冠状动脉侧支循环形成与功能及其影响因素

目的：探讨冠状动脉严重狭窄冠心病患者冠状动脉侧支循环（CCC）形成与功能及其影响因素。方法：采用选择性冠状动脉造影（CAG）的方法，按冠状动脉狭窄程度分为3组：A组：狭窄90%~94%；B组：狭窄95%~99%；C组：狭窄100%。采用Rentrop标准评价CCC形成，将266例患者分为CCC形成组与无CCC形成组；对CCC形成组者，按Werner冠状动脉侧支连接（CC）标准评价CCC功能，分为CC 0级、CC 1级、CC 2级3组，比较分析266例冠状动脉严重狭窄CAD患者、401支冠状动脉CCC形成和功能与冠状动脉狭窄程度及临床特征的关系。结果：C组CCC形成比例高于A与B组（P<0.05 ）， B组CCC形成比例高于A组（P<0.05）； CCC形成组与无CCC形成组患者年龄、性别、高血压、糖尿病、吸烟比例、MI、血清HDL-C及LDL-C水平差异无统计学意义（P>0.05）；在CCC形成患者中，CC 2级组血清HDL-C最高、LDL-C最低，CC 0级组血清HDL-C水平最低、LDL-C最高（P<0.05）。结论：在严重狭窄冠状动脉中，冠状动脉狭窄程度是CCC形成与功能的主要影响因素，CCC形成比例随着狭窄程度加重而升高；在冠状动脉严重狭窄的CAD患者，血清HDL-C及LDL-C水平与CCC的形成无关；但与CCC功能有关，HDL-C水平高者CCC功能好，而LDL-C水平高者则CCC功能差。

Formation and function of coronary collateral circulation and their influencing factors

OBJECTIVE: To clarify the formation and function of coronary collateral circulation (CCC) in coronary artery disease (CAD) patients with severe coronary artery stenosis and their influencing factors. METHODS: Coronary angiography was performed on 266 CAD patients with severe coronary stenosis. CCC formation was evaluated by Rentrop rating on those 266 patients and 401 severe stenosis arteries; while in CCC formed patients, CCC function was evaluated by Werner collateral collection (CC) rating. The formation, function of CCC and their influencing factors were analyzed and compared. RESULTS: CCC formation in those severe stenosis coronary arteries was related to the severity of coronary stenosis: the forming rate of CCC was 42.6% in vessels with 90%-94% stenosis (Group A), 56.9% with 95%-99% stenosis (Group B) and 93.0% with 100% stenosis (Group C) (p <0 .01). Between CCC forming and non-forming groups, there was no significant difference in age, gender, incidence of MI, hypertension and diabetes, history of smoking and serum levels of HDL-C and LDL-C (P > 0.05). In the CCC formation group, serum HDL-C level was the highest in the CC Grade 2 group (according to Werner function rating) and the lowest in the CC Grade 0 group (P < 0.05). Whereas, LDL-C level was the lowest in the CC Grade 2 group and the highest in the CC Grade 0 group (P < 0.05). CONCLUSION: Severity of coronary stenosis was the major influencing factor in CCC formation and function, and the rate of CCC formation increased with the exacerbation of coronary stenosis. Serum HDL-C and LDL-C level had no relationship with CCC formation, but related to CCC function. Better CCC function was found in patients with high level of HDL-C whereas the patients with high level of LDL-C had spoiled CCC function.