冠心病患者经皮冠状动脉介入治疗后支架内再狭窄复发的危险因素及预测模型构建研究  

Study on Risk Factors and Development of a Predictive Model for Recurrent In-stent Restenosis in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

作　　者：朱晨玉江 吕湛[3] 朱法胜 王勇 黄永培 王天杰 杨伟宪 ZHU Chenyujiang;LYU Zhan;ZHU Fasheng;WANG Yong;HUANG Yongpei;WANG Tianjie;YANG Weixian(Department of Clinical Medicine,North Sichuan Medical College,Nanchong 637000,China;Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Cardiology,Shifang People's Hospital,Shifang 618400,China)

机构地区：[1]川北医学院临床医学系,南充637000 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院心内科,北京100037 [3]川北医学院附属医院心内科,南充637000 [4]四川省什邡市人民医院心内科,什邡618400

出　　处：《中国循环杂志》2024年第5期456-463,共8页Chinese Circulation Journal

摘　　要：目的:探索冠心病患者经皮冠状动脉介入治疗(PCI)后支架内再狭窄复发的危险因素,并初步构建支架内再狭窄复发的可视化风险预测模型。方法:收集中国医学科学院阜外医院2017年1~12月1 102例PCI后支架内再狭窄住院患者纳入分析。采用单因素Cox回归分析、LASSO回归及结合临床经验筛选支架内再狭窄复发的预测因子,多因素Cox回归分析建立预测模型。结果:中位随访1 264(1 169,1 334)d期间,111例(10.1%)患者支架内再狭窄复发。多因素Cox回归分析显示,年龄(HR=0.98,95%CI:0.96~0.99)、总胆红素(HR=0.95,95%CI:0.91~0.99)、载脂蛋白A1(HR=0.08,95%CI:0.02~0.42)、高敏C反应蛋白(HR=1.05,95%CI:1.01~1.10)和参照血管直径(HR=0.65,95%CI:0.44~0.98)是支架内再狭窄复发的危险因素,支架内再狭窄复发风险预测模型ROC曲线的AUC为0.70(95%CI:0.64~0.77)。结论:年龄、总胆红素、载脂蛋白A1和参照血管直径越小、高敏C反应蛋白水平越高,支架内再狭窄复发的风险越高;可视化的支架内再狭窄复发风险预测模型预测性能较好,但仍需进一步优化和验证。Objectives:To explore the risk factors for recurrent in-stent restenosis(R-ISR)in patients with coronary heart disease after percutaneous coronary intervention(PCI)and to develop a risk prediction model for R-ISR using a nomogram.Methods:All patients treated for ISR at the Fuwai Hospital,Chinese Academy of Medical Sciences from January to December 2017 were eligible for this study.A total of 1102 ISR patients were included for analysis.Based on the recurrence of ISR after PCI,patients were divided into R-ISR group and non-R-ISR group.Univariate Cox regression analyses,LASSO regression analyses,and the combination of clinical experience were used to select predictors of R-ISR.A multivariate Cox regression model was used to analyze the independent risk factors of R-ISR and to develop a risk prediction model.Results:The median follow-up duration for participants was 1264(1169,1334)days,the incidence rate of R-ISR after PCI was 10.1%.Multivariate Cox regression analysis showed that age(HR=0.98,95%CI:0.96-0.99),total bilirubin(HR=0.95,95%CI:0.91-0.99),apolipoprotein A1(HR=0.08,95%CI:0.02-0.42),high-sensitivity C-reactive protein(HR=1.05,95%CI:1.01-1.10),and reference vessel diameter(HR=0.65,95%CI:0.44-0.98)were independent determinants of R-ISR.Accordingly,the R-ISR risk prediction model was developed with a nomogram,the AUC of this model to predicto R-ISR was 0.70(95%CI:0.64-0.77).Conclusions:Coronary heart disease patients with younger age,lower levels of total bilirubin and apolipoprotein A1,smaller vessel diameter,and higher levels of high-sensitivity C-reactive protein are at higher risk of R-ISR.The developed visual risk prediction model for R-ISR shows promising predictive performance but still requires further optimization and validation.

关 键 词：冠心病 经皮冠状动脉介入治疗 复发性支架内再狭窄 危险因素 预测模型 

分 类 号：R54[医药卫生—心血管疾病]