影响冠状动脉内初次植入药物洗脱支架后支架内再狭窄的影响因素  

Factors affecting in-stent restenosis after initial intracoronary implantation of drug-eluting stents

作　　者：王春丽[1] 郝琦 周强[1] 陈红珍[1] Wang Chunli;Hao Qi;Zhou Qiang;Chen Hongzhen(Department of Heart Transplantation Centre,Zhengzhou 7th.People's Hospital,Zhengzhou,450016,China;不详)

机构地区：[1]郑州市第七人民医院心脏移植中心,郑州450016

出　　处：《中国循证心血管医学杂志》2025年第1期64-67,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划项目(LHGJ20220843)。

摘　　要：目的本研究旨在探讨影响冠状动脉内初次植入药物洗脱支架后支架内再狭窄的影响因素。方法回顾性纳入2017年1月1日至2023年1月1日于郑州市第七人民医院首次接受药物洗脱支架(drug-eluting stent,DES)治疗的冠状动脉样硬化性心脏病(冠心病)患者,并在术后6~24个月行冠状动脉造影术,资料完整的患者,根据有无支架内再狭窄(in-stent restenosis,ISR)进行分组,利用单因素和多因素二元Logistic回归模型,进行危险因素的多元分析。结果本研究共纳入559例患者,其中ISR患者81例(14.4%)。单因素分析显示:性别(χ^(2)=7.883,P=0.005)、高血压病(χ^(2)=17.768,P<0.001)、糖尿病(χ^(2)=4.179,P=0.041)、高尿酸症(χ^(2)=4.416,P=0.036)、颈动脉斑块(χ^(2)=19.698,P<0.001)、平均支架直径(χ^(2)=6.482,P=0.011)、支架总长度(χ^(2)=-12.323,P<0.001)、低密度脂蛋白(Z=-7.224,P<0.001)、纤维蛋白原(Z=-2.085,P=0.037)、甲状腺素(Z=-6.979,P<0.001)10个变量是ISR的影响因素。多因素二元Logistic回归分析显示:性别(OR=0.187,95%CI:0.063~0.555,P=0.003)、高血压病(OR=6.253,95%CI:1.777~22.00,P=0.004)、糖尿病(OR=3.432,95%CI:1.184~9.950,P=0.023)、支架总长度(OR=1.210,95%CI:1.141~1.282,P<0.001)、低密度脂蛋白(OR=6.697,95%CI:3.085~14.54,P<0.001)、甲状腺素(OR=1.130,95%CI:1.069~1.195,P<0.001)6个变量是ISR的独立影响因素。结论影响冠状动脉内初次植入药物洗脱支架后支架内再狭窄的独立影响因素有性别、高血压病、糖尿病、支架总长度、低密度脂蛋白、甲状腺素,这些影响因素帮助临床医护人员识别高危ISR患者并优化治疗策略,从而改善患者预后。Objective The aim of this study was to investigate the factors affecting in-stent restenosis after initial implantation of drug-eluting stents in coronary arteries.Methods Patients with coronary artery disease treated with DES for the first time in our hospital between January 1,2017 and January 1,2023,who underwent coronary angiography between 6 and 24 months after the procedure,with complete data,were retrospectively included,grouped according to the presence or absence of ISR,and multivariate analyses of the risk factors were performed,using univariate and multivariate binary logistic regression models.Results A total of 559 clinical patients were included in this study,and 81(14.4%)were ISR patients.Univariate analysis showed that gender(χ^(2)=7.883,P=0.005),hypertension(χ^(2)=17.768,P<0.001),diabetes mellitus(χ^(2)=4.179,P=0.041),hyperuricosuria(χ^(2)=4.416,P=0.036),carotid plaque(χ^(2)=19.698,P<0.001),mean stent diameter(χ^(2)=6.482,P=0.011),and total stent length(χ^(2)=-12.323,P<0.001),LDL(Z=-7.224,P<0.001),fibrinogen(Z=-2.085,P=0.037),and thyroxine(Z=-6.979,P<0.001)were 10 variables that were influences on ISR,Multifactorial binary logistic regression analysis showed that six variables,namely,sex(OR=0.187,95%CI:0.063~0.555,P=0.003),hypertension(OR=6.253,95%CI:1.777~22.00,P=0.004),diabetes mellitus(OR=3.432,95%CI:1.184~9.950,P=0.023),total length of the stent(OR=1.210,95%CI:1.141~1.282,P<0.001),low-density lipoprotein(OR=6.697,95%CI:3.085~14.54,P<0.001),and thyroxine(OR=1.130,95%CI:1.069~1.195,P<0.001)were 6 variables that were independent influences on ISR.Conclusion Independent influencing factors affecting in-stent restenosis after initial intracoronary implantation of drug-eluting stents are gender,hypertension disease,diabetes mellitus,total stent length,low-density lipoproteins,and thyroxine,which help clinical providers to identify patients at high risk for ISR and optimize therapeutic strategies to improve the prognosis of these patients.

关 键 词：冠心病 药物洗脱支架 支架内再狭窄 影响因素 

分 类 号：R541.4[医药卫生—心血管疾病]