冠心病患者支架置入术后支架内再狭窄的危险评分  

Risk score for in-stent restenosis in patients implanted coronary stents

作　　者：刘伟涛 周浩斌[1] 冼高鹏 彭新 詹琼[1] 白煜佳 曾庆春 黄铮 许顶立[1] Liu Weitao;Zhou Haobin;Xian Gaopeng;Peng Xin;Zhan Qiong;Bai Yujia;Zeng Qingchun;Huang Zheng;Xu Dingli(Department of Cardiology,Southern Medical University Southern Hospital,Guangzhou 510515,Guangdong Province,China)

机构地区：[1]南方医科大学南方医院心血管内科,广州510515 [2]广州医科大学附属第一医院心血管内科

出　　处：《中华老年心脑血管病杂志》2021年第11期1162-1165,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：广州市科技计划项目(201804010086);广州再生医学与健康广东省实验室基础研究与国际合作部科研项目(2018GZR110105001)。

摘　　要：目的确定冠状动脉支架置入术后患者支架内再狭窄(ISR)事件的危险因素并建立ISR危险评分系统。方法选择南方医科大学南方医院既往行冠状动脉支架置入术后患者397例,其中ISR组114例,非ISR组283例。回顾性分析2组的临床资料,用单因素和多因素logistic回归模型分析ISR的影响因素,赋予各项危险因素分值,建立ISR危险评分系统,采用ROC曲线下面积(AUC)和Hosmer-Lemeshows拟合优度评估ISR危险评分系统的应用性能。结果与非ISR组比较,ISR组抗血小板药物依从性比例、估算肾小球滤过率(eGFR)和LVEF水平更低;而吸烟史、支架串联和分叉术式比例、TC、LDL-C、血肌酐水平更高,支架置入时间更长(P<0.05,P<0.01)。多因素logistic回归分析显示,LDL-C、eGFR、支架置入时间、吸烟史、分叉术式是ISR的危险因素(P<0.05,P<0.01)。选取β值最小的吸烟史为常数项,分别为LDL-C、eGFR、吸烟史、支架置入时间和分叉术式这5项危险因素赋值,建立ISR危险评分系统,总分0~7分。ROC曲线分析显示,ISR危险评分系统的AUC为0.823,Hosmer-Lemeshows拟合优度验证显示,ISR危险评分系统预测的ISR与实际发生的ISR有较高的一致性(χ^(2)=2.425,P=0.489),提示ISR危险评分系统具有较高的应用效能。ISR危险评分为2分时,对应的敏感性为75.5%,特异性为77.6%。结论ISR危险评分系统操作方便、准确性较好,是可行性较高的危险评估工具。Objective To identify the risk factors of in-stent restenosis(ISR)and to establish a risk score system for those who were implanted coronary stents.Methods The clinical data of 397 patients implanted coronary stents were analyzed retrospectively,including ISR group(n=114)and non-ISR group(n=283).The influencing factors of ISR were analyzed by univariate and multivariate logistic regression models retrospectively,which was used to establish the ISR risk scoring system.The area under the curve(AUC)of ROC,and Hosmer-lemeshows goodness of fit were used to evaluate the performance of the ISR risk scoring system.Results Compared two groups,in the ISR group,the compliance rate of antiplatelet drugs,the estimated glomerular filtration rate(eGFR)and LVEF levels were lower;smoking history,proportion of stent series and bifurcation,TC,LDL-C,serum creatinine levels were higher,and stent implantation time was longer(P<0.05,P<0.01).The rusult of multivariate logistic regression analysis showed that LDL-C,eGFR,time of stent placement,smoking history and bifurcation operation were independent risk factors for ISR(P<0.05,P<0.01).The smallestβvalue was chosen as a constant term,used to establish the ISR risk score system of a total score of 0~7.ROC curve analysis showed that the AUC of ISR risk score system was 0.823;Hosmer-lemeshows goodness of fit test showed thatχ^(2)=2.425,P=0.489,indicating that the risk score system of ISR could be applied efficiently.When the diagnosis point was 2 scores,it was the best critical point on the ROC curve,with the sensitivity of 75.5%and specificity of 77.6%.Conclusion The risk score system of ISR was a convenient,accurate and feasible tool.

关 键 词：冠心病 支架 冠状动脉再狭窄 危险因素 危险评分 

分 类 号：R541.4[医药卫生—心血管疾病]