椎动脉狭窄患者介入治疗后再狭窄的影响因素研究

Influencing Factors of Restenosis after Interventional Therapy in Patients with Vertebral Artery Stenosis

背景血管内支架植入术是目前临床治疗椎动脉狭窄的主要方式之一,但患者术后椎动脉再狭窄发生率为10%~48%,严重影响其预后。目前关于椎动脉狭窄患者介入治疗后再狭窄的机制尚未完全明确,且鲜有报道其影响因素的研究。目的分析椎动脉狭窄患者介入治疗后再狭窄的影响因素,以为制定相关临床预防措施提供参考。方法选取2012年12月—2018年12月百色市人民医院收治的行椎动脉介入治疗的椎动脉狭窄患者300例,根据术后门诊随访6个月原病变部位血管狭窄程度分为再狭窄组96例和未再狭窄组204例。比较两组患者的临床资料,并采用多因素Logistic回归分析椎动脉狭窄患者介入治疗后再狭窄影响因素。结果两组患者吸烟率、植入支架类型、椎动脉原始内径、椎动脉狭窄长度、术前椎动脉狭窄率、合并严重钙化者所占比例、术后低密度脂蛋白胆固醇(LDL-C)水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,吸烟[OR=1.832,95%CI(1.106,3.036)]、植入金属裸支架[OR=2.016,95%CI(1.213,3.352)]、椎动脉原始内径<3.5 mm[OR=2.129,95%CI(1.526,4.139)]、合并严重钙化[OR=2.350,95%CI(1.894,4.647)]是椎动脉狭窄患者介入治疗后再狭窄的独立危险因素(P<0.05)。结论吸烟、植入金属裸支架、椎动脉原始内径<3.5 mm、合并严重钙化是椎动脉狭窄患者介入治疗后再狭窄的独立危险因素。

Background Intravascular stent implantation is one of the main clinical methods in the treatment of vertebral artery stenosis,but the incidence of restenosis after surgery is 10%-48%,which will seriously affect their prognosis.At present,the mechanism of restenosis in patients with vertebral artery stenosis after intervention therapy is not completely clear,and there are few reports on its influencing factors.Objective To analyze the influencing factors of restenosis after interventional therapy in patients with vertebral artery stenosis,to provide reference for clinical prevention.Methods From December 2012 to December 2018,300 patients with vertebral artery stenosis who treated with vertebral artery intervention in People’s Hospital of Baise were selected,and they were divided into restenosis group(n=96)and non-restenosis group(n=204)according to the degree of vascular stenosis in the original lesion site was followed-up for 6 months after operation.Clinical data were compared between the two groups,and the influencing factors of restenosis after interventional therapy in patients with vertebral artery stenosis were analysed by multivariate Logistic regression analysis.Results There were statistically siginificant differences in smoking rate,type of stent,original inner diameter of vertebral artery,vertebral artery stenosis length,preoperative vertebral artery stenosis rate,incidence of severe calcification,and postoperative LDL-C level between the two groups(P<0.05).Multivariate Logistic regression analysis results showed that,smoking[OR=1.832,95%CI(1.106,3.036)],bare metal stents were implanted[OR=2.016,95%CI(1.213,3.352)],original inner diameter of vertebral artery<3.5 mm[OR=2.129,95%CI(1.526,4.139)],combined with severe calcification[OR=2.350,95%CI(1.894,4.647)]were risk factors for restenosis after interventional therapy in patients with vertebral artery stenosis(P<0.05).Conclusion Smoking,bare metal stents were implanted,original inner diameter of vertebral artery<3.5 mm,combined with severe calcification are risk factors for restenosis after interventional therapy in patients with vertebral artery stenosis.