冠状动脉侧支循环形成与临床意义及其影响因素的研究

目的探讨冠状动脉严重狭窄的冠心病患者(CAD)冠状动脉侧支循环(CCC)形成与临床意义及其影响因素。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标准评价冠状动脉侧支循环形成并对照分析侧支循环形成的良好率,将106例患者分为CCC形成组与无CCC形成组;CCC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106例冠状动脉严重狭窄CAD患者、160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组侧支循环良好率高于A与B组(P<0.05),B组侧支循环良好率高于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、心肌梗死(MI)、血清高密度脂蛋白-胆固醇(HDL-C)及低密度脂蛋白-胆固醇(LDL-C)水平等方面差异无统计学意义(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,良好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 clinical significance 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 factor.Methods Coronary angiography was performed on 106 CAD patients with severe coronary stenosis.who were dwided into three groups,Group A(90%-94% stenosis),Group B(95%-99% stenosis) and Group C(100% stenosis).CCC formation was evaluated by Rentrop rating on those 106 patients and 160 severe stenosis arteries and the incidence of well-developed collateral vessels was analyze,contrastively 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 The incidence of well-developed collateral vessel in those severe stenosis coronary arteries was related to the severity of coronary stenosis:The incidence of well-developed collateral vessel was 45.2% in vessels with 90%-94% stenosis(Group A),64.0% with 95%-99% stenosis(Group B) and 83.3% 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).Conclusions 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.