2型糖尿病患者药物洗脱支架置入术后支架内再狭窄危险因素分析

摘要

目的:探讨冠心病合并2型糖尿病患者药物洗脱支架(DES)置入术后,支架内再狭窄相关危险因素分析.方法:将连续性入选的368例患者根据冠状动脉造影结果分为支架内再狭窄(ISR)组(n=74)及非支架内再狭窄(non-ISR)组(n=294).应用Cox's比例风险模型对两组进行统计学分析.结果:单因素分析ISR组较non-ISR组具有更高的VLDL-C、TG、UA、病变血管数目、多支病变、SYNTAX评分及既往冠状动脉介入术(PCI)病史,non-ISR组具有较高的饮酒史.COX比例风险模型分析糖尿病患者(DM),DES置入术后ISR的独立危险因素是VLDL(HR=1.85,95％ CI=1.24 ～2.77,P=0.002)、UA(每增加50 μmol/L,HR=1.19,95％ CI=1.05 ～ 1.34,P=0.006)、SYNTAX评分(每增加5分,HR=1.34,95％ CI =1.03 ～1.74,P=0.031)、既往PCI病史(HR=3.43,95％ CI=1.57 ～7.80,P=0.003).结论:研究提示VLDL-C、SYNTAX评分、血尿酸水平、既往PCI病史是DM患者ISR的独立危险因素.%Objective:This study aims to analyse the predictors of in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent (DES).Methods:According to whether ISR at follow-up angiography,patients were divided into the ISR group (n =74) and the non-ISR group (n =294).The independent predictors of ISR in patients with DM were explored by multivariate Cox's proportional hazards regression models.Results:Univariate analysis showed that patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol (VLDL-C),triglyceride (TG) and uric acid (UA) levels,more numbers of target vessel lesions,higher prevalence of multi-vessel disease,higher SYNTAX score,higher rate of previous percutaneous coronary stent implantation,but lower rate of drinking compared with patients in the non-ISR group.The independent predictors of ISR in patients with DM after DES implantation included VLDL-C (HR =1.85,95 ％ CI =1.24-2.77,P =0.002),UA (per 50 μmol/L increments,HR =1.19,95％ CI =1.05-1.34,P =0.006),SYNTAX score (per 5 increments,HR =1.34,95％ CI =1.03-1.74,P =0.031) and the history of PCI (HR =3.43,95％ CI =1.57-7.80,P =0.003) by the multivariate Cox's proportional hazards regression analysis.Conclusion:The increased serum VLDL-C and UA level,higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation.It provided new evidence for physicians to take measures to lower the risk of ISR for the better management of diabetic patients after PCI.