侧支循环形成预测因素及其对慢性完全闭塞经皮冠状动脉介入治疗的意义  

Predictors of collateral circulation maturation and its prognostic significance for chronic total occlusion percutaneous coronary intervention

作　　者：冯士涛 赵阳[1] 崔红营[1] 郭晓亮[1] 董安勤 费家玥 王丽娜 李明丽 于萌文 FENG Shitao;ZHAO Yang;CUI Hongying;GUO Xiaoliang;DONG Anqin;FEI Jiayue;WANG Lina;LI Mingli;YU Mengwen(Department of Geriatrics,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450052 China)

机构地区：[1]郑州大学第五附属医院老年医学科,450052

出　　处：《心肺血管病杂志》2022年第7期722-726,731,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家生物技术发展中心国家重点研发计划项目(2018YFC2002300);2018年度河南省医学科技攻关计划联合共建项目(2018020244)。

摘　　要：目的:分析侧支循环形成的影响因素,并分析侧支循环对慢性完全闭塞经皮冠状动脉介入(CTO-PCI)的预后意义。方法:选择2016年1月至2021年1月于郑州大学第五附属医院行CAG确诊为CTO的患者共230例,选择其中成功开通闭塞血管的患者111例纳入预后分析。根据Rentrop分级将患者分为良好侧支组(Rentrop2~3级)和不良侧支组(Rentrop0~1级)。两组分别包含115例vs.115例。预后分析中两组分别包含68例vs.43例。分别比较两组基线资料、实验室检查结果、手术结果及长期预后。结果:侧枝循环的形成影响因素分析中,两组患者基线资料差异无统计学意义,良好侧支组较不良组,NLR低(P<0.05),WBC及淋巴细胞较高(P<0.05),Logistic回归模型分析显示,NLR(OR=0.076,95%CI:0.019~0.315,P<0.001)为侧支血管形成的预测因素。预后分析中,两组患者一般资料具有可比性,良好侧支组手术成功率较不良侧支组更高(80%vs.65.1%,P<0.05),中位随访时间为14个月,两组患者MACCE发生率差异无统计学意义(Log-Rank:P=0.498)。COX回归模型显示各终点事件风险比无差异。结论:侧支循环的形成与较低水平的NLR具有相关性,拥有良好侧支循环的患者手术成功率更高,但MACCE发生率没有降低。Objective:The aim of this study was to analyze the factors that influence the maturation of collateral circulation and the prognostic significance of collateral circulation in chronic total occlusion percutaneous coronary intervention(CTO-PCI).Methods:A total of 230 patients who underwent coronary angiography(CAG)and were confirmed to be CTO in the Fifth Affiliated Hospital of Zhengzhou University from January 2016 to January 2021 were included in the analysis of influencing factors of collateral circulation maturation.A total of 111 patients who successfully opened occluded vessels were included in the analysis of prognosis.Patients were divided into good collateral circulation group(Rentrop 2-3)and poor collateral circulation group(Rentrop 0-1)according to Rentrop grade.The influencing factors of collateral circulation included 115 cases vs 115 cases in the two groups.There were 68 cases vs 43 cases in the two groups.Baseline Data,laboratory findings,surgical results and long-term prognosis were compared between the two groups.Results:There was no significant difference in baseline data between the two groups.The NLR in the good collateral circulation group were lower than those in the poor collateral circulation grou p(P<0.05),WBC and Lymphocyte were high(P<0.05).Logistic regression model analysis showed that,NLR(OR=0.076,95%CI:0.019-0.315,P<0.001)is independent predictors of collateral vessel maturation.In the prognosis analysis,the general data of the two groups were comparable.The success rate of the good collateral circulation group was higher than that of the poor collateral circulation group(80%vs.65.1%,P<0.05).The median follow-up time was 14 months,there was no significant difference in the incidence of major adverse cardiac and cerebral events(MACCE)between the two groups(P=0.498).Cox regression model showed no difference in the risk ratio of each endpoint.Conclusions:The maturity of collateral circulation was associated with a lower level of NLR.Patients with good collateral circulation had a higher

关 键 词：慢性完全闭塞性病变 侧支循环 经皮冠状动脉介入治疗 预后 

分 类 号：R54[医药卫生—心血管疾病]