中文摘要：

目的 探讨影响冠状动脉侧支生成的因素,以及各影响因素之间有无协同作用.方法 入选180例选择性冠状动脉造影显示至少1支主要冠状动脉狭窄程度≥95％的冠心病患者进行回顾性研究.根据Rentrop评分系统对患者冠状动脉侧支情况进行评分,分为侧支生成不良组（Rentrop评分0和1,n=54）和侧支生成良好组（Rentrop评分2和3,n=126）,记录患者的年龄、体质量、性别、吸烟史、高血压病、2型糖尿病、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、血脂、估算的肾小球滤过率（eGFR）等,采用多因素logistic回归模型分析影响冠状动脉侧支生成的影响因素.结果 （1）冠状动脉侧支生成不良组的FBG水平明显高于侧支生成良好组,且eGFR＜ 60 ml·min-1·1.73 m-2的比例明显高于侧支生成良好组（P =0.034,P=0.001）.（2）logistic回归分析发现FBG（OR=1.374,p=0.005）和eGFR ＜60 ml·min-1· 1.73 m-2（OR =2.412,P=0.013）是影响冠状动脉侧支生成不良的独立危险因素.（3）根据ROC曲线获得FBG预测侧支生成不良的最佳界值为5.8 mmol/L,曲线下面积为0.656（P =0.001）.（4）结合患者FBG水平和eGFR水平将患者分为4组,FBG≥5.8 mmol/L且eGFR ＜60 ml· min-1· 1.73 m-2（A组）,FBG≥5.8 mmol/L且eGFR≥60 ml· min-1· 1.73 m-2（B组）,FBG＜ 5.8 mmol/L且eGFR ＜60 ml·min-1· 1.73 m-2（C组）,FBG＜ 5.8 mmoL/L且eGFR≥60ml·min-1·1.73 m-2（D组）,4组侧支生成不良的比例分别为51.7％ （15/29）,36.7％ （18/49）,35.5％ （11/31）和12.7％ （8/63） （P ＜0.001）.校正年龄、性别、吸烟史、高血压、血脂水平异常等因素后,与D组比较,A、B、C组发生冠状动脉侧支生成不良的危险度分别是D组的7.494倍（95％CI=1.410～7.551,P=0.001）、3.921倍（95％ CI=1.061 ～6.910,P =0.005）和3.474倍（95％ CI =0.160～4.477,P=0.047）.结论 空腹血糖升高和肾功能水平降低分别是预测冠状动脉侧支生成不良的独立?

英文摘要：

Objective To explore the factors related to poor coronary collateral circulation （CCC）and the synergy effects among various factors in patients with coronary artery disease （CAD）.Methods A total of 180 patients with coronary angiography confirmed CAD （at least one major coronary artery stenosis equal to or greater than 95%） were included in this study.Coronary collateral circulation was graded according to the Rentrop scoring system.There were in 54 patients with Rentrop 0 and 1 （poor CCC） and 126 patients with Rentrop 2 and 3 （good CCC）.Clinical data including age,weight,gender,history of smoking,and factors that were known to influence the development of collaterals,such as hypertension,diabetes mellitus,fasting blood glucose （FBG）,hemoglobin A1c （HbA1 c）,serum total cholesterol （TC）,triglyceride （TG）,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C） and estimate glomerular filtration rate （eGFR） levels were also documented.Multivariate logistic regression was performed to detect possible factors related to CCC.Results （1） FBG levels and the incidence of eGFR 〈60 ml · min-1 · 1.73 m-2 were significant higher in Rentrop 0 and 1 group than in Rentrop 2 and 3 group （P =0.001,P =0.034,respectively）.（2） After adjusting for age,gender,smoking habits,hypertension,diabetes and dyslipidemia,FBG levels （OR =1.374,P =0.005） and eGFR levels （OR =2.412,P =0.O13） remained as independent risk factors for CCC.（3） The ROC curve showed that the optimal cut-off point for FBG to predict poor CCC was 5.8 mmol/L.The area under the ROC curve was 0.656 （P =0.00l）.（4） According to FBG and eGFR,patients were further divided into FBG ≥ 5.8mmol/L and eGFR 〈60 ml · min-1 · 1.73 m-2 group （group A）,FBG≥5.8 mmol/L and eGFR≥60 ml ·min-1 · 1.73 m-2 group （group B）,FBG 〈 5.8 mmol/L and eGFR 〈 60 ml · min-1 · 1.73 m-2 group （group C）,and FBG 〈 5.8mmol/L and eGFR ≥60 ml · min-1 · 1.73 m-2 g