摘要
目的探讨冠心病合并糖尿病患者支架术后再狭窄发生的危险因素,建立冠心病合并糖尿病患者支架术后再狭窄发生概率的预测模型,为中国冠心病合并糖尿病患者药物洗脱支架的合理使用提供循证医学证据。方法分析我院2002—2004年1126例冠状动脉内非药物洗脱支架置入术患者(2376处病变),使用多元逻辑回归分析比较术后出现再狭窄组和无再狭窄组冠心病合并糖尿病患者临床数据和造影资料,并使用上述数据库建立支架术后再狭窄发生概率预测表。结果在889例(78.9%)有6个月随访冠状动脉造影资料的患者中,151例(17%)有糖尿病。再狭窄定义为支架内及前后5mm范围内狭窄≥50%参考管腔直径。在非糖尿病组(738例),再狭窄的发生率为21.2%,糖尿病组(151例)再狭窄的发生率为35.9%(P<0.001)。多元逻辑分析结果显示参考血管直径(≤3.0mm),病变长度(>15mm)和胰岛素治疗是冠心病合并糖尿病患者术后再狭窄的可预见危险因素(P<0.05)。支架术后再狭窄发生概率的预测表结果显示冠心病合并糖尿病患者再狭窄发生概率首要依赖于参考血管直径。结论冠心病合并糖尿病患者支架术后再狭窄发生概率显著增加。参考血管直径、病变长度和需要胰岛素治疗是冠心病合并糖尿病患者支架术后再狭窄的可预见危险因素。非糖尿病患者合并短病变(<15mm)而无论参考血管直径,糖尿病患者合并冠状动脉大直径血管(>3.0mm)合并短病变(<15mm)预期再狭窄发生率<15%,可以考虑使用金属裸支架。除此之外,建议使用药物洗脱支架。
Objective To identify the potential predictors of restenosis after bare mental stent （BMS） deployment in diabetic patients in Chinese diabetic patients. Methods We retrospectively analyzed all patients implanted with BMS （n = 1126 with 2376 lesions） in our department from 2002 to 2004. The multivariate logistic regression analysis was made to compare the clinical and angiographic characteristics between diabetic patients with and without restenosis. Restenosis was defined as ≥ 50% diameter stenosis within the stent and 5 nun in adjacent. Results The 6-month follow-up angiograms were available in 889 out of 1126 patients （78.9%） and 151 out of 889 patients （ 17% ） were diabetic patients. Restenosis rate in nondiabetic patients group was 21.2% and 35.9% in diabetic patients （ P 〈 0. 001 ）. The predictors of restenosis in diabetics were reference vessel diameter（ ≤3.0 mm） , length of lesion （ 〉 15 mm）and insulin use （P 〈 0. 05 ）. The restenosis predicting model showed that reference vessel caliber was the paramount predictor for restenosis in diabetic patients. Conclusions Restenosis rate post BMS implantation is significantly higher in diabetic patients compared to non-diabetic patients. Vessel caliber, lesion length and insulin use are predictors of restenosis in diabetic patients. Diabetic patients with reference vessel diameter of 〉 3.0 mm combined with lesion length 〈 15 mm and non-diabetic patients with lesion length 〈 15 mm regardless of the vessel caliber could be treated with BMS since the predicted restenosis rate is lower than 15% in these patients, otherwise DES would be a better choice.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2006年第12期1093-1096,共4页
Chinese Journal of Cardiology
关键词
糖尿病
冠状动脉疾病
支架
Diabetes mellitus
Coronary disease
Stents
