冠状动脉慢性完全闭塞病人预后营养指数与冠状动脉侧支循环的相关性研究

Correlation between prognostic nutritional index and coronary collateral circulation in patients with coronary chronic total occlusion

目的:探讨冠状动脉慢性完全闭塞(coronary chronic total occlusion, CTO)病人预后营养指数(prognostic nutritional index, PNI)与冠状动脉侧支循环(coronary collateral circulation, CCC)的关系。方法:选取行冠状动脉造影术检查确诊CTO的病人140例,根据PNI的中位数48分为PNI低和PNI高,根据Rentrop分级分为CCC形成不良组(Rentrop 0~1级,n=44)和CCC形成良好组(Rentrop 2~3级,n=96)。比较2组间一般临床资料及实验室检查结果,应用logistic回归分析CCC形成不良的危险因素。结果:与PNI高相比,PNI低的年龄更大,血管病变数量较多,心力衰竭及MACE占比更高,CCC形成不良占比更多,中性粒细胞计数、尿素氮水平及CHA2DS2-VASc评分更高。完全血运重建及既往心肌梗死占比较低,白细胞及淋巴细胞计数、白蛋白及三酰甘油水平更低,差异均有统计学意义(P<0.05~P<0.01)。与CCC形成良好组比较,CCC形成不良组白蛋白更低、PNI低占比更多、CHA2DS2-VASc评分更高,差异均有统计学意义(P<0.05~P<0.01)。多因素回归分析,CTO病人低PNI与CCC形成不良具有相关性。结论:低PNI是CTO病人冠状动脉侧支循环形成不良的危险因素。

Objective:To explore the relationship between the prognostic nutritional index(PNI)and coronary collateral circulation(CCC)in patients with coronary chronic total occlusion(CTO).Methods:A total of 140 patients who underwent coronary angiography to confirm the diagnosis of CTO were selected and devided into low PNI and high PNI according to the median PNI 48,and divided into poor CCC formation group(Rentrop 0-1,n=44)and good CCC formation group(Rentrop 2-3,n=96)based on the Rentrop grading.The general clinical data and laboratory test results were compared between the two groups.Logistic regression was used to analyze the risk factors of poor CCC formation.Results:Compared with the high PNI group,the low PNI group had older age,more numbers of vascular lesions,higher incidences of heart failure and major cardiovascular adverse events,higher proportion of poor CCC formation,and higher scores for neutrophils,urea nitrogen,and CHA2DS2-VASc scores.The proportion of complete revascularization and previous myocardial infarction was relatively low,and the levels of white blood cells,lymphocytes,albumin,and triglycerides were lower in low PNI group,with statistical significance(P<0.05 to P<0.01).Compared with the good CCC formation group,the poor CCC formation group had lower albumin levels,a higher proportion of low PNI,and a higher CHA2DS2VASc scores,with statistically significant differences(P<0.05 to P<0.01).In multivariate regression analysis,low PNI in CTO patients was associated with poor CCC formation.Conclusions:Low PNI was an independent risk factor of poor CCC in CTO patients.