冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的影响因素研究

摘要

目的：探讨冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的影响因素。方法选取2012年1月—2014年1月于保定市第二医院行经皮冠状动脉介入治疗术的冠心病患者200例作为研究组，根据是否出现支架内再狭窄分为再狭窄组36例与未再狭窄组164例；另选取同期在保定市第二医院体检健康者100例作为对照组。比较3组受试者临床资料，分析冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的影响因素。结果3组受试者性别、年龄、吸烟史阳性率、高密度脂蛋白胆固醇（HDL-C）水平比较，差异无统计学意义（ P ﹥0.05）；3组受试者收缩压、舒张压、血糖及总胆固醇（ TC）、三酰甘油（ TG）、低密度脂蛋白胆固醇（ LDL-C）、同型半胱氨酸、干扰素γ（IFN-γ）、白介素2（IL-2）、肿瘤坏死因子β（TNF-β）、白介素4（IL-4）、白介素6（IL-6）、白介素10（IL-10）水平比较，差异有统计学意义（P ﹤0.05）；狭窄组与未狭窄组患者脑梗死发生率、慢性阻塞性肺疾病发生率、置入支架数量、支架长度、支架直径比较，差异无统计学意义（P ﹥0.05）；狭窄组患者冠心病病程长于未狭窄组，高血压和糖尿病发生率高于未狭窄组（ P ﹤0.05）。多因素 logistic 回归分析结果显示，血糖〔 OR =2.345，95% CI（1.023，6.457）〕、高脂血症〔OR =5.738，95% CI（2.454，14.232）〕、高同型半胱氨酸血症〔 OR =4.338，95% CI（1.133，9.624）〕、Th1/ Th2失衡〔OR =3.453，95% CI（1.023，7.524）〕是冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的影响因素（P ﹤0.05）。结论血糖、高脂血症、高同型半胱氨酸血症、Th1/ Th2失衡是冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的影响因素。%Objective To investigate the influencing factors of in - stent restenosis in postoperative coronary heart disease patients treated by PCI. Methods A total of 200 postoperative coronary heart disease patients treated by PCI were selected as case group in the Second Hospital of Baoding from January 2012 to January 2014,and they were divided into A group (with in - stent restenosis,n = 36)and B group(without in - stent restenosis,n = 164)according to the incidence of in - stent restenosis;a total of 100 healthy people admitted to this hospital for physical examination were selected as control group. Clinical data was compared among the three groups,and the influencing factors of in - stent restenosis in postoperative coronary heart disease patients treated by PCI were analyzed. Results No statistically significant differences of gender,age,positive rate of smoking history or HDL-C was found among the three groups(P ﹥ 0. 05),while there were statistically significant differences of SBP,DBP, FPG, TC, TG, LDL-C, homocysteine, IFN-γ, IL-2, TNF-β, IL-4, IL-6 and IL-10 ( P ﹤ 0. 05 ); no statistically significant differences of incidence of cerebral infarction or COPD,number of embed stents,stent length or stent diameter was found between A group and B group(P ﹥ 0. 05),while course of coronary heart disease of A group was statistically significantly longer than that of B group,incidence of hypertension and diabetes of A group was statistically significantly higher than that of B group,respectively( P ﹤ 0. 05 ). Multivariate logistic regression analysis results showed that,FPG〔 OR= 2. 345,95% CI(1. 023,6. 457)〕,hyperlipidaemia〔OR = 5. 738,95% CI(2. 454,14. 232)〕,hyperhomocysteinemia〔OR = 4. 338,95% CI(1. 133,9. 624)〕 and imbalance of Th1 / Th2 〔 OR = 3. 453,95% CI( 1. 023,7. 524 )〕were influencing factors of in - stent restenosis in postoperative coronary heart disease patients treated by PCI ( P ﹤ 0. 05 ). Conclusion FPG,hyperlipidaemia,hyperhomocysteinemia and imbalance of Th1 / Th2 are influencing factors of in - stent restenosis in postoperative coronary heart disease patients treated by PCI.