经皮冠状动脉腔内成形术后再狭窄病变的进展及预测因子的研究

Study on the development of restenosis after PTCA and its predictors

对冠状动脉成形术（ＰＴＣＡ）后３个月经冠状动脉造影（ＣＡＧ）证实，ＰＴＣＡ实施部位出现中等度（ＡＨＡ分类狭窄度５０％～７５％）狭窄的病例继续追踪一年，观察狭窄病变进展与否，对有关ＣＡＧ所见及临床上诸因子进行比较研究。结果表明，在ＰＴＣＡ后３个月追踪ＣＡＧ的２５７例病人中，ＰＴＣＡ部位出现中等度再狭窄８２例，占全部ＰＴＣＡ病例的３１．９％；其中一年后病变进展的１１例（Ａ组），病变未进展的７１例（Ｂ组）。经ｔ检验，伴有溃疡病变和钙化病变的病人在ＰＴＣＡ前Ａ组明显高于Ｂ组（Ｐ＜０．０５）。通过多元逐步回归分析，ＰＴＣＡ术后６个月内不稳定性心绞痛和血清总胆固醇增高等临床危险因素与ＰＴＣＡ前病变形态的ＡＨＡ分类为Ｃ型病变、钙化、病变血管弯曲度大、冠脉入口病变、ＰＴＣＡ后３个月再狭窄程度、ＰＴＣＡ后冠脉夹层等冠脉造影所见与狭窄病变后期进展有密切关系。而追踪期药物治疗、诸多心血管系统药物对ＰＴＣＡ后慢性期狭窄的进展无明显影响。

This study was aimed at the development of restenosis shown by one year follow up of coronary angiography (CAG) at the same site where moderate restenosis (AHA classification 50%～70% stenosis) was found by CAG three months after PTCA. Moderate restenosis occurred in 82 of 257 patients(31.9%) who had accepted PTCA three months before. Among the 82 patients, development of further restenosis was found in 11 cases (group A), while no further restenosis in the rest (group B). Patients with ulcerative and calcific lesions in group A were more than those in group B. By multivariate stepwise regression, the clinical risk factors of unstable angina within 6 months and high serum cholesterol level after PTCA, and angiographic factors of C type lesions (AHA classification), calcification angular lesions before PTCA, degree of restenosis in three months after PTCA, ostial lesions, and dissection after PTCA had close relations with the late development of restenosis. Drug therapy had no effects on the development of restenosis.