冠状动脉侧支循环与冠心病危险因素的相关性

<正>冠状动脉侧支循环是慢性或反复心肌缺血一种代偿机制。当出现冠心病或动脉硬化性疾病时,危险因素的控制仍对疾病的进展及预后产生重要影响。这些危险因素可分为可改变及不可改变的因素,可改变因素包括:高血压、糖尿病(DM)、高血脂、吸烟、缺乏运动等,不可改变因素包括:年龄、性别及遗传等。大量的研究结果揭示了冠心病危险因素与冠状动脉侧支循环的形成存在密切的关系。1冠状动脉侧支循环简介1.1冠状动脉侧支循环及其临床意义生理状态下冠状动脉     

冠状动脉侧支循环与冠心病预后的关系

冠心病(CAD)患者的冠状动脉侧支循环存在与否，直接影响其预后，预防猝死，提高CAD患者生活质。我们对经冠状动脉造影(SCA)部分患者的临床资料进行了总结、分析，以探讨冠状动脉侧支循环建立的临床意义。     

冠状动脉侧支循环的研究进展

冠状动脉侧支循环可减轻冠心病患者心肌缺血损伤。现综述冠状动脉侧支循环的建立机制,影响因素及改善侧支循环建立的方法。     

冠状动脉侧支循环评估方法

冠心病,是指由于冠状动脉粥样硬化(或)和功能改变(如痉挛)导致心肌血液供应减少或中断而产生的一组临床症候群。冠状动脉的反复或慢性缺血会引发侧支循环的产生,从而在一定程度上增加冠脉血流储备,缩小受损心肌的面积,降低急性冠脉事件后的死亡率,这为冠心病的治疗提供了一个新的方向。而如何评估冠脉侧支循环的作用,并根据评估结果制定相应的治疗方案也成为研究的重点之一。本文主要就近年来冠脉侧支循环的评估方法进行总结。     

冠状动脉侧支循环与冠心病预后的关系

目的 :研究冠状动脉侧支循环与冠心病 (CHD)预后的关系。方法 :依据选择性冠状动脉造影(SCA)结果将 98例SCA患者分为正常对照组 (非CHD组 )、CHD无侧支循环组、CHD有侧支循环组 ,分析各组患者的临床资料。结果 :CHD组与非CHD组相比 ,除糖尿病发病率 (无论有无侧支循环 )较高外 (P <0 .0 1) ,其他CHD易患因素差异均无显著性意义 (P >0 .0 5 ) ;有侧支循环患者与无侧支循环患者相比 ,主要CHD易患因素、不稳定型心绞痛 (UAP)的发生差异无显著性意义 (P >0 .0 5 ) ;但无侧支循环患者心功能不全、心肌梗死、室壁瘤的发生率显著增加 (P <0 .0 1) ;次全闭塞、完全闭塞主要见于有侧支循环者 ;有侧支循环患者以左前降支病变为主 ,无侧支循环患者以右冠状动脉病变为主。结论 :侧支循环存在与否与CHD患者预后密切相关     

冠状动脉侧支循环影响因素的探讨

目的探讨冠状动脉侧支循环形成的相关影响因素。方法选择冠状动脉闭塞病变的患者106例,用单因素和多因素回归分析方法分析了患者年龄、性别、体重指数、血压、血脂、尿酸、血糖、胰岛素水平以及冠状动脉闭塞程度、病变特点等与侧支循环的关系。结果血糖水平和冠状动脉闭塞程度与冠状动脉侧支循环形成之间的回归系数达显著水平(P<0.01)。结论血糖水平和冠状动脉闭塞程度是影响冠状动脉侧支循环形成的重要因素。     

冠状动脉侧支循环研究进展

冠状动脉（冠脉）侧支循环为阻塞远端心肌提供重要的血液供应,因此具有保护缺血心肌的作用。近年来,对影响冠脉侧支形成的临床和生化因素进行了大量的研究,同时探讨了利用增加冠脉侧支循环治疗急性或慢性冠脉阻塞的潜在临床前景。该文简要介绍冠脉侧支循环的心肌保护作用、形成机制、临床影响因素以及治疗策略。     

