行经皮冠状动脉介入治疗的冠状动脉粥样硬化性心脏病患者肾功能与冠状动脉支架再狭窄的关系

Association between renal function and in-stent restenosis of coronary artery in coronary artery disease patients who underwent percutaneous coronary intervention

目的探讨行经皮冠状动脉介入治疗(PCI)的冠状动脉粥样硬化性心脏病(CAD)患者肾功能与冠状动脉支架再狭窄(ISR)的关系。方法纳入行PCI且接受冠状动脉造影随访的CAD患者170例,根据PCI术后是否发生ISR分为ISR组21例与非ISR组149例。收集两组患者的临床资料、实验室检查指标、心脏超声及冠状动脉造影检查结果、PCI治疗情况并进行比较。ISR的危险因素分析采用多因素logistic回归分析。结果170例患者共有PCI血管213条,发生ISR患者21例,发生ISR血管27条,发生率为12.68%。ISR组患者女性比例高于男性。ISR组患者血清肌酐水平高于非ISR组,估算的肾小球滤过率(eGFR)及eGFR≥60 ml·min-1·(1.73 m 2)-1、eGFR≥90 ml·min-1·(1.73 m 2)-1患者比例、后扩张压力均低于非ISR组(P<0.05)。多因素logistic回归分析结果显示,血清肌酐水平升高和eGFR降低均为ISR的独立危险因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,血清肌酐预测ISR的ROC曲线下面积>eGFR,对于诊断ISR具有一定的临床意义。结论肾功能与行PCI的CAD患者冠状动脉ISR的发生有关,血清肌酐对于诊断冠状动脉ISR具有一定的临床价值,肌酐水平越高,发生ISR的风险越大。

Objective To evaluate the association between renal function and in-stent restenosis(ISR)of coronary artery in coronary artery disease(CAD)patients who underwent percutaneous coronary intervention(PCI).Methods A total of 170 CAD patients who underwent PCI and coronary angiography follow-up were included.According to whether ISR occurred after PCI,they were divided into ISR group(21 cases)and non-ISR group(149 cases).Clinical data,results of laboratory,cardiac ultrasound and coronary angiography,PCI treatment condition were collected and compared between the 2 groups.Risk factors of ISR were analyzed by multivariate logistic regression analysis.Results Among the 170 patients,there were 213 PCI vessels.ISR occurred in 21 patients,and there were 27 ISR vessels,the incidence was 12.68%.The proportion of female in ISR group was higher than that of male.The serum creatinine level in ISR group was higher than that in non-ISR group,while the level of eGFR,the proportion of patients with eGFR≥60 ml·min-1·(1.73 m 2)-1 and eGFR≥90 ml·min-1·(1.73 m 2)-1,the postdilation pressure were lower than those in the non-ISR group(P<0.05).Multivariate logistic regression analysis showed that serum creatinine level and eGFR were the independent risk factors for ISR(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under ROC curve of serum creatinine in predicting ISR was higher than eGFR,which had certain clinical significance for the diagnosis of ISR.Conclusion Renal function is associated with ISR of coronary in CAD patients who underwent PCI,serum creatinine has certain clinical value in the diagnosis of coronary ISR.The higher the creatinine level,the greater the risk of ISR.