沈迎,全进伟,杨晨蝶,穆拉迪力·艾合麦提,丁风华,陆林,张瑞岩,沈卫峰,王晓群

• 1:上海交通大学医学院附属瑞金医院心脏科上海交通大学医学院心血管病研究所

摘要(Abstract)：

目的 分析冠状动脉侧支形成状态对冠状动脉慢性完全闭塞（CTO）病变伴左心室射血分数（LVEF）降低的心力衰竭患者经皮冠状动脉介入治疗（PCI）成功后左心功能的影响。方法 选择2015年1月至2020年9月上海交通大学医学院附属瑞金医院PCI数据库中术前LVEF≤40%、至少1支主要冠状动脉存在CTO病变并成功行PCI的患者。根据Rentrop分级，将患者分为侧支形成不良组（0级和1级）和侧支形成良好组（2级和3级）。收集两组的术前基线临床资料，并比较CTO-PCI术前及术后12个月时超声心动图测定的左心室功能和结构变化。结果 成功CTO-PCI术12个月后，所有患者的平均LVEF较基线显著增高[（42.09±9.87）%比（32.43±4.79)%,P<0.001]，而左心室舒张末期容积指数（EDVI)[(182.60±49.47)ml/m~2比（196.10±49.39)ml/m~2,P<0.001]和左心室收缩末期容积指数（ESVI)[(105.13±44.02)ml/m~2比（127.68±38.58)ml/m~2,P<0.001]均较基线下降，差异均有统计学意义。与侧支形成不良组相比，侧支形成良好组LVEF恢复程度更高[ΔLVEF:(11.75±8.24）%比（7.41±12.10)%,P=0.003]，而两组EDVI和ESVI的下降比较，差异均无统计学意义（均P>0.05）。进一步亚组分析发现，在非糖尿病患者中，侧支形成良好组较侧支形成不良组LVEF恢复更好[ΔLVEF:(13.42±8.57）%比（9.49±12.61)%,P=0.021]；而在糖尿病患者中，侧支形成良好组较侧支形成不良组则无显著恢复[ΔLVEF:(9.25±7.18）%比（3.95±10.59)%,P=0.110]。全变量校正模型显示，侧支形成良好的非糖尿病患者CTO-PCI后LVEF恢复的概率是侧支形成不良患者的3.989倍（95%CI 1.071～16.523,P=0.044），差异有统计学意义。结论 对于LVEF降低的心力衰竭患者，成功的CTO-PCI可明显改善左心室收缩功能，促进左心室逆重构。良好的侧支形成有利于CTO-PCI后左心功能的恢复，且这一现象在非糖尿病患者中更为明显。

关键词(KeyWords)： 冠状动脉慢性完全闭塞;侧支循环;心力衰竭;糖尿病;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（81870179、82000369、82170423）;; 上海市卫生健康委员会科研课题青年项目（20194Y0042）;; 上海高校教师产学研研习计划项目（RC0030103）;; 上海交通大学医学院技术转移项目（ZT202103）

作者(Author): 沈迎,全进伟,杨晨蝶,穆拉迪力·艾合麦提,丁风华,陆林,张瑞岩,沈卫峰,王晓群

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