极晚期支架内血栓与支架内再狭窄患者的临床对比分析

发布时间：2018-04-23 06:19

本文选题：冠状动脉疾病 + 支架内血栓　；参考：《中国循环杂志》2017年11期

【摘要】：目的:对比分析极晚期支架内血栓(VLST)与极晚期支架内再狭窄患者的临床特点,探讨VLST的潜在临床危险因素。方法:入选因急性冠状动脉综合征(ACS)入院并经冠状动脉造影证实VLST的患者共21例,另外入选同时期行冠状动脉造影证实极晚期支架内再狭窄的ACS患者共38例作为对照组。比较两组的基线资料、临床检验及检查资料,行Logistic回归分析探讨VLST的危险因素。结果:(1)VLST组有8例(38.1%)近1个月自行停用抗血小板药物,对照组有5例(13.2%),两组比较差异有统计学意义(P=0.03)。(2)VLST组有13例(61.9%)以ST段抬高型心肌梗死(STEMI)为表现,而对照组均以非ST段抬高急性冠状动脉综合征(NST-ACS)为表现(100%),两组差异有统计学意义(P0.001)。(3)两组间年龄、性别、既往高血压、糖尿病、心肌梗死病史、吸烟史及既往介入病史等差异均无统计学意义(P0.05)。(4)与对照组比较,VLST组左心室射血分数(LVEF)显著降低(P=0.001);肌钙蛋白I(Tn I)峰值、N末端B型利钠肽原(NT-pro BNP)峰值均显著升高(P0.001);白细胞总数及超敏C反应蛋白(hs-CRP)水平也显著升高,差异均有统计学意义(P0.001)。(5)两组间超声心动结构、血脂、血糖、肌酐等代谢指标差异无统计学意义(P0.05)。(6)Logistic分析表明,停用抗血小板药物、较高的NT-pro BNP及hs-CRP水平是VLST的独立危险因素(P0.05)。结论:VLST临床表现危重,坚持抗血小板治疗、改善心功能可能有助于减少其发生。
[Abstract]:Objective: to compare the clinical characteristics of extremely late stent thrombus (VLST) and very late stent restenosis and to explore the potential clinical risk factors of VLST. Methods: 21 patients with acute coronary syndrome (ACS) admitted to hospital and confirmed by coronary angiography were enrolled in this study. 38 patients with ACS who underwent coronary angiography at the same time were selected as control group. The baseline data, clinical examination and examination data were compared between the two groups. The risk factors of VLST were analyzed by Logistic regression analysis. Results in the last month, 8 patients in the VLST group and 5 patients in the control group stopped using antiplatelet drugs on their own. The difference between the two groups was statistically significant (P < 0.03, P < 0.05). 13 patients in the VLST group (n = 61.9) showed STEMI (St segment elevation myocardial infarction). In the control group, non-ST-segment elevation acute coronary syndromes (NST-ACSS) was used as the manifestation, and the difference between the two groups was statistically significant (P 0.001)) the age, sex, past hypertension, diabetes mellitus, myocardial infarction history were significantly different between the two groups. Compared with the control group, the left ventricular ejection fraction (LVEF) decreased significantly (P 0.001), and the peak value of cardiac troponin (I(Tn I) and N-terminal B-type natriuretic peptide (NT-pro) increased significantly (P 0.001). The total number of cells and the level of hypersensitive C-reactive protein hs-CRP were also significantly increased. There was no significant difference in the metabolic indexes such as structure of echocardiography, blood lipid, blood glucose and creatinine between the two groups. Logistic analysis showed that the higher levels of NT-pro BNP and hs-CRP were independent risk factors of VLST. Conclusion the critical clinical manifestation of VLST is that persistent antiplatelet therapy and improvement of cardiac function may help to reduce its occurrence.
【作者单位】：中国人民解放军总医院第一附属医院心内科;
【分类号】：R541.4

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