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目的分析慢性冠状动脉闭塞病变患者冠状动脉侧支循环形成的影响因素。方法采用双中心回顾性的方法分析温州医学院附属台州医院及中山大学孙逸仙纪念医院住院的慢性冠状动脉闭塞患者143例的临床资料,根据Rentrop and Cohen分级法对侧支循环形成情况进行分级,并根据分级水平将患者分为侧支循环不良组(0级与1级)与侧支循环良好组(2级和3级)。结果两组年龄、性别、高血压、饮酒、心肌梗死、缺血性脑卒中及总胆固醇、低密度脂蛋白胆固醇、肌钙蛋白T浓度等比较,差异无统计学意义(P>0.05);而两组吸烟、糖尿病及血肌酐、空腹血糖、血红蛋白、高敏C反应蛋白浓度比较,差异有统计学意义(P<0.05)。两组血管闭塞支数比例及靶血管闭塞比例比较,差异均无统计学意义(P>0.05)。以Rentrop and Cohen分级为因变量,以年龄、性别、原发性高血压、糖尿病、血脂浓度、超敏C-反应蛋白、估算的肾小球率过滤(estimated glomerular filtrationrate,eGFR)为自变量进行Logistic回归分析,结果显示糖尿病(OR=1.24,95%CI:1.12～1.41)及eGFR(OR=1.12,95%CI:1.23～1.52)入选回归方程。结论合并糖尿病或肾功能不全的慢性冠状动脉闭塞患者侧支循环差,而糖尿病及肾功能不全可能是影响侧支循环形成的重要因素。
Objective To analyze the influential factors of coronary collateral circulation in patients with chronic coronary artery occlusion. Methods The clinical data of 143 patients with chronic coronary artery occlusion admitted to Taizhou Hospital Affiliated to Wenzhou Medical College and Sun Yat-sen Memorial Hospital of Sun Yat-sen University were analyzed by double-center retrospective method. The formation of collateral circulation was graded according to Rentrop and Cohen classification Patients were divided into poor collateral circulation group (grade 0 and grade 1) and collateral circulation good group (grade 2 and grade 3) according to the level of grading. Results There were no significant differences in age, sex, hypertension, alcohol consumption, myocardial infarction, ischemic stroke, total cholesterol, LDL cholesterol and troponin T concentrations between the two groups (P> 0.05) There were significant differences in smoking, diabetes, serum creatinine, fasting blood glucose, hemoglobin and high-sensitivity C-reactive protein between the two groups (P <0.05). There was no significant difference in the proportions of vessel occlusion count and target vessel occlusion between the two groups (P> 0.05). The Rentrop and Cohen scores were used as the dependent variables and were estimated by age, gender, essential hypertension, diabetes mellitus, serum lipid concentrations, high sensitivity C-reactive protein, estimated glomerular filtration rate (eGFR) as independent variables Logistic regression analysis showed that diabetes (OR = 1.24, 95% CI: 1.12-1.41) and eGFR (OR = 1.12, 95% CI: 1.23-1.52) were included in the regression equation. Conclusions Patients with chronic coronary artery occlusion complicated by diabetes or renal insufficiency have collateral circulation poorly. Diabetes and renal insufficiency may be important factors that affect the formation of collateral circulation.