基于定量血流分数的冠状动脉真性分叉病变介入治疗术后分支灌注受损的危险因素分析  

Analysis of Risk Factors for Impaired Branch Perfusion After Percutaneous Coronary Intervention of Coronary True Bifurcation Lesions Based on Quantitative Flow Ratio

作　　者：龙宇博 周婷[1] 潘宏伟[1] 李媛媛 王长录[1] 张宇[1] 胡湖 胡遵 荣晶晶 LONG Yubo;ZHOU Ting;PAN Hongwei;LI Yuanyuan;WANG Changlu;ZHANG Yu;HU Hu;HU Zun;RONG Jingjing(Department of Cardiology,Clinical Research Center for Heart Failure in Hunan Province,the First Affiliated Hospital of Hunan Normal University,Hunan Provincial People's Hospital,Changsha 410005,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)湖南省心力衰竭临床医学研究中心心血管内科,长沙410005

出　　处：《中国循环杂志》2024年第6期554-561,共8页Chinese Circulation Journal

基　　金：国家自然科学基金面上项目(82070520);仁术基金重点培育项目(RS2022A04)。

摘　　要：目的:拟利用基于Murray定律的定量血流分数分析冠状动脉真性分叉病变介入治疗术后无肉眼可见分支血流减慢而分支出现血流灌注受损的影响因素。方法:连续纳入2022年6月至2023年9月于湖南省人民医院接受经皮冠状动脉介入治疗(PCI)的非左主干冠状动脉真性分叉冠心病患者211例,分叉病变共计234支。收集患者的一般临床指标、冠状动脉分叉病变的解剖学特征数据、分支保护方式、术后分支TIMI血流等资料,并对术后分支血管进行基于Murray定律的定量血流分数(μQFR)测定。PCI术后μQFR<0.8认为分支有灌注障碍,分为术后分支灌注受损组(n=51,53支分支病变),另μQFR≥0.8的患者为术后分支灌注正常组(n=160,181支分支病变)。通过多因素Logistic回归分析评估多种临床及解剖学因素对PCI术后分支灌注的影响。结果:所有患者PCI术后分支血流分级均为TIMI3级,术后分支灌注受损组53支(22.6%)血管术后分支μQFR为0.70±0.10,术后分支灌注正常组为0.93±0.05,两组比较差异具有统计学意义(P<0.001)。与术后分支灌注正常组比较,术后分支灌注受损组分支病变长度、分支参考直径、术后分支开口直径狭窄率、术后分支最狭窄管腔直径狭窄率升高,主支与分支直径比、术前分支最狭窄管腔直径狭窄率、术前主支μQFR降低,差异均有统计学意义(P均<0.05)。术后分支开口直径狭窄率(r=-0.490,P<0.001)、术后分支最狭窄管腔直径狭窄率(r=-0.788,P<0.001)、术前分支最狭窄管腔直径狭窄率(r=-0.280,P<0.001)、术后分支最狭窄管腔直径(r=-0.469,P<0.001)、分支病变长度(r=-0.157,P=0.016)与术后分支μQFR呈显著负相关,分支参考直径(r=0.173,P=0.008)、主支分支直径比(r=0.194,P=0.003)、术后分支开口直径(r=0.328,P<0.001)与术后分支μQFR呈正相关,与临床基线资料均无明显相关性(P均>0.05)。多因素Logistic回归分析,结果显示共有4个因素是术�Objectives:Present study aimed to use quantitative flow ratio based on Murray's law to analyze the risk factors of impaired side branches perfusion without naked eye visible slowing of blood flow in branches after interventional treatment of true bifurcation lesions of the coronary arteries.Methods:A total of 211 patients with non-left main coronary artery true bifurcation coronary artery disease who underwent percutaneous coronary intervention(PCI)in Hunan Provincial People's Hospital from June 2022 to September 2023 were continuously enrolled,with a total of 234 bifurcation lesions.The general clinical indicators,anatomical characteristics of coronary artery bifurcation lesions,branch protection methods,postoperative branch TIMI blood flow and other data were collected,and quantitative flow ratio(μQFR)was measured for postoperative branch blood vessels.Post-PCIμQFR<0.8 was considered as impaired branch perfusion and was included in the postoperative impaired branch perfusion group(n=51,53 branch lesions).Patients withμQFR≥0.8 were included in the postoperative normal branch perfusion group(n=160,181 branch lesions).Multivariate Logistic regression analysis was used to evaluate the effects of various clinical and anatomical factors on branch perfusion after PCI.Results:The post-PCI branch flow grading of all patients was TIMI grade III.The postoperative branchμQFR of 53 vessels(22.6%)in the group with impaired postoperative branch perfusion was 0.70±0.10,and 0.93±0.05 in the group with normal postoperative branch perfusion,and the difference between the two groups was statistically significant(P<0.001).Compared with the postoperative group with normal branch perfusion,the postoperative group with impaired branch perfusion was featured with an elevated branch lesion length,branch reference diameter,postoperative branch opening diameter stenosis rate,postoperative branch narrowest lumen diameter stenosis rate,and a lower main branch-to-branch diameter ratio,preoperative branch narrowest lumen diameter sten

关 键 词：冠状动脉分叉病变 经皮冠状动脉介入治疗 定量血流分数 分支灌注 

分 类 号：R54[医药卫生—心血管疾病]