冠心病合并2型糖尿病患者冠状动脉支架置入术后支架内再狭窄的影响因素研究  

Influencing Factors of In- stent Restenosis in Postoperative Coronary Artery Disease Patients Complicated With Type 2Mellitus Diabetes Undergoing Coronary Stent Implantation

作　　者：郭一洁[1] 陈宇翔[1] 司全金[2] 

机构地区：[1]解放军总医院,北京市100853 [2]解放军总医院海南分院

出　　处：《实用心脑肺血管病杂志》2016年第3期15-18,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的探讨冠心病合并2型糖尿病患者冠状动脉支架置入术后支架内再狭窄的影响因素。方法选取2011年1月—2014年5月在解放军总医院行经皮冠状动脉介入治疗（PCI）的冠心病合并2型糖尿病患者286例,行冠状动脉支架置入术后随访6~12个月,根据冠状动脉造影结果将患者分为支架内再狭窄组113例和无支架内再狭窄组173例。服用双胍类降糖药物患者停药2 d后进行检查,指标包括血糖、纤维蛋白原、尿酸、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇,记录血糖控制情况、病变血管（左主干、前降支、回旋支、右冠状动脉）及支架置入情况（支架直径、支架长度、支架数量）,并采用多因素logistic回归分析筛选冠状动脉支架置入术后支架内再狭窄的影响因素。结果支架内再狭窄组患者血糖、纤维蛋白原、尿酸、三酰甘油水平高于无支架内再狭窄组,血糖控制率低于无支架内再狭窄组,支架直径小于无支架内再狭窄组,支架长度短于无支架内再狭窄组,支架数量多于无支架内再狭窄组（P〈0.05）;两组患者总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平及病变血管比较,差异无统计学意义（P〉0.05）。多因素logistic回归分析结果显示,血糖〔OR=2.648,95%CI（1.723,3.977）〕、纤维蛋白原〔OR=3.657,95%CI（1.569,7.885）〕、三酰甘油〔OR=4.524,95%CI（2.647,12.024）〕是冠状动脉支架置入术后支架内再狭窄的独立危险因素,血糖控制〔OR=0.524,95%CI（0.203,0.947）〕、支架直径〔OR=0.501,95%CI（0.142,0.995）〕是冠状动脉支架置入术后支架内再狭窄的保护因素（P〈0.05）。结论血糖、纤维蛋白原、三酰甘油是冠心病合并2型糖尿病患者冠状动脉支架置入术后支架内再狭窄的独立危险因素,血糖控制、支架直径是保护因素。Objective To analyze the influencing factors of in- stent restenosis in postoperative coronary artery disease patients complicated with type 2 mellitus diabetes undergoing coronary stent implantation. Methods A total of 286 postoperative coronary artery disease patients complicated with type 2 mellitus diabetes undergoing PCI were selected in the General Hospital of Chinese People’s Liberation Army from January 2011 to May 2014,and they were followed up for 6 to 12 months. According to the examination results of coronary angiography and incidence of in- stent restenosis,all of the patients were divided into A group（ with in- stent restenosis,n = 113） and B group（ without in- stent restenosis,n = 173）. Patients taking metformin withdrawal for 2 days,and then received examination,including FBG,FIB,UA,TC,TG,LDL-C,HDL-C,blood glucose control effect,lesion vessels（ including left main coronary artery, anterior descending branch, circumflex artery and right coronary artery） and stent implantation- related index（ including stent diameter, stent length and number of stents）,multivariate logistic regression analysis was used to analyze the influencing factors of in- stent restenosis in postoperative coronary artery disease patients complicated with type 2 mellitus diabetes undergoing coronary stent implantation. Results FBG,FIB,UA and TG of A group were statistically significantly higher than those of B group,blood glucose control rate of A group was statistically significant lower than that of B group,stent diameter and stent length of A group were statistically significantly shorter than those of B group,while number of stents of A group was statistically significantly more than that of B group（ P 〈 0. 05）; no statistically significant differences of TC, LDL-C, HDL-C or lesion vessels was found between the two groups（ P 〉 0. 05）.Multivariate logistic regression analysis showed that, FBG 〔OR = 2. 648,95% CI（ 1. 723,3. 977） 〕, FIB 〔OR = 3. 657,95% CI（ 1. 569,7. 885） 〕 and TG �

关 键 词：冠心病 糖尿病 2型 冠状动脉再狭窄 影响因素分析 

分 类 号：R514.4[医药卫生—内科学] R587.1[医药卫生—临床医学]