冠心病预后与冠状动脉侧支循环的关系

目的：研究冠心病（CHD）预后与冠状动脉侧支循环的关系。方法：依据冠状动脉造影结果98例患者被分为CHD无侧支循环组（62例）、CHD有侧支循环组（20例）、正常对照组（16例）,分析各组患者的临床资料。结果：CHD组（无论有无侧支循环）与正常对照组相比,除糖尿病发病率较高外（P〈0.01）,其他CHD易患因素差异均无显著性（P〉0.05）;有侧支循环与无侧支循环CHD患者相比,主要CHD易患因素、不稳定型心绞痛的发生率差异均无显著性（P〉0.05）;但无侧支循环患者左室射血分数〈50%患者比率（29.0%比10.0%）,心肌梗死（61.3%比30.0%）、室壁瘤（22.6%比0）的发生率较有侧支循环患者显著增加（P〈0.01）。结论：侧支循环存在与否与冠心病患者预后有关。     

冠状动脉侧支循环的研究进展

当冠状动脉狭窄时，相关的冠状动脉的侧支血管明显增长并提供替代血流，良好的侧支血管具有收缩，舒张功能，很大程度上影响着缺血心肌的血液供应，对心脏结构和功能起到一定的保护作用。     

Relationship between plasma apelin level and coronary collateral circulation

Objective

Coronary collaterals play a crucial role during an acute ischemic attack. Angiogenesis has an important role in the formation of coronary collateral vessels. Previously, it was shown that apelin is a potential angiogenetic factor. Thus, we aimed to investigate relationship between plasma apelin levels and coronary collateral circulation in patients with stable coronary artery disease.

Methods

Among patients who underwent coronary angiography with stable angina pectoris, patients with a stenosis of ≥90% were included in our study. Collateral degree was graded according to Rentrop–Cohen classification. Patients with grade 2 or 3 collateral degree were included in good collateral group and patients with grade 0 or 1 collateral degree were included in poor collateral group.

Results

Plasma apelin level was significantly higher in good collateral group (0.69 ± 0.2 vs 0.59 ± 0.2 ng/dl, p < 0.001). Serum nitric oxide levels were similar between two groups. In multivariate regression analysis apelin [6.95 (1.46–33.15), p = 0.015] and presence of total occlusion [4.40 (1.04–18.62), p = 0.044] remained as independent predictors for good coronary collateral development.

Conclusions

Higher plasma apelin level was related to better coronary collateral development. Demonstration of favorable affects of apelin on good collateral development may lead to consider apelin in antiischemic treatment strategies in order to increase collateral development.     

Relation of coronary collateral circulation with epicardial fat volume in patients with stable coronary artery disease

Objective

To investigated the relationship between epicardial fat volume (EFV) and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD).

Methods

The study population consisted of 152 consecutive patients with CAD who underwent coronary angiography and were found to have at least 95% significiant lesion in at least one major coronary artery. EFV was assessed utilizing 64-multislice computed tomography. The patients were classifield into impaired CCC group (Group 1, Rentrop grades 0−1, n = 58), or adequate CCC (Group 2, Rentrop grades 2−3, n = 94).

Results

The EFV values were significantly higher in paitients with adequate CCC than in those with impaired CCC. In multivariate logistic regression analysis, EFV (OR = 1.059; 95% CI: 1.035−1.085; P = 0.001); and presence of angina were independent predictors of adequate CCC. In receiver-operating characteristic curve analysis, the EFV value > 106.5 mL yielded an area under the curve value of 0.84, with the test sensitivity of 49.3%, and with 98.3% specifity.

Conclusions

High EFV, and the presence of angina independently predict adequate CCC in patients with stable coronary artery disease. This association offers new diagnostic opportinities to assess collateral flow by conventional ultrasound techniques.     

