合并冠状动脉侧支循环的AMI患者临床及冠状动脉特征分析(1)
[摘要] 目的:探讨已建立冠状动脉侧支循环的初发急性心肌梗死患者临床及冠状动脉特征。方法:82例确诊为初发急性心肌梗死患者,按有无侧支循环分为有侧支循环组32例和无侧支循环组50例,对两组患者的心血管危险因素及冠状动脉病变特点进行比较分析。结果:和无侧支循环组相比,有侧支循环组患者吸烟比例(21.88% vs 48.00%,P<0.05)、饮酒比例(12.50% vs 34.00%,P<0.05)、糖尿病比例(9.38% vs 32.00%,P<0.05)及心源性休克比例(6.25% vs 24.00%,P<0.05)均较低。梗死前心绞痛比例(65.63% vs 38.00%,P<0.05)及左室射血分数值[(61.05±7.85)% vs(55.84±13.95)%,P<0.01]有侧支循环组显著高于无侧支循环组。冠状动脉造影显示,有侧支循环组多支病变比例(66.67% vs 52.00%,P<0.05)及梗死相关动脉为右冠状动脉比例(59.38% vs 30.00%,P<0.01)显著高于无侧支循环组。结论:吸烟、饮酒及糖尿病不利于侧支循环的形成,侧支循环的形成有利于保存心肌梗死患者的心功能,降低心源性休克的发生率。
, 百拇医药
[关键词] 急性心肌梗死; 侧支循环; 冠状血管造影术; 糖尿病
[中图分类号] R541.4; R542.22; R587.1[文献标识码] A[文章编号] 1671-7562(2010)01-0011-04
doi:10.3969/j.issn.1671-7562.2010.01.003
Clinical and coronary features in patients with acute myocardial
infarction combined with coronary collateral circulation
LIU Ming, CHEN Zhong, LIU Nai-feng, FANG Ying
, 百拇医药
(School of Clinical Medicine, Southeast University, Nanjing 210009, China)
[Abstract] Objective: To study the clinical and coronary lesions characteristics in patients with acute myocardial infarction combined with coronary collateral circulation. Methods: Patients with acute myocardial infarction were divided into two groups according to the combination of coronary collateral circulation(CCC), CCC group(n=32) and non-CCC group(n=50). The clinical risk factors and characteristics of coronary lesions between the two groups were compared. Results: Compared with non-CCC group, the percentage of smoking was lower in CCC group(21.88% vs 48.00%, P<0.05) and so were the alcohol consumption(12.50% vs 34.00%, P<0.05), the history of diabetes mellitus(9.38% vs 32.00%, P<0.05), and cardiogenic shock(6.25% vs 24.00%, P<0.05). Patients with CCC had higher ratio of pre-infarction angina pectoris(65.63% vs 38.00%, P<0.05) and higher values of left ventricular ejection fraction [(61.05±7.85)% vs(55.84±13.95)%,P<0.01)] than those in non-CCC group. The percentage of multi-vessel lesion(66.67% vs 52.00%, P<0.05) and occlusion of right coronary artery(59.38% vs 30.00%, P<0.01) were significantly higher in CCC group than that in non-CCC group. Conclusion: Smoking, alcohol consumption and diabetes mellitus are inversely associated with the development of CCC. The development of CCC can preserve cardiac function of patients with myocardial infarction, reduce the incidence of cardiogenic shock.
