阻塞性睡眠呼吸暂停综合征与冠状动脉支架植入术后再狭窄的相关性分析

发布时间：2018-05-17 23:11

本文选题：阻塞性睡眠呼吸暂停综合征 + 经皮冠状动脉介入治疗　；参考：《郑州大学》2015年硕士论文

【摘要】：背景与目的半个多世纪以来,随着社会经济水平的提高,人类生活方式、饮食结构的改变,我国人民疾病的发生谱和死亡谱也发生着极大的变化。20世纪末期,各种慢性病已成为整个疾病谱的主流,尤其是心血管疾病所占的比例巨大。《中国心血管病报告2013概要》显示:心血管病死亡占城乡总死亡原因的首位,其中农村地区为38.7%,城市为41.1%[1],且患病率处于持续上升阶段,成为威胁人类健康的主要杀手。急性冠脉综合征(acute coronary syndrome,ACS)是一种普遍存在并对人类有严重危害性的心血管疾病,它以冠状动脉粥样斑块破裂或出血,继发完全或不完全性冠脉阻塞为病理生理学基础。目前对ACS的治疗,除了药物预防及控制心血管病危险因素等措施外,经皮冠状动脉介入手术(percutaneous coronary intervention,PCI)渐渐起到了越来越重要的作用,成为治疗冠心病最有效的方法之一[2]。尤其是药物洗脱支架(drug eluting stent,DES)的出现,使术后支架内再狭窄(in-stent restenosis,ISR)的发生率降低,利于PCI术在人群中被广泛的接受和推广。但由于ACS患者本身常存在血管内皮损伤、血栓形成,现有条件无法及时发现其是否存在抗血小板药物抵抗等高危因素,ISR仍然是PCI术后的重要难题[4,5]。ACS患者冠脉ISR的发生率可高达10%左右[6]。为了提高PCI术的临床应用效果,许多专家学者对ISR的影响因素做了分析与探讨。既往回顾性研究表明,影响冠脉ISR的因素主要包括血浆纤维蛋白原(fibrinogen,FIB)水平增高、吸烟、高血压、糖尿病及冠脉多支病变[7]等。阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)作为一种反复发作上呼吸道阻塞的睡眠紊乱性疾病,流行病学调查显示:65岁以上人群OSAS发病率达到45%以上[8],而且发病率呈逐年上升趋势。近年来研究发现其与心血管疾病的危险因素如高血压、心律失常、冠心病、肺动脉高压等有着密切的关系,可能参与了心血管疾病的发生、发展过程。另外,Dai Yumino等人的研究结果表明:OSAS可导致ACS患者PCI术后再次心肌梗死、住院期间死亡等心血管不良事件的发生率升高,但对于它是否与ISR的发生率有关,且会对ISR的发生率产生多大的影响,国内外相关报道较少。本研究旨在分析OSAS与PCI术后冠脉ISR是否具有相关性,OSAS是否为ISR的独立危险因素,并探讨其影响ISR的可能机制,为ISR的二级预防提供临床依据。对象与方法:选取2013年1月至2014年12月期间在郑州大学第一附属医院心内科行PCI治疗并于术后12个月行冠状动脉造影复查的ACS患者158例,根据其复查造影结果分为:支架内再狭窄组(ISR组)和非支架内再狭窄组(非ISR组),其中ISR组39例,男性28例,平均年龄(57.92±9.40)岁;非ISR组119例,男性102例,平均年龄(57.67±9.53)岁。搜集所有患者入院时的基本临床资料、生化指标以及冠脉介入手术相关资料,采用二分类Logistic回归分析的方法分析OSAS是否为ISR的独立危险因素。结果:1.单因素分析结果显示:①ISR组OSAS患者比率较非ISR组高(62%vs37%),P=0.007,差异具有统计学意义;②ISR组糖尿病患者比率较非ISR组高(28%vs 12%),P=0.015,差异具有统计学意义;③ISR组支架直径较非ISR组小(2.93±0.40 mm vs 3.22±0.55 mm),P=0.001,差异具有统计学意义。2.二分类Logistic回归分析结果示:OSAS(OR=2.937,95%CI:1.336-6.456)、糖尿病(OR=2.818,95%CI:1.088-7.301)可能是支架内再狭窄的危险因素,较大的支架直径(OR=0.312,95%CI:0.132-0.735)可能是支架内再狭窄的保护因素。结论:1.OSAS、糖尿病和支架直径与冠状动脉ISR密切相关;2.OSAS、糖尿病可能是冠脉ISR的独立危险因素,较大的支架直径可能是ISR的保护性因素。
[Abstract]:Background and purpose for more than half a century, with the improvement of the social and economic level, the change of human life style and diet structure, the incidence and death spectrum of the people's disease have also changed greatly in the late.20 century. All kinds of chronic diseases have become the main stream of the whole disease spectrum, especially the proportion of cardiovascular diseases. < China Cardiovascular disease report 2013 shows that cardiovascular disease death accounts for the first cause of total death in urban and rural areas, including 38.7% in rural areas and 41.1%[1] in the city, and the prevalence rate is on the rising stage, becoming the major killer of human health. Acute coronary syndrome (acute coronary syndrome, ACS) is a common existence and strict to human beings. Severe cardiovascular disease with coronary atherosclerotic plaque rupture or hemorrhage and secondary complete or incomplete coronary occlusion as a pathophysiological basis. The current treatment of ACS, in addition to drug prevention and control of cardiovascular risk factors, is performed by percutaneous coronary intervention (percutaneous coronary intervention, PCI). It is becoming more and more important to become one of the most effective methods for the treatment of coronary heart disease [2]. especially the emergence of drug eluting stent (DES), which reduces the incidence of in-stent restenosis (ISR) after the operation and is widely accepted and popularized in the crowd. However, the ACS patient itself has been widely accepted and promoted. There is often vascular endothelial injury, thrombosis, the existing conditions can not be found in time to be found in the presence