影响锁骨下动脉支架远期通畅性的危险因素分析

The analysis to risk factors of affecting the long-term patency ratio of stent planted in arteriosclerosis subclavian artery

目的 探讨影响动脉硬化性锁骨下动脉支架远期通畅率的危险因素.方法 用Logistic 回归分析术前白细胞计数、抗血小板药的不坚持服用（即停用3 d以上）、支架放置术后残余狭窄（即直径狭窄率〉20%）、支架放置术前锁骨下动脉病变程度、血脂、血压、血糖等是否是降低支架通畅性的危险因素.用χ2检验及独市样本t检验分析支架通畅组（139例）与非通畅组（15例）术前白细胞计数、抗血小板药的服用、术前锁骨下动脉狭窄或闭塞、支架残余狭窄、血脂、血压、血糖等的统计学差异.用χ2检验术前白细胞计数较高（〉7.08 × 109/L）组（45例）与白细胞计数较低（≤7.08×109/L）组（109例）锁骨下动脉支架通畅率的差异.结果 154例患者术后随访1～4年,锁骨下动脉支架1年通畅率为96.1%（148/154）,3年通畅率为88.5%（69/78）.不坚持服用抗血小板药、支架放置术后残余狭窄是支架通畅率减低的危险因素[OR值分别为5.818（P=0.005,95%CI/为1.688～20.057）及5.253（P=0.014,95%CI为1.391～19.838）].术前白细胞计数增多也是支架通畅率减低的危险因素[OR值为3.135（P〈0.01,95%CI为1.781～5.519）];15例非通畅患者的术前白细胞计数明显高于139例通畅患者（t=-5.008,P〈0.01）,分别为（8.15±1.59）×109/L（5.25×109/L～10.75×109/L）及（6.01±1.36）×109/L（4.07×109/L～8.11×109/L）,同时前者抗血小板药的不坚持服用率及支架残余狭窄发牛率也明显高于后者（P=0.002及P=0.025）.术前白细胞计数较高组及白细胞计数较低组观察结束时支架通畅率分别为71.1%（32/45）及98.2%（107/109）（P〈0.01）.结论 坚持抗血小板药的服用、降低支架放置术后的残余狭窄是提高锁骨下动脉支架远期通畅率的要素;同时不能忽视术前白细胞的增多对锁骨下动脉支架狭窄或阻塞形成的影响.

Objective The discussion of risk factors of affecting the long-term patency ratio of stent planted in arteriosclerosis subclavian artery.Methods To analyse the correlation between preprocedural white blood cell count,antiplatelet agents therapy,residual stenosis in the stent,the preprocedural lesion degree of subclavian artery,serum lipid,blood sugar,blood press et al,and long-term patency of stent by Logistic regression.To explore the significant difference in preprocedural white blood cell count （WBC）,antiplatelet agents therapy,residual stenosis,the preprocedural lesion degree of subclavian artery,serum lipid,blood sugar,blood press and so on between non-patency group （15patients） and patency group （139 patients）.To compare the significant difference of patency ratio of stent at the end of the survey between higher WBC（〉7.08 × 109/L） group （45patients） and lower WBC （≤7.08×109/L） group （109 patients） by χ2-test.Results Among 154 stents planted in subclavian artery,the patency ratio of 1-year was 96.1% （148/154）, and that of 3-year was 88.5% （69/78）.The risk factors of the descended patency ratio of stent are respectively the increasing preprocedural white blood cell count,no antiplatelet agents therapy and residual stenosis[ OR 3.135 （P〈0.001,95%CI 1.781-5.519）;OR 5.818 （P=0.005,95%CI 1.688-20.057） and OR 5.253 （P=0.014,95%CI 1.391-19.838） ].There is the significant difference in preprocedural WBC between non-patency group and patency group （t=-5.008,P〈0.001,（8.15±1.59）×109/L（5.25×109/L-10.75×109/L）V8（6.01±1.36）×109/L（4.07×109/L-8.11×109/L）.And there ale the significant differences in antiplatelet agents therapy and residual stenosis between them （P=0.002 and P=0.025）.At the end of the survey,the patency ratio of stent in subclavian artery of higher and lower WBC group is respectively 71.1% （32/45） and 98.2% （107/109） （P〈0.01）.Conclusion It＇s sustainable antiplatelet agents therapy and decreased residual stenosis the stent that key elements to improve the long-term patency ratio of stent planted in subclavian artery.In addition,pay attention to that increasing white blood cell disturbs the long-term patency ratio of stent.