, http://www.100md.com
[Key words] acute myocardial infarction; collateral circulation; coronary angiography; diabetes mellitus
冠状动脉侧支血管由于其直径细小(通常<200 μm),故在正常或轻度冠状动脉病变的患者冠状动脉血管造影中不能被观察到。冠状动脉狭窄程度达到99%或者完全闭塞的情况下,在冠状动脉造影中可以观察到冠状动脉侧支血管。参与冠状动脉侧支血管建立和开放的最重要因素是正常与阻塞血管之间的压力梯度,此压力梯度通过增加侧支循环的血流速率、活化内皮细胞和刺激血管内皮生长因子等导致侧支血管的开放[1]。而且,在缺血性心脏病中,侧支循环的形成存在着明显的个体差异,导致这些差异的影响因素仍不十分清楚[2]。
本研究采用病例对照研究的方法对32例合并侧支循环和50例无侧支循环的首发急性心肌梗死(AMI)患者进行研究,旨在探讨AMI合并冠状动脉侧支循环患者的临床和冠状动脉病变特征,以及冠状动脉侧支循环形成的可能机制及其影响因素。
1 对象与方法
1.1 研究对象
选择2006年8月至2008年3月在东南大学附属中大医院心血管内科住院,并依据WHO制定的AMI诊断标准确诊为AMI者(排除因再次心梗入院者)作为研究对象,按有无冠状动脉侧支循环分为两组:有侧支循环组32例,无侧支循环组50例。患者均有完备的病历资料及冠状动脉造影结果。
1.2 研究方法, 百拇医药(刘 鸣 陈 忠 刘乃丰 方 瑛)
, 百拇医药
[关键词] 急性心肌梗死; 侧支循环; 冠状血管造影术; 糖尿病
[中图分类号] R541.4; R542.22; R587.1[文献标识码] A[文章编号] 1671-7562(2010)01-0011-04
doi:10.3969/j.issn.1671-7562.2010.01.003
Clinical and coronary features in patients with acute myocardial
infarction combined with coronary collateral circulation
LIU Ming, CHEN Zhong, LIU Nai-feng, FANG Ying
, 百拇医药
(School of Clinical Medicine, Southeast University, Nanjing 210009, China)
[Abstract] Objective: To study the clinical and coronary lesions characteristics in patients with acute myocardial infarction combined with coronary collateral circulation. Methods: Patients with acute myocardial infarction were divided into two groups according to the combination of coronary collateral circulation(CCC), CCC group(n=32) and non-CCC group(n=50). The clinical risk factors and characteristics of coronary lesions between the two groups were compared. Results: Compared with non-CCC group, the percentage of smoking was lower in CCC group(21.88% vs 48.00%, P<0.05) and so were the alcohol consumption(12.50% vs 34.00%, P<0.05), the history of diabetes mellitus(9.38% vs 32.00%, P<0.05), and cardiogenic shock(6.25% vs 24.00%, P<0.05). Patients with CCC had higher ratio of pre-infarction angina pectoris(65.63% vs 38.00%, P<0.05) and higher values of left ventricular ejection fraction [(61.05±7.85)% vs(55.84±13.95)%,P<0.01)] than those in non-CCC group. The percentage of multi-vessel lesion(66.67% vs 52.00%, P<0.05) and occlusion of right coronary artery(59.38% vs 30.00%, P<0.01) were significantly higher in CCC group than that in non-CCC group. Conclusion: Smoking, alcohol consumption and diabetes mellitus are inversely associated with the development of CCC. The development of CCC can preserve cardiac function of patients with myocardial infarction, reduce the incidence of cardiogenic shock.
, http://www.100md.com
[Key words] acute myocardial infarction; collateral circulation; coronary angiography; diabetes mellitus
冠状动脉侧支血管由于其直径细小(通常<200 μm),故在正常或轻度冠状动脉病变的患者冠状动脉血管造影中不能被观察到。冠状动脉狭窄程度达到99%或者完全闭塞的情况下,在冠状动脉造影中可以观察到冠状动脉侧支血管。参与冠状动脉侧支血管建立和开放的最重要因素是正常与阻塞血管之间的压力梯度,此压力梯度通过增加侧支循环的血流速率、活化内皮细胞和刺激血管内皮生长因子等导致侧支血管的开放[1]。而且,在缺血性心脏病中,侧支循环的形成存在着明显的个体差异,导致这些差异的影响因素仍不十分清楚[2]。
本研究采用病例对照研究的方法对32例合并侧支循环和50例无侧支循环的首发急性心肌梗死(AMI)患者进行研究,旨在探讨AMI合并冠状动脉侧支循环患者的临床和冠状动脉病变特征,以及冠状动脉侧支循环形成的可能机制及其影响因素。
1 对象与方法
1.1 研究对象
选择2006年8月至2008年3月在东南大学附属中大医院心血管内科住院,并依据WHO制定的AMI诊断标准确诊为AMI者(排除因再次心梗入院者)作为研究对象,按有无冠状动脉侧支循环分为两组:有侧支循环组32例,无侧支循环组50例。患者均有完备的病历资料及冠状动脉造影结果。
1.2 研究方法, 百拇医药(刘 鸣 陈 忠 刘乃丰 方 瑛)