冠状动脉支架术后再狭窄的相关因素研究

发布时间：2018-05-05 04:16

本文选题：经皮冠状动脉内介入治疗 + 再狭窄　；参考：《河北医科大学》2014年硕士论文

【摘要】：目的：当前心血管疾病已经成为威胁人类健康的头号杀手，尽管随着医疗技术的进一步发展与提高，冠心病患者的病死率大幅度降低，但随着人民生活水平的提高、生活节奏的加快，人群血压、血清总胆固醇、血糖、体重指数均呈上升趋势，冠心病的发病率随之上升。世界卫生组织总干事陈冯富真曾表示：“如果中国近5-10年不加强对心血管疾病等慢性病的防控，那么中国改革开放成果的一半将被消耗殆尽”。因此，广泛开展冠心病的防治工作十分重要。1977年Gruntzig第一例经皮腔内冠状动脉成形术(Percutaneous transluminal coronary angioplasty,PTCA)的诞生[1]，开创了介入性心脏病学的新纪元。1986年Sigwart等首次将网状金属支架用于冠状动脉[2]，揭开了支架治疗血管性疾病的新篇章。尽管设备和药物治疗在不断地进步与完善，但支架术后再狭窄(In-stent stenosis,ISR)仍是经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后的一大缺陷[3]。ISR是冠状动脉支架术后的重要并发症，术后3-6个月多发[4]，金属裸支架(Bare-metal stents,BMS)术后1年内再狭窄的发生率为20%-30%，使用药物涂层支架(Drug-eluting stents,DES)的置入可使术后1年内再狭窄发生率降至7%[5]以下，但其远期再狭窄率与普通金属裸支架并无差别[6]，仍有超过15%的冠状动脉支架置入患者在一年内因再狭窄的发生而接受再次介入治疗[7]。目前认为与ISR相关的临床危险因素包括：年龄偏小(低于60岁)、糖尿病、高血压病、不稳定性心绞痛、合并外周血管病变；与冠状动脉病变部位相关的危险因素包括：分叉病变、多支病变、弥漫性病变、前降支病变[8]等；另外病变血管直径、长度、狭窄程度、置入支架类型、数目、总长度、支架重叠等也对ISR的发生具有明显影响[10,11]。尤其糖尿病者和有介入术后再狭窄发生史者ISR的发生率更高[9]。本研究通过观察PCI术后患者再狭窄发生情况，结合其临床和冠脉造影特点，探讨经皮冠状动脉介入术后再狭窄的相关因素，为预防和治疗支架再狭窄提供理论基础。方法：入选2010年2月至2013年11月间在河北医科大学第三医院心内科行PCI治疗，，并有术后一年冠状动脉造影(Coronaryangiography,CAG)复查资料的患者250例。根据冠脉造影复查结果，将患者分为再狭窄组(支架置入段内径狭窄≥50%)和对照组(无再狭窄或狭窄50%)，其中再狭窄组130例，对照组120例。回顾性分析两组患者的临床资料及冠状动脉造影特点，找出支架术后再狭窄的高危因素，并采用Logistic回归分析其与冠脉支架内再狭窄的相关关系。结果：再狭窄组与对照组对比结果显示：男性、吸烟、糖尿病史、白细胞计数、前降支病变、分叉病变、支架长度、支架重叠在两组之间具有统计学差异，采用Logistic回归分析发现吸烟史(OR=2.423,95%CI=1.365-4.302,P=0.003)、糖尿病史(OR=2.175,95%CI=1.021-4.634,P=0.044)、支架长度(OR=1.029,95%CI=1.002-1.057,P=0.033)、分叉病变(OR=2.159,95%CI=1.035-4.506,P=0.040)与支架术后再狭窄相关。结论：吸烟、糖尿病病史、支架较长、分叉病变，提示为支架术后再狭窄的高危因素，应对这类患者强化药物治疗及高危因素的控制。
[Abstract]:Objective: at present, cardiovascular disease has become the leading killer of human health. Although with the further development and improvement of medical technology, the mortality of patients with coronary heart disease has been greatly reduced, but with the improvement of the people's living standard, the pace of life, blood pressure, serum total cholesterol, blood sugar and body mass index are on the rise. The incidence of coronary heart disease is rising. Chen Fengfuzhen, director general of the WHO, said: "if China does not strengthen the prevention and control of chronic diseases such as cardiovascular disease in the last 5-10 years, then half of the results of China's reform and opening up will be depleted." therefore, the prevention and treatment of coronary heart disease is very important in.1977 year Gruntzig first. Percutaneous transluminal coronary angioplasty (PTCA) was born [1]. The new era of interventional cardiology, the new era of.1986 Sigwart, was first used to use reticular metal stents for coronary artery [2], uncovering a new chapter of stent treatment for vascular disease. Although equipment and drug treatment are constantly being treated Progress and improvement, but after stent restenosis (In-stent stenosis, ISR) remains a major defect after percutaneous coronary intervention (Percutaneous coronary intervention, PCI). [3].ISR is an important complication after coronary artery stenting, and more [4] after 3-6 months of operation, and restenosis within 1 years after the operation of bare metal stents (Bare-metal stents, BMS). The incidence of 20%-30% and the use of drug coated stent (Drug-eluting stents, DES) could reduce the incidence of restenosis to less than 7%[5] within 1 years after the operation, but the long-term restenosis rate was not different from that of the ordinary bare metal stent, and more than 15% of the patients with coronary stent implantation were again accepted in one year for restenosis. The clinical risk factors associated with ISR in the treatment of [7]. include younger age (less than 60 years), diabetes, hypertension, unstable angina, and peripheral vascular lesions. The risk factors associated with the site of coronary artery disease include bifurcation lesions, multiple lesions, diffuse lesions, [8] in the anterior descending branch, and other diseases. Vascular diameter, length, stenosis, stent type, number, length, and overlap of stents also have a significant impact on the occurrence of ISR, [10,11]. especially diabetes and the incidence of ISR in patients with restenosis after intervention. The incidence of restenosis in patients after PCI was observed, combined with clinical and coronary angioplasty. To explore the related factors of restenosis after percutaneous coronary intervention, and to provide a theoretical basis for preventing and treating stent restenosis.
Methods: from February 2010 to November 2013, 250 patients were treated with PCI in the Department of Cardiology, Third Hospital of Hebei Medical University, and 250 cases were rechecked by coronary angiography (CAG) after one year. The patients were divided into restenosis group (the stenosis of stent diameter more than 50%) and the control group (no group). Restenosis or stenosis was 50%), of which 130 cases were restenosis group and 120 cases in control group. The clinical data and coronary arteriography characteristics of the two groups were analyzed retrospectively. The high risk factors for restenosis after stenting were found, and the correlation between the restenosis and the coronary stent restenosis was analyzed by Logistic regression.
Results: the comparison between the restenosis group and the control group showed that smoking, diabetes history, leukocyte count, anterior descending lesion, bifurcation lesion, stent length, and stent overlap were statistically different among the two groups, and the history of smoking (OR= 2.423,95%CI=1.365-4.302, P=0.003) and diabetes history were found by Logistic regression analysis (OR=2.175,95%CI=1.021 -4.634 (P=0.044), length of stent (OR=1.029,95%CI=1.002-1.057, P=0.033), and OR=2.159,95%CI=1.035-4.506 (P=0.040) were associated with restenosis after stent placement.
Conclusion: smoking, diabetes history, long stents and bifurcated lesions are the high risk factors for restenosis after stenting, and should be used to strengthen the control of drug treatment and high risk factors in these patients.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R541.4

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