冠心病患者药物洗脱支架置入术后支架内再狭窄危险因素分析

Risk factors of in-stent restenosis after drug-eluting stent implantation in patients with coronary atherosclerotic heart disease

目的分析冠心病(冠状动脉粥样硬化性心脏病)患者药物洗脱支架置入术后支架内再狭窄的危险因素。方法收集2017年1月至2018年9月于南京医科大学附属南京医院行冠状动脉药物洗脱支架置入术的120例冠心病患者的临床资料,包括术后12个月随访,行经皮冠状动脉造影复查的情况,根据是否存在支架内再狭窄情况分为再狭窄组(17例)和非再狭窄组(103例)。比较2组基线资料、实验室检查指标水平、心功能情况、靶血管病变情况及置入支架情况,分析冠状动脉药物洗脱支架置入术后支架内再狭窄的危险因素。结果再狭窄组术前吸烟、术后吸烟、糖尿病、冠心病家族史比例和血清纤维蛋白原、血尿酸、胱抑素C水平以及冠状动脉Gensini积分、三支病变比例、术前狭窄程度均高于非再狭窄组,置入支架数量多于非再狭窄组[(1.9±1.1)个比(1.4±0.8)个],支架直径小于非再狭窄组,支架长度长于非再狭窄组[(30±8)mm比(24±9)mm],规律用药比例、血清总胆红素水平低于非再狭窄组[58.8%(10/17)比92.2%(95/103),(11±4)μmol/L比(15±6)μmol/L](均P<0.05)。Logistic回归分析结果表明,术前吸烟、术后吸烟、糖尿病、置入支架长度、冠心病家族史、血清胱抑素C水平均为支架内再狭窄的危险因素,规律用药和血清总胆红素水平为支架内再狭窄的保护因素(均P<0.05)。结论吸烟、糖尿病、置入支架长度、冠心病家族史和血清胱抑素C水平为支架内再狭窄的危险因素,规律用药和血清总胆红素水平为支架内再狭窄的保护因素。

Objective To analyze the risk factors of in-stent restenosis after drug-eluting stent implantation in patients with coronary atherosclerotic heart disease(CHD).Methods From January 2017 to September 2018,clinical datas of 120 patients with CHD who underwent coronary artery drug-eluting stent implantation in Nanjing First Hospital,Nanjing Medical University were collected.They were followed up for 12 months after the operation.According to whether there was restenosis in the stent,the patients were divided into restenosis group(17 cases)and non restenosis group(103 cases).The baseline data,laboratory indexes,cardiac function,target vessel disease and stent implantation were compared between the two groups,and the risk factors of restenosis after drug-eluting stent implantation were analyzed.Results The preoperative smoking,postoperative smoking,diabetes mellitus,rate of CHD family history,serum fibrinogen,blood uric acid,cystatin C levels,Gensini score of coronary artery,proportion of three vessel lesions and degree of preoperative stenosis in restenosis group were higher than those in non restenosis group(all P<0.05).The number of stents inserted was more[(1.9±1.1)vs(1.4±0.8)],stent diameter was less,stent length was longer[(30±8)mm vs(24±9)mm]in restenosis group than those in non restenosis group(all P<0.05).The proportion of regular medication and serum total bilirubin level in restenosis group were lower than those in non restenosis group[58.8%(10/17)vs 92.2%(95/103),(11±4)μmol/L vs(15±6)μmol/L](all P<0.05).Logistic regression analysis showed that preoperative smoking,postoperative smoking,diabetes,stent length,CHD family history and serum cystatin C level were risk factors for in-stent restenosis,regular medication and total bilirubin level were protective factors for in-stent restenosis(all P<0.05).Conclusion Smoking,diabetes mellitus,stent length,family history of CHD and serum cystatin C level were risk factors for in-stent restenosis,regular medication and serum total bilirubin level were protective factors for in-stent restenosis.