Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708, Taiwan, ROC.
BMC Nephrol. 2012 Aug 30;13:98. doi: 10.1186/1471-2369-13-98.
Coronary collateral circulation plays an important role to protect myocardium from ischemia, preserve myocardial contractility and reduce cardiovascular events. Chronic kidney disease (CKD) is associated with poor coronary collateral development and cardiovascular outcome. However, limited research investigates the predictors for collateral development in the CKD population.
We evaluated 970 consecutive patients undergoing coronary angiography and 202 patients with CKD, defined as a glomerular filtration rate less than 60 ml/min/1.73 m2, were finally analyzed. The collateral scoring system developed by Rentrop was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group.
The patients with poor collateral (n = 122) had a higher incidence of hypertension (82% vs 63.8%, p = 0.005), fewer diseased vessels numbers (2.1 ± 0.9 vs 2.6 ± 0.6, p < 0.001) and a trend to be diabetic (56.6% vs. 43.8%, p = 0.085) or female sex (37.7% vs. 25.0%, p = 0.067). Multivariate analysis showed hypertension (odd ratio (OR) 2.672, p = 0.006), diabetes (OR 1.956, p = 0.039) and diseased vessels numbers (OR 0.402, p < 0.001) were significant predictors of poor coronary collaterals development. Furthermore, hypertension and diabetes have a negative synergistic effect on collateral development (p = 0.004 for interaction).
In the CKD population hypertension and diabetes might negatively influence the coronary collaterals development.
冠状动脉侧支循环对保护心肌免受缺血、保持心肌收缩力和减少心血管事件起着重要作用。慢性肾脏病（CKD）与侧支循环不良发育和心血管结局不良有关。然而，有限的研究调查了 CKD 人群中侧支发育的预测因素。
我们评估了 970 例连续接受冠状动脉造影的患者和 202 例 CKD 患者，定义为肾小球滤过率小于 60ml/min/1.73m2，最终分析了这些患者。采用 Rentrop 侧支评分系统将患者分为侧支循环差（等级 0 和 1）或侧支循环良好（等级 2 和 3）组。
侧支循环差的患者（n=122）高血压发生率更高（82%比 63.8%，p=0.005），病变血管数更少（2.1±0.9 比 2.6±0.6，p<0.001），且有糖尿病（56.6%比 43.8%，p=0.085）或女性（37.7%比 25.0%，p=0.067）的趋势。多变量分析显示高血压（优势比 2.672，p=0.006）、糖尿病（优势比 1.956，p=0.039）和病变血管数（优势比 0.402，p<0.001）是侧支循环不良发育的显著预测因素。此外，高血压和糖尿病对侧支循环发育有负协同作用（p=0.004 交互作用）。
在 CKD 人群中，高血压和糖尿病可能会对冠状动脉侧支循环的发育产生负面影响。
