CYP2C19中代谢型急性冠脉综合征患者PCI术后支架内再狭窄的影响因素分析  

Clinical influencing factors of in-stent restenosis in acute coronary syndrome patients with CYP2C19 intermediate metabolize

作　　者：吴天源[1] 李韶南[1] 罗义[1] 吕磊[1] 孙少喜[1] 

机构地区：[1]广州市第一人民医院心血管内科,广东省广州市510180

出　　处：《中国心血管病研究》2017年第12期1098-1101,共4页Chinese Journal of Cardiovascular Research

基　　金：广东省医学科学技术研究基金项目（项目编号：201611119319867）;

摘　　要：目的 探讨CYP2C19中代谢型急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后发生支架内再狭窄（ISR）的临床影响因素.方法 选取2014年1月到2016年4月入住心内科的ACS患者308例进行CYP2C 19基因多态性检测,其中入选120例CYP2C 19中代谢型患者,术后随访12个月并返院复查冠脉造影.ISR判断标准为原病变冠脉直径狭窄程度≥50％,按有无再狭窄分为ISR组38例和无再狭窄组82例,应用多因素Logistic回归模型对20个临床资料、血清学指标、造影结果和支架使用等因素进行回顾性分析.结果 Logistic多因素回归分析显示,影响CYP2C19中代谢型ACS患者PCI术后发生ISR的危险因素中,糖尿病、高尿酸、长病变、钙化病变、支架长度较长（＞20 mm）、支架植入数多是ISR发生的独立危险因子（OR=1.338、2.468、3.788、11.386、4.182、2.916,P＜0.05）,高hs-CRP也是危险因子（OR=4.183,P=0.068）;而较高总胆红素水平、支架直径较大（＞3 mm）是ISR的独立保护因子（OR =0.428、0.486,P＜0.05）.结论 糖尿病、高尿酸、复杂病变、支架长度较长（＞20 mm）、支架植入数多等可增加ISR发生的危险性,而较高总胆红素水平、支架直径较大（＞3 mm）则减少ISR的发生.Objective To explore the clinical influencing factors of in-stent in acute coronary syndrome patients with CYP2C19 Intermediate Metabolize.Methods The CYP2C19 gene polymorphism was detected in 308 patients with ACS who were admitted to Department of cardiology from January 2014 to April 2016,among them,120 patients with CYP2C19 Intermediate metabolize were enrolled.The PCI patients were followed up for 12 months and the coronary angiography was performed at our hospital.ISR standard was more than 50% of coronary artery lesion compared with the original diameter.The patients were divided into ISR group（n=38） and no restenosis group （n=82） according to absence or presence of in-stent restenosis.Multivariate Logistic regression was used to identify independent relative factors among 20 clinical data,serological indexes,angiographic findings and stent use for INR were analyzed retrospectively.Results Multivariate Logistic regression analysis showed that independent risk factors for occurrence of ISR were Diabetes mellitus,hyperuricemia,long lesion,calcification lesion,long stent length （〉20 mm） and more stent implantation （OR =1.338、2.468、3.788、11.386、4.182、2.916,P〈0.05）.High hs-CRP also is a risk factor（OR=4.183,P=0.068）.The higher total bilirubin level and larger stent diameter （〉3 mm）were found to be an independent protective factors of ISR （0R=0.428、0.486,P〈0.05）.Conclusion Diabetes mellitus,hyperuricemia,complicated lesions,longer stent length（〉20 mm）,and more stent implantation may promote the occurrence of ISR,whereas higher total bilirubin levels and larger stent diameter （〉3 mm） may reduce the occurrence of ISR

关 键 词：急性冠脉综合征 基因多态性 CYP2C19 支架内再狭窄 危险因素 

分 类 号：R543.3[医药卫生—心血管疾病]