冠状动脉药物洗脱支架植入术后支架内再狭窄预测因素研究

发布时间：2018-04-22 14:06

本文选题：冠状动脉粥样硬化性心脏病 + 药物洗脱支架　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:寻找冠状动脉药物洗脱支架内再狭窄的相关因素,探究利用易于获得的临床资料评估预测支架内再狭窄的可能性,为临床工作中管理和随访支架植入术后病人提供参考。方法:回顾性分析2014年1月1日至2016年12月31日期间于浙江大学附属第二医院心血管内科住院行冠状动脉造影检查同时临床资料完整的190名患者,支架内再狭窄组和无支架内再狭窄组各95名,收集患者既往高血压、糖尿病等病史、吸烟史以及用药史;患者初次接受冠脉介入治疗时冠脉病变情况以及植入支架数量;患者复查冠脉造影时的检验检查报告,如糖化血红蛋白(HbAlc)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、载脂蛋白A1、载脂蛋白B、肌酐、同型半胱氨酸、左室射血分数(LVEF)等,探索支架内再狭窄的相关因素,和预测支架内再狭窄的方法。结果:本研究共入选190例,其中冠脉造影提示支架内再狭窄组和无支架内再狭窄组各95例,两组之间有糖尿病史(33.68%vs.16.84%)及吸烟史(55.79%vs.34.74%)的患者比例以及低密度脂蛋白(2.02±0.76 mmol/1 vs.1.68±0.55 mmol/1)、载脂蛋白 B(0.72±0.23 g/1 vs.0.64±0.17 g/1)、冠脉 Gensini 评分(51.43±26.71 vs.32.58±18.94)和支架植入数量(2.35±1.24 vs.1.71±0.91)都存在显著差异(p0.05),而其他临床特征均无显著差异。对支架内再狭窄的部分相关因素进行logistic回归分析,结果显示糖尿病、吸烟史、载脂蛋白B0.8g/1和Gensini评分大于36分可以作为支架内再狭窄的独立预测因素。利用Gensini评分大于36分记为2分、有糖尿病、吸烟史、载脂蛋白B0.8 g/1分别记1分,计算支架内再狭窄危险评分,利用危险评分大于等于2分预测支架内再狭窄的敏感性为58.1%,特异性为84.4%,ROC工作曲线的曲线下面积为0.754(95%CI:0.671-0.836,p0.05)。结论:患者有糖尿病、吸烟史、载脂蛋白B0.8 g/1和Gensini评分大于36分都是支架植入术后10月到3年内发生支架内再狭窄的独立危险因素。利用Gensini评分大于36分记为2分、有糖尿病、吸烟史、载脂蛋白B0.8 g/1分别记1分,计算支架内再狭窄危险评分,利用危险评分大于等于2分预测支架内再狭窄有一定的预测价值。
[Abstract]:Objective: to explore the related factors of coronary artery drug-eluting stent restenosis and evaluate the possibility of predicting stent restenosis by using available clinical data to provide reference for clinical management and follow-up of patients after stent implantation. Methods: a retrospective analysis of 190 patients with complete clinical data was performed in Department of Cardiovascular Medicine, second affiliated Hospital of Zhejiang University, from January 1, 2014 to December 31, 2016. 95 patients in the stent restenosis group and 95 patients in the non-stent restenosis group were collected the history of hypertension, diabetes, smoking and medication, the coronary artery lesion and the number of stents implanted during the first coronary intervention. The examination reports of patients during coronary angiography, such as glycosylated hemoglobin (HbAlcN), low density lipoprotein (LDLN), high density lipoprotein (HDL), apolipoprotein A1, apolipoprotein B, creatinine, homocysteine, left ventricular ejection fraction (LVEF), etc. To explore the relevant factors of stent restenosis and the method of predicting stent restenosis. Results: 190 patients were enrolled in this study. Coronary angiography showed that there were 95 cases in the in-stent restenosis group and 95 cases in the non-stent restenosis group. There were significant differences between the two groups in the proportion of patients with diabetes mellitus (33.68 vs 16.84V) and smoking history (55.79 vs 34.74), the low density lipoprotein (LDL-C) 2.02 卤0.76 mmol/1 vs.1.68 卤0.55 mmol / 1, apolipoprotein B 0.72 卤0.23 g / 1 vs.0.64 卤0.17 g / 1, coronary Gensini score 51.43 卤26.71 vs.32.58 卤18.94) and the number of stents implanted 2.35 卤1.24 vs.1.71 卤0.91, respectively. There was no significant difference in bed characteristics. Logistic regression analysis showed that diabetes, smoking history, apolipoprotein B0.8g/1 and Gensini scores were independent predictors of restenosis in stent. Patients with diabetes mellitus, smoking history, apolipoprotein B 0.8 g / 1 and apolipoprotein B 0.8 g / 1 were scored 2 points with Gensini score greater than 36. The risk of restenosis in stent was calculated. The sensitivity of predicting restenosis in stent with hazard score greater than or equal to 2 was 58.1, the specificity was 84.4 and the area under the curve of ROC working curve was 0.754 ~ 95CI: 0.671-0.836 (p0.05). Conclusion: diabetes, smoking history, apolipoprotein B 0.8 g / 1 and Gensini score greater than 36 are independent risk factors for stent restenosis within 10 to 3 years after stent implantation. Using Gensini score > 36 to score 2, diabetes, smoking history, apolipoprotein B0.8 g / 1 and apolipoprotein B0.8 g / 1 respectively, calculating the risk score of restenosis in stent, predicting restenosis in stent with risk score greater than or equal to 2 has certain predictive value.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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