of anti platelet drug resistance and other high-risk factors, ISR is still an important problem after PCI operation, the incidence of coronary ISR in [4,5].ACS patients can be as high as 10% [6]. in order to improve the clinical application of PCI, many experts and scholars on the influencing factors of ISR The analysis and discussion were done. The previous retrospective study showed that the factors affecting the coronary ISR include increased plasma fibrinogen (fibrinogen, FIB), smoking, hypertension, diabetes and multiple coronary artery disease [7]. Obstructive sleep apnea syndrome (obstructive sleep apnea syndrome, OSAS) as a recurrent seizure. The epidemiological survey shows that the incidence of OSAS in people over 65 years old is up to 45% [8], and the incidence is increasing year by year. In recent years, the study found that there is a close relationship with the risk factors of cardiovascular diseases such as hypertension, arrhythmia, coronary heart disease, pulmonary hypertension and so on, which may be involved in the heart blood. In addition, the results of Dai Yumino et al. Have shown that OSAS can lead to a recurrence of myocardial infarction in ACS patients after PCI and the incidence of cardiovascular adverse events during hospitalization, but whether it is associated with the incidence of ISR and how much effect on the incidence of ISR, related reports at home and abroad. The purpose of this study is to analyze the correlation between OSAS and the coronary ISR after PCI, whether OSAS is an independent risk factor for ISR, and explore the possible mechanism of its influence on ISR, and provide a clinical basis for the two level prevention of ISR. Object and method: from January 2013 to December 2014, PCI treatment in the Department of Cardiology at the First Affiliated Hospital of Zhengzhou University was selected. And 158 cases of ACS patients underwent coronary angiography 12 months after operation. According to their reexamination results, they were divided into stent restenosis group (group ISR) and non stent restenosis group (non ISR group), of which group ISR was 39 cases, male 28 cases, average age (57.92 + 9.40) years, 119 cases in non ISR group, 102 men, and average age (57.67 + 9.53) years. All The basic clinical data, biochemical indexes and the related data of coronary intervention were used to analyze the independent risk factors of OSAS as ISR by two classification Logistic regression analysis. Results: 1. the results of single factor analysis showed that (1) the ratio of OSAS patients in group ISR was higher than that of non ISR group (62%vs37%), P=0.007, and the difference was statistically significant. (2) the ratio of diabetic patients in group ISR was higher than that in non ISR group (28%vs 12%) and P=0.015, and the difference was statistically significant. (3) the diameter of the stent in ISR group was smaller than that of non ISR group (2.93 + 0.40 mm vs 3.22 + 0.55 mm), and the difference was statistically significant for.2. two classification of Logistic regression analysis. 088-7.301) may be a risk factor for restenosis in the stent. Larger stent diameter (OR=0.312,95%CI:0.132-0.735) may be a protective factor for restenosis in the stent. Conclusion: 1.OSAS, diabetes and stent diameter are closely related to coronary artery ISR; 2.OSAS, diabetes may be an independent risk factor for coronary ISR, and a larger stent diameter may be possible. It is a protective factor for ISR.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4;R766

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