冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的相关危险因素分析  

Risk Factors for in Stent Restenosis after Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

作　　者：罗江宾 王天松 何喜民 冯旭霞[1] 陈其敬[1] 孙乐瑾[3] LUO Jiang-bin;WANG Tian-song;HE Xi-min;FENG Xu-xia;CHEN Qi-jing;SUN Le-jin(Department of Cardiology, Sanya People's Hospital of Hainan Province,Sanya,Hainan,572000,China;Department of Cardiology, Sanya Hospital of Traditional Chinese Medicine of Hainan Province,Sanya,Hainan,572000,China;Department of Intensive Care Unit, Hainan Provincial People's Hospital,Haikou,Hainan,570311,China)

机构地区：[1]海南省三亚市人民医院心内科,海南三亚572000 [2]海南省三亚市中医院心内科,海南三亚572000 [3]海南省人民医院重症医学科,海南海口570311

出　　处：《现代生物医学进展》2019年第15期2966-2969,2983,共5页Progress in Modern Biomedicine

基　　金：海南省卫计委科研项目(13A20357);三亚市医疗卫生科技创新项目(2015YW47)

摘　　要：目的:探究冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的相关危险因素。方法:选取2014年6月~2017年6月期间我院收治的行PCI的CHD患者200例为研究对象,术后随访一年再行冠脉造影检测,根据患者是否发生ISR分为观察组(38例,发生ISR)和对照组(162例,未发生ISR),收集并比较两组患者基线资料及生化指标,采用多因素logistic回归分析CHD患者PCI术后发生ISR的危险因素。结果:观察组吸烟、饮酒、高血压、糖尿病的人数占比、病程及支架直径均高于对照组,差异有统计学意义(P<0.05)。观察组脂蛋白(a)[LP(a)]、纤维蛋白原(FIB)及尿酸(UA)水平显著高于对照组,总胆红素(TBIL)水平显著低于对照组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,吸烟、糖尿病、支架直径(小)以及高水平LP(a)、低水平UA为CHD患者行PCI术后发生ISR的危险因素。结论:CHD患者行PCI术后发生ISR的危险因素有吸烟、糖尿病、支架直径以及高水平LP(a)、低水平UA,因此在PCI术中应尽可能选用较大的支架,同时戒烟、控制血糖有利于预防ISR的发生,定期检测血清LP(a)、UA水平变化,并采取有效的医疗与保健措施能够减少ISR的发生风险。Objective: To explore the risk factors of in stent restenosis(ISR) after percutaneous coronary intervention(PCI) in patients with coronary heart disease(CHD). Methods: 200 patients with CHD undergoing percutaneous PCI in our hospital from June 2014 to June 2017 were selected as subjects. Coronary angiography was performed after one year follow-up. The patients were divided into observation group(38 cases with ISR) and control group(162 cases without ISR) according to whether the patients had ISR. The baseline data and biochemical indicators were collected and compared between the two groups. Multivariate logistics regression analysis was used to analyzed the risk factors for CHD in patients with PCI after ISR. Results: The proportion and duration of smoking, drinking, hypertension, diabetes mellitus and stent diameter in the observation group were higher than those in the control group, the differences were statistically significant(P<0.05). The levels of lipoprotein(a)[LP(a)], fibrinogen(FIB) and uric acid(UA) in the observation group were significantly higher than those in the control group, the level of total bilirubin(TBIL) was significantly lower than that of the control group,the differences were statistically significant(P<0.05). Multivariate logistic regression analysis showed that smoking,diabetes mellitus,stent diameter(small), higher level of LP(a) and lower level of UA were risk factors for ISR after PCI in patients with CHD. Conclusion:The risk factors of ISR in CHD patients after PCI are smoking,diabetes mellitus, stent diameter(small), higher level of LP(a) and lower level of UA. Therefore, large scaffolds should be used as far as possible in PCI, at the same time, giving up smoking and controlling blood sugar are good for preventing the occurrence of ISR. Serum levels of LP(a) and UA are measured regularly, and taking effective medical and health care measures can reduce the risk of ISR.

关 键 词：冠心病 冠状动脉介入治疗 支架内再狭窄 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]