红细胞分布宽度预测2型糖尿病患者支架内再狭窄

Relationship between red blood cell distribution width and in stent restenosis in type 2 diabetes patients

目的探讨红细胞分布宽度(RDW)对皮冠状动脉介入治疗(PCI)的2型糖尿病患者植入药物洗脱支架后发生支架内再狭窄(ISR)的预测价值。方法回顾性分析因不稳定型心绞痛入院、行PCI治疗植入药物洗脱支架的582例2型糖尿病患者的临床资料,其中292例在支架植入术后进行了冠状动脉造影随访,平均随访8个月。根据冠状动脉造影检查结果,将患者分为支架内再狭窄组(n=45)和非再狭窄组(n=247)。详细记录患者病史资料(年龄、性别、吸烟、既往病史)、实验室检查结果(RDW、C反应蛋白水平等),以及心脏彩超、冠状动脉造影等结果。结果 ISR组体质指数和吸烟史均比非ISR组高(P<0.05)。ISR组RDW、C反应蛋白水平在入院和随访时均比非ISR组高。与非ISR组相比,ISR组的支架长度更长、直径更小。单因素分析显示,RDW与ISR呈正相关(P<0.01)。多元回归分析显示,体质指数、吸烟、RDW、C反应蛋白、支架长度、支架直径是药物洗脱支架ISR的预测因子(P<0.01)。结论糖尿病患者在具备同样的危险因素情况下,RDW对植入药物洗脱支架的不稳定型心绞痛患者发生ISR有预测作用,慢性炎症参与了ISR的形成过程。

Aim To explore the predictive value of red blood cell distribution width（RDW） for in-stent restenosis（ISR） after coronary stenting with drug-eluting stent（DES） in patients of type 2 diabetes. Methods The study retrospectively searched data at Tianjin Nankai Hospital for 582 unstable angina pectoris patients with type 2 diabetes who underwent PCI from January 2012 to December 2016. Among these patients,292 patients with coronary DES implantation were enrolled in this study. The ISR was analyzed by coronary angiography analysis at a mean follow-up of eight months.According to whether ISR was detected,type 2 diabetes patients were divided into two groups： the ISR group（n = 45） and the non-ISR group（n = 247）. Patients＇ clinical and demographic characteristics were recorded including age,gender,smoking,anamnesis,RDW,C-reactive protein（CRP）,cardiac ultrasound,coronary angiography,and so on.Results The body mass index（BMI） levels were higher in the ISR group than that in the non-ISR group（P〈0.05）.Patients with ISR had higher smoking rates（P〈0. 05）. In addition,patients in the ISR group had significantly higher RDW levels compared with patients in the non-ISR group both at admission and at follow-up（P〈0. 01,respectively）.Furthermore,the ISR group had significantly longer stent length and lower stent diameter compared with the non-ISR group（P〈0.01,respectively）. In an univariate model using RDW as a continuous variable,there was a significantly positive association between RDW levels and the incidence of ISR（P〈0.01）. Further multivariate logistic regression analysis revealed that BMI,smoking,RDW,CRP,stent length,and stent diameter were associated independently with ISR.Conclusion Elevated RDW has predictive value for ISR occurrence in type 2 diabetes patients with coronary DES implantation,which indicates that a chronic inflammatory response might be involved in the pathogenesis of ISR.