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目的分析冠心病患者冠状动脉支架置入术(PCI)后支架内再狭窄的相关因素。方法收集我院成功行PCI并于术后1 a行冠状动脉造影随访的患者797例,以支架置入段内径狭窄≥50%为再狭窄,分为再狭窄组153例和无狭窄组644例。回顾性分析两组患者的临床资料、生化指标及冠状动脉造影结果的差异,采用多因素Logistic分析其与冠状动脉支架内再狭窄的关系。结果再狭窄组糖尿病患病率为34.64%,高于无狭窄组的23.91%(P<0.01),支架直径为(2.90±0.41)mm,小于无狭窄组的(3.02±0.90)mm(P<0.01),血清尿酸为(406.54±78.18)μmol/L,高于无狭窄组的(343.78±76.64)μmol/L(P<0.01),血清总胆红素水平为(11.70±4.71)μmol/L,低于无狭窄组的(13.16±6.43)μmol/L(P<0.01)。多因素Logistic分析显示,糖尿病(OR=2.340,95%CI 1.893～3.011)、尿酸(OR=1.653,95%CI 1.447～2.083)、支架直径(OR=0.668,95%CI 0.496～0.898)、血清总胆红素浓度水平(OR=0.838,95%CI 0.797～0.980)与冠状动脉支架内再狭窄有关(P均<0.01)。结论糖尿病、支架直径、尿酸、总胆红素为冠状动脉支架置入术后支架内再狭窄的相关因素。其中糖尿病、高尿酸血症为冠状动脉支架内再狭窄的危险因素,较大支架直径、正常范围内较高水平的血清总胆红素为冠脉支架内再狭窄的保护因素。
Objective To analyze the related factors of in-stent restenosis after coronary stenting (PCI) in patients with coronary heart disease. Methods A total of 797 patients who underwent coronary angiography at 1-year postoperative PCI were enrolled in this study. The patients with restenosis were divided into three groups: restenosis group (n = 153) and stenosis group (n = 644) . The clinical data, biochemical parameters and the results of coronary angiography were retrospectively analyzed. Logistic regression analysis was used to analyze the relationship between them and coronary stent restenosis. Results The prevalence of diabetes in the restenosis group was 34.64%, higher than that in the non - stenosis group (23.91%, P <0.01). The diameter of the stent was (2.90 ± 0.41) mm, less than that in the stenosis group (3.02 ± 0.90) mm (P < 0.01). Serum uric acid was (406.54 ± 78.18) μmol / L higher than that in the non-stenosis group (343.78 ± 76.64) μmol / L and the total serum bilirubin level was (11.70 ± 4.71) μmol / L (13.16 ± 6.43) μmol / L in patients without stenosis (P <0.01). Multivariate logistic analysis showed that there were significant differences in the prevalence of diabetes (OR = 2.340, 95% CI 1.893-3.01 1), uric acid (OR = 1.653, 95% CI 1.447-2.083), and stent diameter (OR 0.668,95% CI 0.496-0.898) Total bilirubin concentration (OR = 0.838, 95% CI 0.797-0.980) was related to coronary stent restenosis (all P <0.01). Conclusion Diabetes mellitus, stent diameter, uric acid, total bilirubin are the related factors of in-stent restenosis after coronary stenting. Diabetes mellitus and hyperuricemia are the risk factors of coronary stent restenosis. The larger stent diameter and the higher level of serum total bilirubin in the normal range are the protective factors of coronary stent restenosis.