前降支病变冠状动脉粥样硬化性心脏病患者接受经皮冠状动脉介入治疗对于侧支循环及心功能的影响研究
전강지병변관상동맥죽양경화성심장병환자접수경피관상동맥개입치료대우측지순배급심공능적영향연구
Influence of percutaneous coronary intervention on collateral circulation and heart function in coronary heart disease with anterior descending lesion
  • 万方数据
    中国医药 중국의약
    China Medicine
    2015年 12期 1742-1745 ,共4页

    郑进民%赵桂琴%李新

    정진민%조계금%리신

    冠状动脉疾病%前降支病变%经皮冠状动脉介入%侧支循环%心功能 冠狀動脈疾病%前降支病變%經皮冠狀動脈介入%側支循環%心功能
    관상동맥질병%전강지병변%경피관상동맥개입%측지순배%심공능
    Coronary heart disease%Anterior descending artery lesions%Percutaneous coronary intervention%Collateral circulation%Heart function
    目的 研究前降支病变冠状动脉粥样硬化性心脏病(冠心病)患者接受经皮冠状动脉介入治疗(PCI)对侧支循环及心功能的影响.方法 选取2011年3月至2013年7月南京明基医院接受冠状动脉造影诊断为前降支单支病变的246例冠心病患者作为研究对象,根据侧支循环开放情况将患者分为侧支循环组(105例)和无侧支循环组(141例),侧支循环组患者再根据血流来源分为对侧侧支循环组(58例)、同侧+对侧侧支循环组(26例)、同侧侧支循环组(21例).比较各组患者PCI治疗前后心功能指标[左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、B型钠尿肽(BNP)和红细胞体积分布宽度(RDW)]差异.结果 侧支循环组和无侧支循环组患者在年龄、性别、高血压、糖尿病及吸烟史方面差异无统计学意义(P＞0.05).侧支循环组与无侧支循环组患者术前及术后1、6个月心功能指标分别为[侧支循环组LVEF:(45.7±9.8)％、(46.6±0.4)％、(47.4±0.4)％,LVEDV:(48.36±6.82)、(48.67±0.28)、(53.12±0.32) ml, BNP: (6.32±1.59)、(5.72±0.08)、(5.59±0.07) ng/L, RDW:(14.59±1.68)％、(13.75±0.07)％、(13.56±0.13)％;无侧支循环组LVEF:(43.6±8.8)％、(45.4±0 3)％、(46.3±0.3)％ ,LVEDV: (48.51 ±5.36)、(48.87 ±0.26)、(55.36±0.38) ml, BNP: (6.39±1.27)、(6.21±0.09)、(6.05±0.06) ng/L, RDW:(14.86±1.87)％、(14.41±0.09)％、(13.76±0.12)％],2组患者术前各指标差异无统计学意义(P＞0.05),侧支循环组患者术后1个月的LVEF、BNP、RDW水平及术后6个月时的LVEF、BNP、LVEDV、RDW水平与无侧支循环组患者比较差异有统计学意义(P＜0.05).对侧侧支循环组、同侧+对侧侧支循环组、同侧侧支循环组患者术前及术后l、6个月心功能指标分别为[对侧侧支循环组LVEF:(46.0±8.9)％、(47.7±0.4)％、(48.0±0.4)％,LVEDV: (48.03±7.11)、(48.35±0.33)、(52.92±0.28) ml, BNP: (6.21±1.49)、(5.79±0.13)、(5.52±0.08) ng/L,RDW:(14.53±1.76)％、(13.58±0.13)％、(13.28±0.15)％;同侧+对侧侧支循环组LVEF: (45.6±8.8)％、(48.8±0.7)％、(49.6±0.8)％,LVEDV: (47.84±5.36)、(51.96±0.85)、(50.89±0.88) ml,BNP: (6.13 ± 1.85)、(5.65±0.12)、(5.31±0.16) ng/L,RDW: (14.34±1.62)％、(13.32 ±-0.24)％、(13.03±0.23)％;同侧侧支循环组LNEF: (40.3±8.8)％、(45.5±0.8)％、(45.7±0.9)％, LVEDV:(50.63±6.76)、(49.22 ±0.78)、(56.12±0.96) ml, BNP: (7.38±1.52)、(6.32±0.19)、(5.86±0.16) ng/L,RDW:(14.86±1.87)％、(14.41±0.09)％、(15.23±0.24)％],3组患者术前各指标差异无统计学意义(P＞0.05),两两比较术后1个月的LVEF、BNP、RDW水平及术后6个月的LVEF、BNP、LVEDV、RDW水平差异有统计学意义(P＜0.05).结论 前降支病变冠心病患者接受PCI治疗对于存在侧支循环患者的心功能改善效果更好,尤其是对存在对侧+同侧侧支循环患者改善明显,对存在对侧侧支循环和同侧侧支循环者次之.
