胰岛素治疗在冠心病伴糖尿病患者支架置入术后再狭窄的作用——倾向性评分分析

The Treatment of Insulin on In-stent Restenosis among Coronary Heart Disease with Diabetes Mellitus Patients Following Coronary Stent Implantation:A Propensity Score Matching Analysis

目的 运用倾向性评分匹配法（PSM）,分析胰岛素对冠心病（CHD）伴2型糖尿病（DM）支架置入术后再狭窄（ISR）的影响。方法 搜集本院2006年1月至2009年4月接受冠状动脉支架置入术的137例DM患者;根据是否使用胰岛素分为胰岛素组57例,对照组80例。运用PSM对两组患者采用1∶1最邻近匹配法,得到组间协变量均衡的样本。匹配后的样本采用COX比例风险模型评估支架术后再狭窄的危险因素。结果 两组共有36对患者匹配成功,匹配后的两组患者在一般临床资料比较中无统计学差异。胰岛素组中1、3、5年的累计狭窄率分别为21.7%、59.6%和59.6%,对照组为9.1%、37.7%和45.2%,经log-rank检验,差异存在统计学意义（P=0.032）。经COX比例风险模型多因素分析发现,吸烟史（HR：2.32,95%CI：1.35~4.31,P=0.008）、糖化血红蛋白〉7.5%（2.27,1.26~3.68,0.031）、总胆固醇〉5.0 mmol/L（1.89,1.18~3.57,0.034）、肌酐清除率〉90 ml/min（0.36,0.21~0.88,0.027）、冠状动脉多支病变（2.26,1.18~4.29,0.024）和胰岛素治疗（2.27,1.09~4.15,0.041）是CHD伴DM支架术后ISR的独立因素。结论 对于伴有DM的CHD患者,胰岛素治疗是支架置入术ISR的独立危险因素。

Objective To analyze the effect of insulin on in - stent restenosis （ISR） in coronary heart disease （CHD） patients with type 2 diabetes mellitus （DM） following coronary stent implantation based on propensity score matching （PSM）. Methods The analysis was based on a retrospective study on 137 CHD with DM patients who underwent coronary stent implantation at our hospital from January 2006 to April 2009. They are divided into two groups according to the usage of insulin ： the insulin group （ n = 57 ） and the control group （ n = 80 ）. The group covariate were balanced through the PSM function using 1：1 nearest neighbor matching method. Cox Proportional hazards models were applied to identify the independent risk factors for ISR after matching. Results Thirty six pairs of patients were successfully matched. No significant difference was found between the two matched groups in the general clinical features. The 1, 3, and 5 year cu- mulative ISR rates were 21.7% ,59.6% and 59.6% in the insulin group, and 9.1% ,37.7% and 45.2% in the control group respectively. There were statistically significant differences between the two groups by log rank test （ P = 0. 032 ）. Cox proportional hazard model by multivariate analysis found that history of smoking （HR： 2.32, 95% CI： 1.35 -4.31, P = 0. 008）, hemoglobin AIC 〉 7.5% （2.27, 1.26 - 3.68, 0. 031 ）, total cholesterol 〉 5.0mmol/L（ 1.89, 1.18 - 3.57, 0. 034）, creatinine clearance rate 〉 90 ml/min （0.36, 0.21 -0.88, 0. 027） , multiple lesions of coronary artery （2.26, 1.18 -4.29, 0. 024）, and the insulin group （2.27, 1.09 -4.15, 0. 041 ） are independent factors for ISR. Conclusion The application of PSM can effectively balance the covariates of groups in non - randomised study, insulin is an independent risk factor for ISR on the CHD patients with DM following coronary stent implantation.