冠状动脉支架内再狭窄的危险因素分析  

The Analysis of Risk Factors in the Case of Coronary Artery In-Stent Restenosis

作　　者：蒯铮[1] 樊冰[1] 卜丽萍[1] 钱菊英[1] 王齐兵[1] 葛雷[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海市心血管病研究所,上海200032

出　　处：《中国临床医学》2008年第5期585-587,共3页Chinese Journal of Clinical Medicine

基　　金：国家863重大课题基金资助(编号:2006AA02A406)

摘　　要：目的:探讨冠状动脉支架内再狭窄的危险因素。方法:将205例患者根据冠状动脉造影结果分为支架内再狭窄组(n=169)及非支架内再狭窄组(n=36),并根据支架内是否闭塞及Mehran分型进行亚组分析。采用单因素及Logistic多因素回归分析临床特征及冠状动脉造影特征与再狭窄的关联。结果:单因素分析显示:①支架内再狭窄组的需要胰岛素治疗的糖尿病、长病变及多支病变患者比例高于非支架内再狭窄组(P值分别为0.047/0.027/<0.001);②术后发生支架内闭塞的组别中需要胰岛素治疗的糖尿病患者比例及术前狭窄程度均高于术后未发生支架内闭塞的组别(P分别为0.024/0.013);③术后再狭窄的程度(根据Mehran分型)较严重的组别中需要胰岛素治疗的糖尿病患者及分叉病变的患者比例增高(P值分别为0.040/0.001)。Logistic多因素分析证实多支病变为支架内再狭窄的独立的危险性预测因素,比值比为33.409,对有无支架内再狭窄的判对率为97.2%。结论:多支病变为支架内再狭窄的独立的危险性预测因素;需要胰岛素治疗的糖尿病及长病变可能与支架内再狭窄发生相关;需要胰岛素治疗的糖尿病及术前狭窄程度较重可能与术后支架内闭塞相关;需要胰岛素治疗的糖尿病及分叉病变可能与再狭窄的严重程度相关。Objective：Analyse the risk factors in the case of coronary artery in-stent restenosis （ISR）. Methods：Divide 205 patients into non-ISR group（n = 36） and ISR group（n = 169）. The latter was further divided into certain subgroups. Study the re lationship between ISR and factors influencing clinical features and coronary angiographic characteristics by means of univariate analysis and logistic regression analysis. Results： Univariate analysis showed ①the proportion of need for insulin therapy among diabetic patients, long vessel lesion and multivessel coronary disease were higher in ISR group versus non-ISR group （P = 0.047/0.027/〈0.001 ）;②the proportion of need for insulin therapy among diabetic patients and degree of previously stenosis lesion were higher in occlusive lesion group versus non-occlusive lesion group （P = 0. 024/0. 013）; ③the proportion of need for insulin therapy among diabetic patients and bifurcative vessel lesion were higher in severe type （according to Mehran classification） （P = 0. 040/0. 001）; however, logistic regression analysis revealed that there was negative correlation between multivessel coronary disease and ISR（OR = 33. 409）. Conclusion： Multivessel coronary disease is the independent risk factor of ISR. The need for insulin therapy among diabetic patients and long vessel lesion are probably linked to ISR; the need for insulin therapy among diabetic patients and degree of previously stenosis lesion are probably linked to occlusive ISR; the need for insulin therapy among diabetic patients and bifurcative vessel lesion are probably linked to high risk type according to Mehran classification.

关 键 词：支架内再狭窄 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]