经皮冠状动脉介入治疗术后发生支架内再狭窄的冠心病患者心血管危险因素分析  

Comparative analysis of cardio-metabolic risk factors in coronary artery disease patients with in-stent restenosis after percutaneous coronary intervention

作　　者：周迎生[1] 苏申慧 汤雅迪 史晓鹏 赵一楠[1] Zhou Yingsheng;Su Shenhui;Tang Yadi;Shi Xiaopeng;Zhao Yinan(Department of Endocrinology and Metabolism,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院内分泌代谢科,北京市心肺血管疾病研究所,100029

出　　处：《中华老年医学杂志》2020年第4期386-390,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(81641027);北京市学科带头人基金资助项目(2013-2-006);北京市科委科研基金资助项目(Z131100004013044);北京市保健科研课题项目(京15-11号)。

摘　　要：目的:分析冠心病患者经皮冠状动脉介入治疗术(PCI)后发生支架内再狭窄(ISR)时心血管危险因素。方法:回顾性分析2010——2017年在北京安贞医院完成首次(T1)经PCI,并随访复查(T2)冠状动脉造影的冠心病患者169例。依据患者随访再次行冠状动脉造影复查结果,其中ISR为66例,对照组为非再狭窄者(NISR)103例。将患者再分为老年再狭窄组(E-ISR,17例)和对照组(E-NISR,19例)以及中青年再狭窄组(Y-ISR,49例)和对照组(Y-NISR,84例)。收集患者在两次住院期间的病史、化验检查、造影报告等临床资料,分析组间或不同年龄间心血管危险因素及冠状动脉血管病变的临床特点。结果:与对照组相比,ISR组患者T2时期收缩压、糖化血红蛋白(HbA1c)、空腹血糖(FBG)、合并糖尿病比例、既往心梗病史、Gensini评分及3支病变比例较高[(128.6±16.4)mmHg与(123.4±10.7)mmHg(1 mmHg=0.133 kPa),P=0.023;(7.0±1.6)%与(6.2±0.9)%,P<0.001;6.6 mmol/L与5.7 mmol/L,P<0.001;53.0%与31.1%,P=0.004;36.4%与20.4%,P=0.022;40与29分,P=0.010;57.6%与40.8%,P=0.033]。老年患者收缩压高、肾小球滤过率低[(135.9±27.)mmHg与(124.1±10.8)mmHg,P=0.013;(77.5±14)ml·min^-1·1.73 m^-2与(84.8±9.4)ml·min^-1·1.73 m^-2,P=0.033],而中青年则高血压病程长以及低密度脂蛋白、HbA1c、Gensini评分高[129.7个月与83.1个月,P=0.008;(2.78±1.08)mmol/L与(2.31±0.65)mmol/L,P=0.002;(7.2±1.7)%与(6.1±0.9)%,P<0.001;41分与29分,P=0.009]。结论:老年与中青年冠心病患者PCI术后发生ISR的临床特征不同,应积极控制血压、血脂、血糖等代谢危险因素。Objective To analyze the characteristics of cardio-metabolic risk factors coronary artery disease(CAD)patients with in-stent restenosis(ISR)after percutaneous coronary intervention(PCI).Methods A total of 169 patients undergone primary(T1)PCI and followed up and rechecked by coronary angiography(T2)in our hospital from 2010 to 2017 were enrolled.According to the results of coronary angiography during follow-up,patients were divided into the ISR group(n=66)and the control group(non-ISR or NISR,n=103).Patients were sub-grouped into the elderly ISR group(the E-ISR group,n=17),the elderly non-ISR group(the E-NISR group,n=19),the young ISR group(the Y-ISR group,n=49)and the young non-ISR group(the Y-NISR group,n=84).Clinical data including medical history,laboratory results,and coronary angiography records during the two hospital stays were collected.Cardio-metabolic risk factors and clinical features of coronary artery disease were analyzed for the groups.Results The levels of systolic blood pressure,glycated hemoglobin A1c(HbA1c),fasting blood glucose(FBG),the percentage of patients with diabetes or myocardial infarction(MI)history,the coronary Gensini score and the percentage of patients with triple vessel disease were higher in the ISR group than in the NISR group(128.6±16.4)mmHg vs.(123.4±10.7)mmHg,P=0.023;(7.0±1.6)%vs.(6.2±0.9)%,P<0.001;6.6 mmol/L vs.5.7 mmol/L,P<0.001;53.0%vs.31.1%,P=0.004;36.4%vs.20.4%,P=0.022;40 vs.29,P=0.01;57.6%vs.40.8%,P=0.033.The E-ISR group had higher systolic blood pressure and a lower glomerular filtration rate than the E-NISR group(135.9±27.2)mmHg vs.(124.1±10.8)mmHg,P=0.013;77.5±14.4 ml·min^-1·1.73 m^-2vs.(84.8±9.4)ml·min^-1·1.73 m^-2,P=0.033,but the Y-ISR group had longer hypertension history,higher levels of low-density lipoprotein and HbA1c,and higher Gensini scores than the Y-NISR group[129.7 months vs.83.1 months,P=0.008;(2.78±1.08)mmol/L vs.(2.31±0.65)mmol/L,P=0.002;(7.2±1.7)%vs.(6.1±0.9)%,P<0.001;41 vs.29,P=0.009].Conclusions Clinical features are different bet

关 键 词：冠心病 冠状动脉再狭窄 

分 类 号：R541[医药卫生—心血管疾病]