倾向性评分匹配法评价冠心病支架置入术后再狭窄  

Assessment of in-stent restenosis with coronary heart disease following coronary stent implantation base on propensity score matching method

作　　者：夏芳 刘光华[2] 欧阳强[2] 张焱 石一夫 梁洁 韩荣丽 赵岚 

机构地区：[1]上海市徐汇区大华医院心内科,上海200237 [2]上海交通大学医学院附属新华医院放射介入科,上海200092

出　　处：《中国介入影像与治疗学》2015年第4期218-222,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的 引入倾向性评分匹配法（PSM）比较伴糖尿病的冠心病患者与单纯冠心病患者支架置入术后再狭窄的差异。方法 回顾性分析在本院接受冠状动脉支架植入术患者资料, 伴糖尿病的冠心病患者137例（CHD＋DM组）, 单纯冠心病283例（CHD组）。使用SPSS软件的PSM功能对两组采用1：1最邻近匹配法, 得到组间协变量均衡的样本。匹配后的样本采用Cox比例风险模型评估支架术后再狭窄的危险因素。结果 两组匹配成功各120例。Cox比例风险模型多因素分析, 吸烟史（HR=2.50, 95%CI：1.34-4.64, P=0.004）、高血压史（HR=2.24, 95%CI：1.08-4.63, P=0.030）、肌酐清除率〈110 ml/min（HR=3.12, 95%CI：1.22-5.03, P=0.024）、冠状动脉多支病变（HR=2.15, 95%CI：1.14-4.07, P=0.018）和伴糖尿病（HR=2.22, 95%CI：1.14-4.33, P=0.020）是冠心病支架术后再狭窄的独立危险因素。PSM后, CHD＋DM组1、3、5年的累计狭窄率分别为10.70%, 40.30%和43.80%, CHD组为4.70%, 23.70%和29.60%, 差异有统计学意义（P=0.023）。结论 应用PSM可以有效地均衡非随机研究组间的协变量, 糖尿病是冠心病患者支架置入术再狭窄的危险因素。Objective To compare the difference in in-stent restenosis （ISR） between the coronary heart disease （CHD） with diabetes mellitus （DM） and simplex CHD following coronary stent implantation through the introduction of propensity score matching （PSM）. Methods The analysis was based on a retrospectively data on patients who underwent coronary stent implantation patients. Among them, CHD with DM （CHD＋DM group） patients were 137 cases, simplex CHD （CHD group） patients were 283 cases. The two groups covariate were balanced based on the PSM function of SPSS software using 1：1 nearest neighbor matching method. The Cox Proportional hazards models were applied to identify the independent risk factors for ISR after PSM. Results One hundred and twenty pairs of patients were successfully matched. Cox proportional hazard model by multivariate analysis found that history of smoking （HR=2.50, 95%CI： 1.34—4.64, P=0.004）, history of hypertension （HR=2.24, 95%CI： 1.08—4.63, P=0.030）, creatinine clearance rate〈110 ml/min （HR=3.12, 95%CI： 1.22—5.03, P=0.024）, multiple lesions of coronary artery （HR=2.15, 95%CI： 1.14—4.07, P=0.018）, and DM （HR=2.22, 95%CI： 1.14—4.33, P=0.020） were independent risk factors for ISR in CHD patients. The 1, 3, and 5 years cumulative ISR rates were 10.70%, 40.30% and 43.80% in the CHD＋DM group, and 4.70%, 23.70% and 29.60% in the CHD group, respectively. There were statistically significant differences between the two groups （P=0.023）. Conclusion The application of PSM can effectively balanced the covariates of groups in non-randomised study, DM is a risk factor for ISR for the CHD patients following coronary stent implantation.

关 键 词：冠状动脉疾病 糖尿病 支架再狭窄 倾向性评分匹配 

分 类 号：R541.4[医药卫生—心血管疾病]