中青年与老年冠心病患者病变特点差异及PCI术后支架内再狭窄的危险因素分析

Difference in pathological characteristics between middle-aged and young patients and elderly patients with coronary heart diseaseand risk factors of in-stent restenosis after PCI

目的探讨中青年与老年冠状动脉粥样硬化性心脏病(冠心病)患者病变特点差异,分析经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的危险因素。方法回顾性分析2021年4月至2023年4月于合肥市第三人民医院接受PCI的170例冠心病患者的临床资料,分为中青年组(年龄<60岁)78例,老年组(年龄≥60岁)92例。比较两组冠状动脉(冠脉)病变特点,分析两组PCI术后发生ISR的危险因素。结果两组患者病变支数、累及血管和冠脉钙化、弥漫性狭窄情况比较,均具有统计学意义(P<0.05);随访显示,中青年组PCI术后ISR发生率为10.26%,老年组ISR发生率为18.48%,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,性别、高血压、饮酒史、吸烟史、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)是中青年冠心病患者PCI术后发生ISR的危险因素;而高血压、糖尿病、饮酒史、吸烟史、TC、LDL-C是老年冠心病患者PCI术后发生ISR的危险因素(P<0.05)。结论中青年、老年冠心病患者的冠脉病变特点存在一定差异,老年冠心病患者病变负担更重,临床上应根据不同年龄段患者病变特点进行针对性干预。

Objective To discuss the difference in pathological characteristics between middle-aged and young patients and elderly patients with coronary heart disease(CHD),and analyze the risk factors of instent restenosis(ISR)after percutaneous coronary intervention(PCI).Methods The clinical materials were retrospectively analyzed in CHD patients undergone PCI(n=170)chosen from the Third People’s Hospital of Hefei City from Apr.2021 to Apr.2023.All patients were divided into middle-aged and young group(aged<60,n=78)and elderly group(aged≥60,n=92).The pathological characteristics of coronary artery were compared between 2 groups,and risk factors of ISR after PCI were analyzed in 2 groups.Results The differences in number of diseased vessels,calcification of involved vessels and coronary artery and diffuse stenosis had statistical significance between 2 groups(P<0.05).The outcomes of follow-up showed that ISR incidence after PCI was 10.26%in middle-aged and young group and 18.48%in elderly group(P>0.05).The results of multi-factor Logistic regression analysis showed that gender,hypertension,drinking and smoking history,total cholesterol(TC)and low-density lipoproteincholesterol(LDL-C)were risk factors for ISR occurrence after PCI in middle-aged and young patients,and hypertension,diabetes,drinking and smoking history,TC and LDL-C were risk factors for ISR occurrence after PCI in elderly patients(P<0.05).Conclusion There are some differences in pathological characteristics between young and middle-aged CHD patients and elderly CHD patients.The lesion burden of CHD is heavier in elderly CHD patients,and targeted intervention can be carried out according topathological characteristics for patients in different ages.