    목적 연구전강지병변관상동맥죽양경화성심장병(관심병)환자접수경피관상동맥개입치료(PCI)대측지순배급심공능적영향.방법 선취2011년3월지2013년7월남경명기의원접수관상동맥조영진단위전강지단지병변적246례관심병환자작위연구대상,근거측지순배개방정황장환자분위측지순배조(105례)화무측지순배조(141례),측지순배조환자재근거혈류래원분위대측측지순배조(58례)、동측+대측측지순배조(26례)、동측측지순배조(21례).비교각조환자PCI치료전후심공능지표[좌심실사혈분수(LVEF)、좌심실서장말기용적(LVEDV)、B형납뇨태(BNP)화홍세포체적분포관도(RDW)]차이.결과 측지순배조화무측지순배조환자재년령、성별、고혈압、당뇨병급흡연사방면차이무통계학의의(P＞0.05).측지순배조여무측지순배조환자술전급술후1、6개월심공능지표분별위[측지순배조LVEF:(45.7±9.8)％、(46.6±0.4)％、(47.4±0.4)％,LVEDV:(48.36±6.82)、(48.67±0.28)、(53.12±0.32) ml, BNP: (6.32±1.59)、(5.72±0.08)、(5.59±0.07) ng/L, RDW:(14.59±1.68)％、(13.75±0.07)％、(13.56±0.13)％;무측지순배조LVEF:(43.6±8.8)％、(45.4±0 3)％、(46.3±0.3)％ ,LVEDV: (48.51 ±5.36)、(48.87 ±0.26)、(55.36±0.38) ml, BNP: (6.39±1.27)、(6.21±0.09)、(6.05±0.06) ng/L, RDW:(14.86±1.87)％、(14.41±0.09)％、(13.76±0.12)％],2조환자술전각지표차이무통계학의의(P＞0.05),측지순배조환자술후1개월적LVEF、BNP、RDW수평급술후6개월시적LVEF、BNP、LVEDV、RDW수평여무측지순배조환자비교차이유통계학의의(P＜0.05).대측측지순배조、동측+대측측지순배조、동측측지순배조환자술전급술후l、6개월심공능지표분별위[대측측지순배조LVEF:(46.0±8.9)％、(47.7±0.4)％、(48.0±0.4)％,LVEDV: (48.03±7.11)、(48.35±0.33)、(52.92±0.28) ml, BNP: (6.21±1.49)、(5.79±0.13)、(5.52±0.08) ng/L,RDW:(14.53±1.76)％、(13.58±0.13)％、(13.28±0.15)％;동측+대측측지순배조LVEF: (45.6±8.8)％、(48.8±0.7)％、(49.6±0.8)％,LVEDV: (47.84±5.36)、(51.96±0.85)、(50.89±0.88) ml,BNP: (6.13 ± 1.85)、(5.65±0.12)、(5.31±0.16) ng/L,RDW: (14.34±1.62)％、(13.32 ±-0.24)％、(13.03±0.23)％;동측측지순배조LNEF: (40.3±8.8)％、(45.5±0.8)％、(45.7±0.9)％, LVEDV:(50.63±6.76)、(49.22 ±0.78)、(56.12±0.96) ml, BNP: (7.38±1.52)、(6.32±0.19)、(5.86±0.16) ng/L,RDW:(14.86±1.87)％、(14.41±0.09)％、(15.23±0.24)％],3조환자술전각지표차이무통계학의의(P＞0.05),량량비교술후1개월적LVEF、BNP、RDW수평급술후6개월적LVEF、BNP、LVEDV、RDW수평차이유통계학의의(P＜0.05).결론 전강지병변관심병환자접수PCI치료대우존재측지순배환자적심공능개선효과경호,우기시대존재대측+동측측지순배환자개선명현,대존재대측측지순배화동측측지순배자차지.
