中老年冠心病患者冠状动脉药物洗脱支架置入术后支架内再狭窄的相关因素分析  

Analysis of Influencing Factors of In-stent Restenosis after Coronary Artery Drug-eluting Stent Implantation in Middle-aged And Elderly Patients with Coronary Heart Disease

作　　者：谷臣锋 刘剑雄[2] 郑庆昆[2] 付秋玉[2] 刘家勉[2] 谭玲[2] 

机构地区：[1]遵义医学院研究生院,贵州遵义563003 [2]遵义医学院附属成都市第二人民医院心内科,四川成都610017

出　　处：《四川医学》2017年第7期797-801,共5页Sichuan Medical Journal

摘　　要：目的探讨中老年冠心病(CHD)患者冠状动脉(冠脉)药物洗脱支架(DES)置入术后支架内再狭窄(ISR)的相关因素。方法选取2013年1月至2016年9月在成都市第二人民医院心内科导管室经冠脉造影(CAG)确诊为CHD,成功行冠脉内DES置入且在术后1年内完成CAG复查的523例患者。根据CAG复查情况分为ISR(n=90)和非ISR组(n=433)。比较两组患者的一般临床资料、血清学生化指标、术前冠脉病变特征及支架置入情况,分析经皮冠脉介入治疗(PCI)术后1年内(包括1年)发生ISR的影响因素。结果 (1)两组患者性别、年龄、身体质量指数(BMI)、高血压、高脂血症、心律失常、左室射血分数(LVEF)、左室舒张末容积(LVEDV)及收缩末容积(LVESV)比较,差异无统计学意义(P>0.05);术前吸烟及术后吸烟、CHD家族史、服药不规律比较,差异有统计学意义(P<0.05)。(2)两组患者总胆汁酸(TBA)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TCho)、低密度脂蛋白胆固醇(LDL-C)比较,差异无统计学意义(P>0.05);血尿酸(SUA)、胱抑素C(CYS-C)、总胆红素(TBil)比较,差异有统计学意义(P<0.05)。(3)两组患者病变部位、支架长度、单支及双支病变比较,差异无统计学意义(P>0.05);三支病变、支架数量及直径与ISR发生率关系比较;差异有统计学意义(P<0.05)。(4)多因素二元Logistic回归分析显示,术后吸烟、服药不规律、糖尿病、CHD家族史、支架数量及直径、SUA及CYS-C对CHD患者PCI术后发生ISR有统计学意义(P<0.05)。结论术后吸烟、糖尿病、CHD家族史、支架数量及直径、SUA及CYS-C是PCI患者发生ISR的影响因素,而TBil是ISR的保护因素。Objective To explore the influencing factors of in-stent restenosis （ISR）after coronary artery drug-eluting stent（DES） implantation in middle-aged and elderly patients with coronary heart disease（CHD）. Methods 5：23 patients were se- lected who received DES after being diagnosed with CHD by CAG and finished CAG reexamination in one year in Chengdu second people＇s hospital from January 2013 to September 2016. The patients were divided into ISR group （n = 90 ）and non-ISR group （n = 433 ） according to reexamination. The general clinical data, serum biochemical indexes, preoperative coronary lesion characteristics and stent implantation were compared between the two groups and the influencing factors of ISR were analyzed within 1 year（ inclu- ding 1 year） after percutaneous coronary intervention （ PCI ）. Results （1）The difference of gender, age, body mass index （ BMI）, hy- pertension, hyperlipidemia, cardiac arrhythmias, left ventricular ejection fraction （LVEF）, left ventrieular end-diastolic volume（ LV- EDV ）and end-systolic volume （LVESV）between two group was not statistically significant（ P 〉 0.05 ） ;the difference of preopera- tive smoking and postoperative smoking, CHD family history and medication irregular was statistically significant （ P 〈 0.05 ）. （2） There was no significant difference in total bile acid（TBA） ,triglyceride（ TG）, high density lipoprotein cholesterol （HDL-C）, total eholesterol（TCho） and low density lipoprotein cholesterol（LDL-C） between the two groups（ P 〈 0. 05 ）. The levels of serum uric acid（SUA）, cystatin C （CYS-C）and total bilirubin （TBil）were statistically significant （P 〈 0. 05 ）. （3）There was no significant difference in the lesion site, stent length, single and double vessel disease between the two groups （ P 〉 0. 05 ）. There were significant differences in the relationship between the number and diameter of the three vessels, the number of stents and the diameter

关 键 词：冠心病 经皮冠状动脉介入治疗 药物洗脱支架 支架内再狭窄 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]