多支慢性冠状动脉闭塞病变侧支循环形成的影响因素分析  

The determinants of collateral circulation in chronic coronary occlusion

作　　者：徐立庆[1] 周旭晨[2] 栗印军[1] 

机构地区：[1]沈阳市第四人民医院心血管内科,沈阳110021 [2]大连医科大学附属一院心脏中心,辽宁大连116023

出　　处：《中国实用内科杂志》2010年第12期1127-1128,共2页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨影响慢性冠状动脉闭塞病变(CTO)多支病变侧支循环形成的因素。方法选择2003—2008年沈阳市第四人民医院心血管内科40例既往无心肌梗死的CTO患者,分为侧支良好组(A组)和侧支不良组(B组)。对两组患者的冠脉造影特点、临床特征进行对比分析。结果 A组中左优势冠脉即回旋支粗大占67.8%,B组中左优势冠脉仅占25.0%(P<0.05),A组近端病变患者明显多于B组(P<0.01),心绞痛病程(>3个月)在A组中占96.4%,在B组中占66.6%(P<0.05)。多因素logistic回归分揭示冠脉近端病变和糖尿病是良好侧支循环形成与否的独立影响因素。结论冠脉近端部位闭塞及左优势冠脉类型易于在CTO多支病变中建立侧支循环,心绞痛病程(>3个月)时侧支循环明显增多,冠脉近端病变和糖尿病是侧支循环形成的独立影响因素。Objective To explore the determinants of collateral circulation in chronic coronary occlusion.Methods 40 patients with chronic coronary occlusion and without a past history of myocardial infarction were recruited from Shenyang Fourth People＇s Hospital.These patients were divided into group A and group B.Coronary angiography and clinical characteristics of both groups were compared and analyzed.Results The prevalence of left dominant coronary artery in group A（67.8%） was higher than that in group B（25.0%）（P〈0.05）.More patients in Group A had proximal lesions than did patients in group B（P〈0.01）.96.4% of the patients in Group A had angina pectoris for more than months compared with 66.6% of the patients in Group B（P〈0.05）.Multivariate logistic regression analysis revealed that the proximal lesion and diabetes mellitus were independent factors influencing good collateral circulation.Proximal lesions of coronary artery may promote while the diabetes mellitus may inhibit the formation and development of collateral circulation.Conclusion Patients with occlusion over proximal end of coronary artery or with left dominant coronary artery may be likely to develop collateral circulation.Duration of angina pectoris longer than 3 months may be associated with more collateral vessels.Proximal lesion and diabetes mellitus may be independent predictors of collateral circulation development.

关 键 词：慢性冠状动脉闭塞 侧支循环 冠状动脉造影术 

分 类 号：R5[医药卫生—内科学]