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目的 :分析伴有多种危险因素的冠心病患者发生支架内再狭窄(in-stent restenosis,ISR)的影响因素。方法:收集207例1年前接受冠状动脉介入治疗且伴有2个或2个以上危险因素的冠心病患者,其中100例发生ISR(ISR组),107例无ISR(对照组),分析2组患者的一般资料及实验室检查结果。结果 :ISR的发生与冠心病传统危险因素的多少无关。ISR组患者的糖尿病患病率高于对照组(51%比32%,P=0.01),而ISR组的平均体质量指数(body mass index,BMI)则低于对照组(24.90±3.16和25.91±3.53,P=0.03);同时,ISR组的尿酸[(343.79±103.40)μmol/L比(331.99±84.05)μmol/L,P=0.046]及红细胞分布宽度(red blood cell distribution width,RDW)[(13.88±1.05)%比(13.24±0.74)%,P<0.01)]水平亦均高于对照组。多元回归分析显示,糖尿病、低BMI、高RDW及糖尿病患者使用胰岛素治疗与ISR的发生间有相关性,尿酸不是ISR的独立危险因素,可能与其他危险因素相互作用从而增加了ISR的发生率。结论:糖尿病、低BMI、高RDW可能是冠心病患者发生ISR的危险因素,其中糖尿病患者的胰岛素治疗或可减少ISR的发生率。
Objective: To analyze the influencing factors of in-stent restenosis (ISR) in patients with coronary heart disease accompanied by multiple risk factors. Methods: A total of 207 patients with coronary heart disease who underwent coronary intervention 1 year before and who had at least 2 or more risk factors were enrolled. Among them, ISR (ISR group) occurred in 100 cases, ISR (107 cases) Group of patients with general information and laboratory test results. Results: The incidence of ISR has nothing to do with the traditional risk factors of coronary heart disease. The prevalence of diabetes in ISR group was significantly higher than that in control group (51% vs 32%, P = 0.01), but the mean body mass index (BMI) in ISR group was lower than that in control group (24.90 ± 3.16 and 25.91 ± 3.43, P = 0.03); meanwhile, uric acid [(343.79 ± 103.40) μmol / L ratio in the ISR group (331.99 ± 84.05) μmol / L, P = 0.046] and red blood cell distribution width (RDW) [(13.88 ± 1.05)% vs (13.24 ± 0.74)%, P <0.01)] were also higher than the control group. Multivariate regression analysis showed that there was a correlation between insulin therapy and ISR in diabetes, low BMI, high RDW and diabetes mellitus. Uric acid was not an independent risk factor for ISR and might interact with other risk factors to increase the incidence of ISR. Conclusion: Diabetes mellitus, low BMI and high RDW may be the risk factors of ISR in patients with coronary heart disease, and insulin treatment in diabetic patients may reduce the incidence of ISR.