慢性心肌缺血中侧支循环作用的研究

目的:运用冠脉造影和非介入性方法研究冠状动脉慢性闭塞多支病变(Chronic Occlusive Multivessle Disease)中侧支循环与临床状况及表示侧支循环状况的临床指标。方法:选择既往无心肌梗塞、有稳定型和不稳定型心绞痛病史,冠脉造影示至少一支冠脉完全闭塞并有多支病变的病人,根据CAG判断侧支循环的分级情况,病人被分为侧支良好组(A组:侧支循环2．3级)和侧支不良组(B组:侧支循环0,1级),对两组患者临床特征进行对比分析。结果:40例冠脉慢性闭塞多支病变患者中侧支良好的有28例(A组),侧支不良的有12例(B组)。心绞痛病程(>3个月)在A组中占96．4％,在B组中占66．6％,B组明显少于A组(P<0．05)。异常Q波的出现率两组分别为28．5％(A组),66．6％(B组),B组明显高于A组(P<0．05)。室壁运动正常者A组占39．2％,明显高于B组的10％(P<0．01)。左室射血分数(LVEF)A组明显高于B组(50±8．0:44．8±5．5,P<0．05)。结论:病程较短,有异常Q波,室壁运动异常,左室射血分数<50％者提示侧支循环不佳。     

严重冠脉病变侧支循环形成影响因素探讨

目的：探讨严重冠脉病变侧支循环影响因素。方法：对79例冠脉狭窄≥90％和（或）闭塞病变血管造影进行分析。结果：79例严重冠脉病变有68例见侧支循环，其中右冠病变47例，伴侧支循环44例，占93．61％（44／47），前降支病变51例，伴侧支循环29例，占56．86％（29／51），回旋支病变26例，伴侧支循环20例，占76．92％（20／26），合并糖尿病39例，37例伴侧支循环，非糖尿病40例，31例伴侧支循环（P＜0．05），合并高血压组49例，46例伴侧支循环，非高血压组30例，22例伴侧支循环（P＜0．01）。结论：严重冠脉慢性病变多数建立侧支循环，以右冠病变显著，糖尿病（或）高血压促进侧支循环建立。     

冠状动脉侧支循环影响因素的Meta分析

目的 系统评价冠状动脉(冠脉)侧支循环影响因素.方法 计算机检索Web of Science、The Cochrane Library、PubMed、EMbase、CNKI、WanFang及CBM数据库,搜集建库至2020年1月有关冠脉侧支循环相关影响因素的病例对照研究.由2名研究者独立阅读并筛选文献,提取资料并评价纳...     

Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral circulation.

AIMS: The aim of our study in patients with coronary artery disease (CAD) and present, or absent, myocardial ischaemia during coronary occlusion was to test whether (i) left ventricular (LV) filling pressure is influenced by the collateral circulation and, on the other hand, that (ii) its resistance to flow is directly associated with LV filling pressure. METHODS AND RESULTS: In 50 patients with CAD, the following parameters were obtained before and during a 60 s balloon occlusion: LV, aortic (Pao) and coronary pressure (Poccl), flow velocity (Voccl), central venous pressure (CVP), and coronary flow velocity after coronary angioplasty (V(?-occl)). The following variables were determined and analysed at 10 s intervals during occlusion, and at 60 s of occlusion: LV end-diastolic pressure (LVEDP), velocity-derived (CFIv) and pressure-derived collateral flow index (CFIp), coronary collateral (Rcoll), and peripheral resistance index to flow (Rperiph). Patients with ECG signs of ischaemia during coronary occlusion (insufficient collaterals, n = 33) had higher values of LVEDP over the entire course of occlusion than those without ECG signs of ischaemia during occlusion (sufficient collaterals, n = 17). Despite no ischaemia in the latter, there was an increase in LVEDP from 20 to 60 s of occlusion. In patients with insufficient collaterals, CFIv decreased and CFIp increased during occlusion. Beyond an occlusive LVEDP > 27 mmHg, Rcoll and Rperiph increased as a function of LVEDP. CONCLUSION: Recruitable collaterals are reciprocally tied to LV filling pressure during occlusion. If poorly developed, they affect it via myocardial ischaemia; if well grown, LV filling pressure still increases gradually during occlusion despite the absence of ischaemia indicating transmission of collateral perfusion pressure to the LV. With low, but not high, collateral flow, resistance to collateral as well as coronary peripheral flow is related to LV filling pressure in the high range.