【作者】 梁艺海；

【导师】 李志樑；

【作者基本信息】 南方医科大学 ， 临床医学（专业学位）， 2013， 博士

【摘要】 目的分析老年冠心病患者冠状动脉侧支循环形成的相关因素,探讨侧支循环的存在对PCI术后近期疗效的影响。材料与方法1、研究对象选择本研究选取符合下述标准的171例2012年1月-2012年9月期间在珠江医院接受了经皮冠状动脉介入治疗的老年冠心病患者,其中男性110例,女性81例,年龄61-89岁,平均年龄71.61±6.433岁。病例选择标准：年龄大于60岁,有完整的临床资料和冠脉造影结果,经冠状动脉造影证实至少有一支冠脉血管狭窄≥75%的患者。排除标准：(1)曾行冠脉血运重建的患者,如冠状动脉搭桥术、经皮冠状动脉介入术、冠脉球囊扩张术等。(2)曾行骨髓或器官移植的患者；(3)合并瓣膜病、心肌病、肺心病、先心病等患者；(4)合并恶性肿瘤的患者；(5)合并多器官功能衰竭、尿毒症的患者。2、研究方法及数据采集根据冠状动脉造影结果,按Rentrop分级将患者分为两组：侧支循环组为Rentrop分级为1～3级的患者,无侧支循环组为Rentrop分级为0级的患者。采集两组患者中有可能影响患者侧支循环建立的相关的临床数据进行分析：包括患者的基本资料、血生化检查结果、实验室检查结果、冠脉造影结果以及PCI术后住院时间、主要不良心血管事件和并发症发生率等,对比两组间数据的差异性。3、数据处理数据由SPSS19.0统计软件包处理。计量资料均以均数士标准差表示,组间差异采用两独立样本t检验；计数资料以百分比来表示,采用卡方检验比较两组间差异。P<0.05认为具有统计学的差异性。结果1.两组患者在年龄、性别、吸烟率、甘油三脂、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、空腹血糖、病变血管数等方面均无统计学的差异性(P>0.05)。2、两组患者高血压史比例为30.2%VS43.5%(P=0.072),室壁瘤的发病率为5.8%VS10.6%(P=0.255),数据存在组间差异,但均无统计学意义。3、两组患者糖尿病史比例14.0%VS27.2%(P=0.034),术前心绞痛病史(95.3%vs83.5%,P=0.012)术后LVEF44.20%±6.79%VS37.21%±7.79%(P<0.01),术后住院时间(6.9±1.849VS8.05+2.557,P=0.001)、冠脉狭窄程度(P<0.01)、右冠状动脉病变数(84.9%vs58.8%,P=0.000)主要不良心血管事件和并发症发生比例(52.9%VS19.4%,P<0.01),具有显著的统计学差异性。结论对经PCI治疗的老年冠心病患者而言：1、年龄、性别、吸烟史、高血压史、甘油三脂、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、病变血管数等冠脉侧支循环形成无显著影响。2、糖尿病对冠脉侧支循环形成产生不利影响。有心绞痛病史的患者出现侧支循环的可能性大。3、冠脉狭窄程度是冠脉侧支循环形成的主要影响因素。4、右冠状动脉闭塞较左冠状动脉闭塞更易形成侧支循环。5、冠脉侧支循环存在可保护心脏功能,降低主要不良心血管事件及并发症的发生率,改善PCI术后近期疗效。更多还原

【Abstract】 ObjectiveThis research is to discuss the related factor of the formation of collateral circulation in elderly patients and the short-term effect of PCI under the condition of collateral circulation.Materials and Methods1. Objective of the researchIn this research we selected171cases from Jan2012to Sep2012that meeting the following standards-elderly patients with coronary heart disease after percutaneous coronary intervention in Zhujiang Hospital. The patients were aged61-89years including male110cases, female81cases, whose mean age is71.61±6.43.Selection criteria:patients who is older than60years, had complete clinical data and coronary angiography results, and patients confirmed by coronary angiography and at least one branch of coronary artery stenosis overpass75%.Exclusion criteria:(1) patients who once had coronary revascularization, such as coronary artery bypass surgery, percutaneous coronary intervention, coronary angioplasty.(2) patients who underwent bone marrow or transplant;(3) patients with valvular heart disease, cardiomyopathy, pulmonary heart disease, congenital heart disease;(4) patients with malignant tumor;(5) patients complicated with multiple organ failure, uremia.2. Research methods and date collectionThe patients were divided into2groups:collateral circulation group and without collateral circulation based on the results of coronary arteriography. Collateral circulation group was defined from1to3while without collateral circulation group was defined0.We collected the date that may be influenced the establishment of collateral circulation:basic information, including patient’s blood biochemical examination results, laboratory test results, the results of coronary angiography and PCI postoperative hospitalization time, major adverse cardiovascular events and complications.3. Data processingData were processed by SPSS19statistical software package. The measurement data are defined as X±SD while the differences between groups using Two independent samples t-test. whereas discrete variables are expressed as percentages, compared by means of the chi-square test. P<0.05was defined to be statistically differences.Results1There were no statistically difference in the two group(P>0.05) in age, gender, smoking rate, TG, TC, HDL-C, LDL-C,blood sugar and pathological changes of vessel.2The hypertension rate of the two group is30.2%to43.5%while the occurrence of ventricular aneurysm is5.8%to10.6%, with no statistical differences.3In this research, we found that there had a statistically significant difference in the rate of diabetes, preinfarction angina, hospitalization duration, coronary artery stenosis (P<0.01), The proportions of right coronary artery disease, and major adverse cardiovascular events and complications (52.9%VS19.4%, P<0.01)ConclusionFor the elderly patients with coronary artery disease treated by PCI:1The parameters including age, gender, smoking, hypertension, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, the number of diseased vessels had no significant effect to the formation of collateral circulation.2Dabetes have an adverse effect on the formation of coronary collateral circulation. The patients with angina are more likely to have collateral circulation than those without angina.3The degree of coronary artery stenosis is the main factors inducing the formation of coronary collateral circulation.4、occluded RCA is easier to have benign collateral circulation than the occluded LAD and LCX.5coronary collateral circulation can protect cardiac function, reduce major adverse cardiac events and complications and improve the effect fo PCI treatment.更多还原