血清总25羟基维生素D与冠状动脉药物洗脱支架置入术后支架内再狭窄的相关性

Correlation between Serum Total 25 Hydroxyvitamin D and In Stent Restenosis after Drug-eluting Stent Implantation

目的探讨血清总25羟基维生素D与冠状动脉置入药物洗脱支架术后发生支架内再狭窄的关系。方法回顾性分析就诊于中国医科大学附属盛京医院因不稳定型心绞痛于冠状动脉置入药物洗脱支架的患者,患者于术后9～12个月内复查冠状动脉造影,共纳入710例患者,根据复查造影结果分为再狭窄组98人,非再狭窄组612人。所有患者空腹肘静脉采血进行血清总25羟基维生素D及相关化验检查,记录置入支架直径长度、冠状动脉狭窄程度等手术资料。结果再狭窄组患者血清总25羟基维生素D平均水平[(12.86±6.59) ng·mL^(-1)]低于非再狭窄组[(16.47±6.75) ng·mL^(-1)];再狭窄组总胆红素水平、置入支架直径小于非再狭窄组;再狭窄组糖尿病及心梗家族史的比例高于非再狭窄组。多元Logistic回归分析提示血清总25羟基维生素D(OR=0.870,95%CI:0.830～0.913,P<0.001)是支架内再狭窄发生的保护因素。ROC曲线分析显示,血清总25羟基维生素D预测非再狭窄的灵敏度和特异性分别为91.7%及61.2%。结论血清总25羟基维生素D是冠状动脉支架术后支架内再狭窄的独立保护因素。

OBJECTIVE To investigate the relationship between serum total 25 hydroxyvitamin D and in stent restenosis after drug-eluting stent implantation. METHODS A retrospective analysis was performed in the patients who were treated with coronary drug-eluting stent implantation for unstable angina pectoris in Shengjing Hospital of China Medical University. The patients were rechecked by coronary angiography within 9-12 months after the percutaneous coronary intervention. A total of 710 patients were included,98 patients in restenosis group,612 patinets in control group. All patients received fasting blood sampling from elbow vein for serum total 25 hydroxyvitamin D and related laboratory tests. RESULTS The level of total serum 25 hydroxyvitamin D in restenosis group[( 12. 86 ± 6. 59) ng·mL-1]was lower than non-restenosis group[( 16.47± 6.75) ng·mL-1],the total bilirubin level and stent diameter in restenosis group were less than non-restenosis group,and the proportion of diabetes and myocardial infarction family history in restenosis group were higher than non-restenosis group. Multiple logistic regression analysis showed that serum total 25 hydroxyvitamin D( OR = 0. 870,95% CI: 0. 830-0. 913,P < 0. 001) was a protective factor for the occurrence of in stent restenosis. The ROC curve analysis showed that the total serum 25 hydroxyvitamin D had a predictive value for non-restenosis,the sensitivity was 91.7% and the specificity was 61.2%. CONCLUSION Serum total 25 hydroxyvitamin D is an independent protective factor for in stent restenosis after coronary stenting.