介入治疗后冠状动脉再狭窄与冠心病易患因素吸烟关系分析  

Risk factors of coronary heart disease and restenosis after transluminal coronary angioplasty and coronary stenting

作　　者：蔡煦[1] 沈卫峰[1] 张大东[1] 张建盛[1] 于金德[1] 龚兰生[1] 

机构地区：[1]上海第二医科大学附属瑞金医院心脏科,200025

出　　处：《上海医学》2000年第8期461-464,共4页Shanghai Medical Journal

摘　　要：目的　探讨国人冠心病介入治疗后再狭窄与冠心病易患因素吸烟关系。方法　冠心病介入治疗35 2例中 ,选择连续 6 5例 (86个冠脉狭窄病变 )术后 3～ 16个月随访重复冠脉造影者 ,冠脉定量分析 (QCA)术前、术后和随访复查冠脉造影图象 ,并分析再狭窄发生率及随访时内径丢失与冠心病易患因素的关系。结果　再狭窄发生时间与吸烟史、多个易患因素、多支病变、病变类型、前降支病变、随访期尿酸呈正性相关 ,与支架置入呈负性相关。吸烟者 (37个病变 ) 16个月再狭窄累计发生率 (88.33 % )高于非吸烟者 (4 9个病变 ,6 6 .49% ,P<0 .0 5 ,Kaplan Meier法和log rank检验 ) ,再狭窄者吸烟量大 ;吸烟史者随访最小内径较小 ,但晚期内径丢失大于非吸烟者。结论　冠心病易患因素与介入后再狭窄发生可能有密切关系 ,多个易患因素特别是吸烟史 。Objective To determine the risk factors, cigarette smoking in relation to restenosis after coronary angioplasty. Methods Quantitative coronary analysis and angiographic characteristics of the lesions were determined in 65 patients with angiographies in pre and post intervention and during follow up in all 352 patients with coronary angioplasty or coronary stenting. Angiographic restenosis was defined as at least 50% of the luminal diameter was stenosed which was seen on the follow up angiogram after initial successful procedure. A multivariate Cox regression analysis was performed to assess the factors correlated with restenosis.Results Restenosis was correlated positively with pre procedure smoking, multiple vulnerable factors, several vessels involvement, types of lesion, LDA involvement, and uric acid level during follow up, but negatively with stent implantation. The cumulative rate of restenosis (88.33%) during 16 months follow up in 27 smoking patients(37 lesions) was higher than that in 38 non smoking patients (49 lesions, 66.49% by Kaplan Meier method and log rank test, P <0.05). The smoking patients had smaller minimal luminal diameter and late loss of lumen than non smokers.Conclusion Restenosis after angioplasty correlates closely with multiple risk factors, in particular, the smoking.(Shanghai Med J, 2000,23∶461 464)

关 键 词：冠状动脉再狭窄 PTCA 吸烟 冠心病 介入疗法 

分 类 号：R541.4[医药卫生—心血管疾病]