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冠心病合并糖尿病患者药物洗脱支架置入后2年支架内再狭窄的预测因素 被引量:14

Predictors of in-stent restenosis in coronary heart disease patients complicating with diabetes mellituswithin 2 years after drug-eluting stents implantation
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摘要 目的分析冠心病合并糖尿病患者首次置人药物洗脱支架(DES)后发生支架内再狭窄(ISR)的预测因素,并建立预测模型。方法回顾性分析2005年1月至2012年12月在我院置人DES的冠心病合并糖尿病患者的临床资料。应用SPSS17.0软件产生的随机数字,将3073例患者随机分为模型产生队列和模型验证队列。模型产生队列(2048例)又分为再狭窄组和对照组,对2组之间差异有统计学意义的临床指标进行单因素和多因素logistic回归分析;按/3回归系数所占的比重给多因素logistic回归分析中有统计学意义的指标赋予分值,并建立评分模型。在模型验证队列(1025例)中进行模型预测能力的验证。结果217例(7.1%)糖尿病患者在首次置入DES后2年诊断ISR,模型产生队列中ISR患者共149例(7.3%)。多因素logistic回归分析显示,糖尿病患者首次置入DES后2年发生ISR的预测因素为多支病变(OR=3.69,95%CI:2.65~8.93,P=0.000)、弥漫病变(OR=2.92,95%CI:2.03~6.46,P=0.000)、肾小球滤过率〈60ml·min一·1.73m。(OR=4.73,95%CI:3.51—10.62,P=0.000)、吸烟(OR=3.37,95%CI:2.39~8.46,P=0.000)、年龄〈60岁(0R=1.44,95%CI:1.26~4.63,P=0.024)以及糖化血红蛋白≥6.3%(()尺=2.48,95%C1:1.84~4.27,P=0.002)。模型验证队列患者的评分显示,ISR发生率随评分增加而增加;评分为5.5时,模型预测的灵敏度和特异度分别为76.5%(95%叫:64.6%~85.9%)和76.1%(95%CI:73.2%~78.7%),受试者工作特征(ROC)曲线下面积为0.851(95%CI:0.813~0.890,P=0.000)。结论冠心病合并糖尿病患者置人DES后2年的ISR发生率较低,多种预测因素与其相关。评分模型对DES置人后的ISR有较好的预测能力。 [ Abstract] Objective To determine predictors for in-stent restenosis (ISR) within 2 years after drug-eluting stent (DES) implantation in coronary heart disease patients complicating with diabetes mellitus and to establish predictive model. Methods We retrospectively analyzed clinical data of patients underwent DES implantation in our hospital between January 2005 and December 2012. Using random number generated by SPSS 17.0, a total of 3 073 cases were randomly divided into two cohort, model derivation cohort (MDC) and model validation cohort (MVC). MDC (2 048 cases) was divided into in-stent restenosis (ISR) group and control group. Predictors were identified using univariable and muhivariable logistic regression analysis in MDC. Integer point values were assigned to each predictor based upon their β coefficient in muhivariable logistic regression model to establish scoring model. The summed scores of each case in MVC ( 1 025 cases ) were calculated to test predictive ability of the model. Results Of all these 3 073 cases, 217 cases (7. 1% ) were diagnosed with ISR within 2 year after DES implantation. The incidence of ISR within 2 year after DES implantation was 7.3% ( 149 cases) in MDC and logistic regression analysis identified six ISR risk factors: multiple target vessels ( OR = 3.69, 95% CI: 2. 65 - 8.93, P =0.000), diffused lesions (OR =2.92, 95%CI: 2. 03 -6.46, P=0.000), GFR 〈60 ml ~ rain-' 1.73 m-2 (0R=4.73, 95% CI: 3.51- 10.62, P =0.000), smoking (OR =3.37, 95%Cl: 2.39- 8.46, P = 0. 000), age 〈 60 years old ( OR = 1.44, 95% CI: 1.26 - 4.63, P = 0. 024) , HbAlc I〉 6. 3% (OR =2.48, 95% CI: 1.84 -4. 27, P = 0. 002). Risk score was well associated with the rate of ISR in MVC. Sensitivity was 76. 5% (95% CI: 64. 6% - 85.9% ) , specificity was 76.1% (95% CI: 73.2% - 78.7% ) , and areas under the ROC curve was 0. 851 ( 95% CI: 0. 813 - 0. 890, P = 0. 000 ) when score was set at 5.5. Conclusions The incidence of ISR in coronary heart disease patients complicating with diabetes mellitus within 2 years after DES implantation is relatively low. Several factors are associated with ISR in these patients and risk for ISR could be reliably identified by the established scoring model.
出处 《中华心血管病杂志》 CAS CSCD 北大核心 2014年第1期14-18,共5页 Chinese Journal of Cardiology
基金 国家科技部支撑计划(2009BA186804) 解放军总医院博士创新基金(12BCZ07)
关键词 支架 糖尿病 预测 Stents Diabetes mellitus Forecasting
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