    Objective To explore the influence of percutaneous coronary intervention (PCI) on collateral circulation and heart function in coronary heart disease with anterior descending lesion.Methods Totally 246 patients of coronary heart disease with single-vessel of anterior descending lesion confirmed by coronary angiography from March 2011 to July 2013 were enrolled and divided into collateral circulation group (105 cases) and non-collateral circulation group (141 cases);the patients in collateral circulation group were divided into collateral circulation group (58 cases), ipsilateral + contralateral collateral circulation group (26 cases), and ipsilateral collateral circulation group (21 cases).The cardiac function indicators, including left ventricular ejection fraction (LVEF), left ventricular end diastolic volume (LVEDV), B type natriuretic peptide (BNP) and red blood cell volume distribution width (RDW), were compared among groups.Results There were no significant differences between collateral circulation group and non-collateral circulation group regarding age, sex, hypertension, diabetes and smoking (P ＞ 0.05).The cardiac function before operation, 1 and 6 months after operation in collateral circulation group were as followed : LVEF (45.7 ± 9.8) ％ , (46.6 ± 0.4) ％ , (47.4 ± 0.4) ％ , LVEDV (48.36±±6.82), (48.67 ±0.28), (53.12±0.32)ml, BNP (6.32 ±1.59), (5.72±0.08), (5.59 ±0.07) ng/L, RDW (14.59 ± 1.68) ％, (13.75 ± 0.07) ％ , (13.56 ± 0.13) ％;in non-collateral circulation group was as followed : LVEF (43.6 ± 8.8) ％, (45.4 ± 0.3) ％, (46.3 ± 0.3) ％, LVEDV (48.51 ± 5.36),(48.87±0.26), (55.36 ±0.38) ml, BNP (6.39±1.27), (6.21 ±0.09), (6.05 ±0.06) ng/L, RDW (14.86 ± 1.87) ％, (14.41 ± 0.09) ％, (13.76 ± 0.12) ％.Above indicators were not significantly different between groups;the levels of LVEF, BNP, RDW 1 month after operation, the levels of LVEF, BNP, LVEDV,RDW 6 months after operation in non-collateral circulation group were significantly improved compared with those in collateral circulation group (P ＜ 0.05).The cardiac function before operation, 1 and 6 months after operation in contralateral collateral circulation group were as followed : LVEF (46.0 ± 8.9) ％ , (47.7 ± 0.4) ％ , (48.0 ±0.4)％, LVEDV (48.03 ±7.11), (48.35 ±0.33), (52.92 ±0.28) ml, BNP(6.21 ± 1.49), (5.79±0.13), (5.52 ± 0.08) ng/L, RDW (14.53 ± 1.76) ％, (13.58 ± 0.13) ％, (13.28 ± 0.15) ％;in ipsilateral +contralateral collateral circulation group was as followed : LVEF (45.6 ± 8.8) ％, (48.8 ± 0.7) ％ , (49.6 ±0.8)％, LVEDV (47.84 ±5.36), (51.96 ±0.85), (50.89 ±0.88) ml, BNP (6.13±1.85), (5.65 ±0.12), (5.31 ±0.16) ng/L, RDW (14.34 ± 1.62)％, (13.32 ±0.24)％, (13.03 ±0.23)％;in ipsilateral collateral circulation group was as followed: LVEF (40.3± 8.8)％, (45.5 ±0.8)％, (45.7 ±0.9)％,LVEDV: (50.63 ±6.76), (49.22 ±0.78), (56.12 ±0.96) ml, BNP (7.38 ± 1.52), (6.32±0.19),(5.86±0.16) ng/L, RDW (14.86±1.87)％ , (14.41 ±0.09)％ , (15.23 ±0.24)％.Above indicators were not significantly different among groups before operation (P ＞ 0.05).The levels of LVEF, BNP, RDW 1 month after operation, the levels of LVEF, BNP, LVEDV, RDW 6 months after operation were significantly different among contralateral collateral circulation group, ipsilateral + contralateral collateral circulation group and ipsilateral collateral circulation group (P ＜ 0.05).Conclusion In coronary heart disease patients with anterior descending lesion, the effect of PCI in improving heart function was better for those having collateral circulation, especially for ipsilateral and contralateral collateral circulation.
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