冠状动脉介入治疗后再狭窄的多因素分析

Multivariate analysis of clinical factors in restenosis after coronary interventional treatment

目的分析冠状动脉介入治疗后再狭窄和临床易患因素的关系。方法回顾性分析了１０３例（１２８支血管）在我院进行了经皮冠状动脉腔内成形术（ＰＴＣＡ）成功者，并于术后６个月有完整随访资料的病人，通过单因素及多因素方法分析再狭窄与临床因素的关系。结果冠状动脉再狭窄５１支，非再狭窄７７支，总再狭窄率为３９．８％（５１／１２８）。单因素分析中发现，冠状动脉内支架≥３５ｍｍ组和稳定性心绞痛组的再狭窄率较低（３／２９和６／３０，Ｐ＜０．０１和０．０５），而病变Ｂ和Ｃ型与再狭窄呈正相关（４６／５１与５１／７７，Ｐ＜００１）、病变远端有侧支循环（１７／５１与２／７７，Ｐ＜０．０１）、再狭窄与非再狭窄组长病变分别（３８±４２）ｍｍ与（１６±５２）ｍｍ（Ｐ＜０．０１），术前直径狭窄程度分别为（８６±１４）％与（７９±１５）％，（Ｐ＜０．０１）、球囊最大充盈压力分别为（８．３±２．１）ｋＰａ与（７．４±１．７）ｋＰａ（Ｐ＜００１），术前最小管腔直径分别为（０４３±０４１）ｍｍ与（０６６±０４３）ｍｍ，（Ｐ＜００５），术后分别为（２６±０６）ｍｍ与（２９±０６）ｍｍ，（Ｐ＜００５）。多元Ｌｏｇｉｓｔｉｃ回归分析结?

Objective To found the independent predictors for restenosis after coronary interventional treatment.Methods Quantitative angiography was performed in 103 patients(128 successfully dilated lesions)at angioplasty and at 6 month follow up ,and then univariate analysis and multivariate logistic regression analysis were performed to identify correlates of restenosis with clinical factors. Results The total restenosis rate was 39.8%(51 of 128 lesions). According to univariate analysis, the patients who had undergone coronary tenting≥3.5mm had a lower rate of restenosis(3/29 and 6/30) and the others with the ACC/AHA lesion type B and C(46/51 and 51/77), collateral circulation to the obstruction set(17/51 and 2/77) ,high percentage diameter stenosis before PTCA(86±14)% and (79±15)%, and high maximal inflation pressure(8.3±2.1) kPa and (7.4±1.7) kPa had a higher rate of restenosis ( P <0.01).Stable angina showed a low restenosis rate (3/29 and 6/30).The less minimal lumen diameter before(0.43±0.41)mm and (0.66±0.43) mm and after PTCA(2.56±0.55) mm and (2.85±0 59)mm, had the higher the restenosis rate ( P <0 05).Multivariate logistic regression analysis showed that coronary stenting had a low rate of restenosis,and that lesion type B and C, high percentage diameter stenosis before PTCA,high maximal inflation pressure,and male had a high rate of restenosis.Conclusion Coronary stent,percentage diameter stenosis before PTCA,lesion type,maximal inflation pressure, and sex were independent predictors for restenosis.