不同程度侧支循环对冠状动脉慢性完全闭塞性病变患者心功能的影响

段娜 栾波 侯爱洁 罗德锋

[摘要] 目的 探討不同程度侧支循环对冠状动脉慢性完全闭塞性病变患者心功能的影响。 方法 选取2016年1月至2018年12月辽宁省人民医院接受冠状动脉造影明确诊断至少有一支冠状动脉血管完全闭塞并成功开通的冠状动脉粥样硬化性心脏病患者110例，根据Rentrop分类将患者分为侧支循环不良组（0级或1级）和侧支循环良好组（2级或3级）;收集两组患者术前、术后1个月和术后6个月的N端脑钠肽前体指标、6 min步行试验、超声心动图评价的左心室射血分数及左心室舒张期末容积。 结果 术后1个月，两组患者NT-proBNP水平均低于术前（P<0.05）;侧支循环不良组术后1个月NT-proBNP水平低于术前，术后6个月水平低于术后1个月（P<0.05）;侧支循环良好组术后1个月NT-proBNP水平低于术前（P<0.05），术后1个月和术后6个月NT-proBNP水平比较，差异无统计学意义（P>0.05）;不同程度侧支循环与不同时间点NT-proBNP指标存在交互效应（P<0.05）;两组患者术后1个月和6个月LVEDD水平均低于术前，LVEF值高于术前，差异有统计学意义（P<0.05），但不存在交互效应（P>0.05）;两组患者术后1个月和6个月6 min步行试验距离明显长于术前，差异有统计学意义（P<0.05），同时不同程度侧支循环与不同时间点6 min步行试验距离存在交互效应（P<0.05）。 结论 侧支循环对冠状动脉慢性完全闭塞性病变患者术前心功能及活动耐量有一定的改善作用，并且对于冠状动脉慢性完全闭塞性病变患者成功开通闭塞血管后的心功能改善具有一定的预测价值。

[关键词] 冠状动脉慢性完全闭塞性病变;冠状动脉;侧支循环;心功能

[中图分类号] R542.22          [文献标识码] A          [文章编号] 1673-9701（2021）08-0024-05

Effects of different degrees of collateral circulation on cardiac function in patients with chronic complete occlusive disease of coronary artery

DUAN Na   LUAN Bo   HOU Aijie   LUO Defeng

Department of Cardiology， People′s Hospital of China Medical University， People′s Hospital of Liaoning Province， Shenyang   110016， China

[Abstract] Objective To investigate the effects of different degrees of collateral circulation on the cardiac function of patients with chronic complete occlusive disease of coronary artery. Methods A total of 110 patients with coronary atherosclerotic heart disease who underwent coronary angiography and had at least one coronary artery completely occluded and successfully opened in People′s Hospital of Liaoning Province from January 2016 to December 2018 were continuously collected. According to the Rentrop classification， the patients were divided into the poor collateral circulation group（grade 0 or 1） and the good collateral circulation group（grade 2 or 3）. The N-terminal pro-brain natriuretic peptide indexes， 6-min walk test， and echocardiography were collected to evaluate left ventricular ejection fraction and left ventricular end-diastolic volume before the operation， at one month after the operation， and six months after the operation. Results One month after operation， NT-proBNP levels in the two groups were lower than those before operation（P<0.05） The level of NT-proBNP at 1 month after operation was lower than that before operation， and that at 6 months after operation was lower than that at 1 month after operation（P<0.05）; The level of NT-proBNP in the group with good collateral circulation at 1 month after operation was lower than that before operation（P<0.05）. There was no significant difference in the level of NT-proBNP between 1 month after operation and 6 months after operation（P>0.05）; There were interaction effects between different degree of collateral circulation and NT-proBNP at different time points（P<0.05）; LVEDD at 1 and 6 months after operation was lower than that before operation， LVEF was higher than that before operation， the difference was statistically significant（P<0.05）， but there was no interaction effect（P>0.05）; The distance of 6 min walking test at 1 month and 6 months after operation in the two groups was significantly longer than that before operation， and the difference was statistically significant（P<0.05）. At the same time， there was interaction effect between different degrees of collateral circulation and 6 min walking test distance at different time points（P<0.05）. Conclusion The collateral circulation has a certain effect on improving the preoperative cardiac function and activity tolerance of patients with chronic complete occlusive disease of the coronary artery. It has a certain predictive value for the improvement of cardiac function in patients with chronic complete occlusive disease of the coronary artery after successfully opening the occluded vessel.

[Key words] Chronic complete occlusive disease of the coronary artery; Coronary artery; Collateral circulation; Cardiac function

冠状动脉侧支循环（Coronary collateral circulation，CCC）是指连接不同冠状动脉或同一冠状动脉不同部分细小的解剖上存在的微循环血管。在冠状动脉明显狭窄或闭塞时，侧支循环能发挥代偿作用为远端心肌供血，它的形成是冠状动脉血管闭塞后形成的一种代偿机制，与缺乏发达侧支循环的患者相比，良好的侧支循环可减少梗死面积，改善心室功能和存活率[1]。近年来随着慢性完全闭塞（CTO）介入技术，尤其是逆向技术的发展，侧支循环在介入治疗中的意义越来越重要。然而侧支循环在冠心病患者的作用及预后仍存在争议。……