首次和重复经桡动脉冠状动脉介入术后桡动脉无鞘区急慢性损伤的光学相干断层成像比较  

Comparison of acute and chronic non-sheathed radial artery injury between the first and repeat transradial intervention by optical coherence tomography

作　　者：牛丹[1] 华琦[2] 柳子静 李紫旋 宋佳慧 闫蕊 王国忠[1] 张利彬[1] 郭金成[1] Niu Dan;Hua Qi;Liu Zijing;Li Zixuan;Song Jiahui;Yan Rui;Wang Guozhong;Zhang Libin;Guo Jincheng(Department of Cardiology,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China;Department of Cardiology,Xuanwu Hospital,Capital Medical University,Beijing 100054,China)

机构地区：[1]首都医科大学附属北京潞河医院心内科,北京101149 [2]首都医科大学宣武医院心内科,北京100054

出　　处：《首都医科大学学报》2020年第3期464-469,共6页Journal of Capital Medical University

基　　金：首都卫生发展科研专项项目(2018-2-7082)。

摘　　要：目的利用光学相干断层成像(optical coherence tomography,OCT)对经皮桡动脉冠状动脉介入(transradial intervention,TRI)术后桡动脉无鞘区(non-sheathed radial artery,NSRA)急慢性损伤进行评估。方法 2016年2月至2017年9月有162例患者在OCT指导下完成TRI后对NSRA进行OCT检查,根据患者有无TRI史分为重复TRI组(n=31)和首次TRI组(n=131),对比两组急性损伤(内膜撕裂、夹层、穿孔、血栓和痉挛)发生率和慢性损伤指标差异,包括内膜面积、管腔狭窄率(percentage of lumen narrowing,%LN)、血管内膜与中膜厚度比值(intima-media ratio,IMR)和内膜厚度指数(intimal thickness index,ITI)。结果 NSRA急性损伤发生率为31.5%,重复TRI组患者NSRA总体急性损伤发生率明显高于首次TRI组(48.4%vs 27.5%,P=0.032),内膜撕裂(6.5%vs 5.3%,P=1.000)、夹层(9.7%vs 1.5%,P=0.075)、穿孔(3.2%vs 1.5%,P=1.000)、血栓(12.9%vs 6.9%,P=0.457)及痉挛(29.0%vs 16.0%,P=0.094)的发生率两组差异无统计学意义。重复TRI组患者内膜面积(0.59 mm^2vs 0.46 mm^2,P=0.011)、IMR(0.40 vs 0.28,P=0.001)和ITI(0.27 vs 0.22,P=0.012)明显大于首次TRI组,而%LN差异无统计学意义(31.70%vs 30.81%,P=0.244)。多因素Logistic回归分析显示,重复TRI是NSRA急性损伤发生的独立危险因素(OR=2.772,95%CI:1.053~7.301,P=0.039)。结论 TRI术后NSRA急性损伤发生率为31.5%,与首次TRI组相比,重复TRI组NSRA急性损伤发生率更高且慢性内膜增生显著,重复TRI是NSRA急性损伤发生的独立危险因素。Objective To evaluate the acute and chronic effects of transradial intervention(TRI)on the non-sheathed radial artery(NSRA)by optical coherence tomography(OCT).Methods A total of 162 patients who underwent both OCT-guided TRI and NSRA OCT examination between February 2016 and September 2017 were enrolled.The patients were divided into the first TRI group(n=131)and the repeat TRI group(n=31).The incidence rate of acute injury including intimal tear,dissection,perforation,thrombus and spasm as well as the chronic injury indexes,including intimal area,percentage of lumen narrowing(%LN),intima-media ratio(IMR)and intimal thickness index(ITI),were compared between the two groups.Results The incidence of acute injury in NSRA was 31.5%in the repeat TRI group,significantly higher than that in the first TRI group(48.4%vs 27.5%,P=0.032).There was no significant difference in the incidence of intimal tear(6.5%vs 5.3%,P=1.000),dissection(9.7%vs 1.5%,P=0.075),perforation(3.2%vs 1.5%,P=1.000),thrombus(12.9%vs 6.9%,P=0.457),and spasm(29.0%vs 16.0%,P=0.094)between the two groups.Intimal area(0.59 mm 2 vs 0.46 mm 2,P=0.011),IMR(0.40 vs 0.28,P=0.001)and ITI(0.27 vs 0.22,P=0.012)of the patients in the repeat TRI group were significantly greater than those in the first TRI group,while%LN showed no difference(31.70%vs 30.81%,P=0.244).Multivariate Logistic regression analysis revealed that repeat TRI was an independent risk factor for acute NSRA injury(OR=2.772,95%CI:1.053-7.301,P=0.039).Conclusions The incidence of acute injury after TRI in NSRA was 31.5%.Compared with the first TRI group,the repeat TRI group has significantly higher incidence of acute injury and intimal hyperplasia.Repeat TRI is an independent risk factor for acute NSRA injury.

关 键 词：桡动脉 鞘管 冠状动脉介入 光学相干断层成像 

分 类 号：R540.4[医药卫生—心血管疾病]