急性冠脉综合征经皮冠脉介入治疗后无复流现象及支架内再狭窄的危险因素分析  

Risk factors of no reflow and in-stent restenosis after percutaneous coronary intervention in patients with acute coronary syndrome

作　　者：李庆军[1] 吴庆法 冯明瑞[1] 温志桥[1] 李泽林[1] 李娟[1] 刘善铭[1] 

机构地区：[1]湛江中心人民医院心血管内科,广东湛江524000

出　　处：《中国临床研究》2017年第5期635-639,共5页Chinese Journal of Clinical Research

摘　　要：目的探究急性冠脉综合征(ACS)经皮冠脉介入(PCI)治疗后无复流现象及发生支架内再狭窄的相关危险因素。方法收集2016年4月至2016年10月收治的接受PCI治疗的136例ACS患者的临床资料,根据管腔狭窄情况分为甲组(冠脉无狭窄组)和乙组(冠脉狭窄组),根据冠状动脉造影(TIMI)血流分级标准分为丙组(血流正常组)和丁组(无复流组)。采用单因素和多因素Logistic逐步回归分析无复流现象与发生支架内再狭窄的相关危险因素。结果单因素分析显示,乙组吸烟、糖尿病史、心肌梗死、脑卒中、高脂血症的发生率显著高于甲组(P<0.05,P<0.01),血小板计数、心功能Killip分级以及术前狭窄程度均显著高于甲组(P均<0.01),两组间临床诊断分布差异有统计学意义(P<0.01)。丁组糖尿病史、心肌梗死、脑卒中、白细胞增多的发生率显著高于丙组(P<0.05,P<0.01),血小板计数、心功能Killip分级、术前狭窄程度、支架直径以及支架长度也均显著高于丙组(P<0.05,P<0.01),两组间临床诊断和冠脉病变部位分布差异有统计学意义(P均<0.05);多因素Logistic逐步分析显示,吸烟、术前狭窄程度和临床诊断为支架内再狭窄的影响因素;糖尿病史、白细胞增多、术前狭窄程度、心功能Killip分级>2级为无复流现象的影响因素。结论吸烟、术前狭窄程度越高以及临床诊断为不稳定性心绞痛和非ST段抬高心肌梗死均是支架内再狭窄的独立危险因素,而糖尿病史、存在白细胞增多、术前狭窄程度高、心功能Killip分级>2级均是无复流现象的独立危险因素。Objective To explore the risk factors of no reflow and in-stent restenosis after percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）. Methods The clinical data, coronary artery lesions and stent implantation data of 136 ACS patients undergoing PCI between April 2016 and October 2016 were collected. The patients were divided into no-stenosis group, stenosis group according to the degree of lumen stenosis and normal blood flow group and no reflow group according to Thrombolysis in Myocardial Infarction （TIMI） blood flow classification. Univariate and multivariate Logistic stepwise regression analysis were used to analyze the risk factors of no reflow and in-stent restenosis. Results Univariate analysis showed that （1） smoking, diabetes history, myocardial infarction, stroke, hyperlipidemia in stenosis group were significantly more than those in no- stenosis group （ P 〈 0. 05, P 〈 0. 01 ） ; platelet count, Killip classification for heart function and stenosis degree before PCI in stenosis group were significantly higher than those in no-stenosis group（ all P 〈 0. 01 ） ; there was significant difference in clinical diagnosis between two groups （ P 〈 0. 01 ）. （2） diabetes history, myocardial infarction,stroke and leucocytosis in no reflow group were significantly more than those in normal blood flow group （ P 〈 0. 05, P 〈 0. 01 ） ; platelet count, Killip classification for heart function, stenosis degree before PCI, diameter and length of stent in no reflow group were significantly higher than those in normal blood flow group （P 〈 0. 05 ,P 〈 0. 01 ） ;there were significant differences in clinical diagnosis and coronary lesions position （all P 〈 0. 05 ）. Multivariate Logistic stepwise regression analysis showed that smoking, stenosis degree before PCI and clinicaldiagnosis were the influence factors of in-stent restenosis ; diabetes mellitus, leucocytosis, stenosis degree before PCI, Killip classification of heart function

关 键 词：急性冠脉综合征 经皮冠脉介入治疗 无复流 再狭窄 危险因素 

分 类 号：R543.3[医药卫生—心血管疾病]