagnosed as CTO and received revascularization by PCI. The patients were followed up for about 1 y, and their baseline information and data of echocardiography and serology were collected and analyzed by using SPSS20.0 software. Results Compared with baseline data, the levels NT-pro BNP [（295.25±468.90） pg/ml vs.（492.90±840.25） pg/ml, P=0.001], LDL [（1.94±0.65） mmol/L vs.（2.41±0.93） mmol/L, P0.001], TG [（1.33±1.02） mmol/L vs.（1.52±1.02） mmol/L, P=0.018] and TC [（3.25±0.79） mmol/L vs.（4.15±1.12） mmol/L, P0.001] decreased significantly after revascularization for 1 y. Compared with baseline data, the level of NT-pro BNP was significantly lower in 1-vessel disease subgroup than that in multi-vessel disease subgroup [（254.9±381.6） pg/ml vs.（515.2±600.5） pg/ml, P=0.027], and was significantly lower in non-coronary collateral circulation subgroup than that in coronary collateral circulation subgroup [（210.65±279.05） pg/ml vs.（457.65±559.48） pg/ml, P=0.040] after revascularization for 1 y. Conclusion The revascularization by PCI can promote heart function through improving left ventricular myocardial remodeling in CTO patients, and those with single vessel disease or non-collateral circulation can obtain more benefit.