伴有多种危险因素的冠心病患者支架内再狭窄的影响因素

Relevant factors for in-stent restenosis in coronary artery disease patients with multiple risk factors

目的 :分析伴有多种危险因素的冠心病患者发生支架内再狭窄(in-stent restenosis,ISR)的影响因素。方法:收集207例1年前接受冠状动脉介入治疗且伴有2个或2个以上危险因素的冠心病患者,其中100例发生ISR(ISR组),107例无ISR(对照组),分析2组患者的一般资料及实验室检查结果。结果 :ISR的发生与冠心病传统危险因素的多少无关。ISR组患者的糖尿病患病率高于对照组(51%比32%,P=0.01),而ISR组的平均体质量指数(body mass index,BMI)则低于对照组(24.90±3.16和25.91±3.53,P=0.03);同时,ISR组的尿酸[(343.79±103.40)μmol/L比(331.99±84.05)μmol/L,P=0.046]及红细胞分布宽度(red blood cell distribution width,RDW)[(13.88±1.05)%比(13.24±0.74)%,P<0.01)]水平亦均高于对照组。多元回归分析显示,糖尿病、低BMI、高RDW及糖尿病患者使用胰岛素治疗与ISR的发生间有相关性,尿酸不是ISR的独立危险因素,可能与其他危险因素相互作用从而增加了ISR的发生率。结论:糖尿病、低BMI、高RDW可能是冠心病患者发生ISR的危险因素,其中糖尿病患者的胰岛素治疗或可减少ISR的发生率。

Objective： To analyze the relevant factors of in-stent restenosis in coronary artery disease patients undergone successful percutaneous coronary intervention（PCI） one year before. Methods： The demographic and laboratory data of 207 post-PCI patients with 2 or more risk factors of coronary artery disease were retrospectively analyzed. Among these patients, 100 developed in-stent restenosis（ISR）,and the remaining 107 patients without restenosis were served as the control group. Results： The incidence of ISR had no relationship with the number of risk factors for coronary heart disease. The number of diabetic patients in ISR group was more than that in control group（51% vs 32%, P=0.01）, and the average body mass index（BMI） was lower in ISR group than that in control group（24.90±3.16 and 25.91±3.53, P=0.03）.The uric acid level and RDW（red blood cell distribution width） level were higher in ISR group（343.79 ±103.40 vs331.99±84.05, P=0.046; 13.88±1.05 vs 13.24±0.74, P〈0.01）. Logistic regression analysis showed that diabetes, low BMI,higher RDW and insulin treatment were associated with the occurrence of ISR. Conclusion： Diabetes mellitus, higher RDW and low BMI are the risk factors of ISR in coronary artery disease patients with multiple risk factors, while insulin therapy might reduce the incidence of ISR.