本文關(guān)鍵詞： 頸內(nèi)動脈 支架內(nèi)再狹窄 炎癥因子 TBIL　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:采用回顧性病例對照研究,探討患者生化指標(biāo)與頸內(nèi)動脈支架內(nèi)再狹窄發(fā)生的相關(guān)性,尋找支架內(nèi)再狹窄發(fā)生的危險(xiǎn)因素,探索支架內(nèi)再狹窄的發(fā)生的主要影響因素,并判斷這些因素對ISR的預(yù)測價值,為臨床診療提供依據(jù)。方法:回顧性分析自2013年1月至2016年1月于大同市三醫(yī)院經(jīng)DSA確診頸內(nèi)中重度狹窄并行CAS的患者83例,定期經(jīng)CDU、CTA或DSA隨訪3、6、9個月,1-3年。共置入83枚支架,患者年齡35~80歲(58.95±9.09),其中男性65例,女性18例。根據(jù)隨訪結(jié)果將隨訪對象分為再狹窄組12例,無再狹窄組71例。臨床觀察指標(biāo)包括:患者臨床資料、臨檢、生化等共22項(xiàng)因素。通過單因素及多因素Logistic回歸分析這些因素與ISR的相關(guān)性,最后通過ROC曲線分析相關(guān)因素對ISR的預(yù)測價值。結(jié)果:83例患者中,再狹窄患者12例,再狹窄率14.5%。單因素分析顯示:(1)再狹窄組與非再狹窄組在年齡、性別、高血壓病、高脂血癥、卒中史、冠心病、總膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、載脂蛋白A、術(shù)后FIB、FIB差值、術(shù)后白細(xì)胞、白細(xì)胞差值、NEUT差值比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);(2)與無再狹窄組比較,再狹窄組患者糖尿病比例明顯偏高(66.7%vs19.7%,P=0.002);TBIL水平明顯偏高[(9.27±1.56)vs(11.00±4.10),P=0.030];術(shù)后FIB明顯升高[(5.13±1.46)vs(3.75±0.78),P=0.008];FIB差值[(2.08±1.50)vs(0.93±0.76),P=0.024];術(shù)后白細(xì)胞明顯升高[(9.52±1.48)vs(8.23±2.44),P=0.020];白細(xì)胞差值[(2.28±1.48)vs(0.95±2.18),P=0.047];NEUT差值[(10.79±10.06)vs(5.40±8.00),P=0.041]。以是否發(fā)生再狹窄為因變量,以糖尿病、TBIL、術(shù)后FIB、術(shù)后白細(xì)胞、白細(xì)胞差值、NEUT差值為自變量,行多因素logistic回歸分析,結(jié)果顯示,糖尿病、術(shù)后FIB、NEUT差值被納入回歸方程,其中TBIL[OR(95%CI):0.379(0.149-0.964);P=0.042],是ISR的保護(hù)因素;糖尿病[OR(95%CI):9.644(1.177-79.051);P=0.035]、術(shù)后FIB[OR(95%CI):5.166(1.315-20.303);P=0.019]、NEUT差值[OR(95%CI):1.225(1.030-1.457);P=0.022],是ISR的獨(dú)立危險(xiǎn)因素。(3)最后通過ROC曲線分析:術(shù)后FIB、NEUT%差值及聯(lián)合預(yù)測因子ROC曲線面積分別為0.795(95%CI:0.643-0.946;P=0.001)、0.656(95%CI:0.491-0.820;P=0.086)、0.883(95%CI:0.794-0.971;P0.001)。術(shù)后FIB及聯(lián)合預(yù)測因子均能較好的預(yù)測ISR的發(fā)生,其中以聯(lián)合預(yù)測因子診斷價值更高。結(jié)論:頸內(nèi)動脈支架內(nèi)再狹窄的發(fā)生率為14.5%。多因素Logistic回歸分析結(jié)果顯示:糖尿病史、TBIL水平、術(shù)后FIB、NEUT差值與ISR相關(guān)。其中TBIL水平是ISR的保護(hù)因素;糖尿病、術(shù)后FIB、中性粒細(xì)胞差值是ISR的獨(dú)立危險(xiǎn)因素。術(shù)后FIB及聯(lián)合預(yù)測因子均能較好的預(yù)測ISR的發(fā)生,其中以聯(lián)合預(yù)測因子預(yù)測價值更高。
[Abstract]:Objective: to investigate the correlation between biochemical parameters and restenosis in internal carotid artery stents, to find out the risk factors of restenosis in internal carotid artery, and to explore the main influencing factors of restenosis in stent by retrospective case-control study. To evaluate the predictive value of these factors to ISR and to provide the basis for clinical diagnosis and treatment. Methods: from January 2013 to January 2016, 83 patients with moderate or severe intracervical stenosis and CAS were retrospectively analyzed in three hospitals of Datong city. The patients were followed up by DSA or DSA for 3 ~ 6 years, 9 months and 1 ~ 3 years. 83 stents were implanted. The age of the patients was 58.95 鹵9.09, including 65 males and 18 females. According to the follow-up results, 12 patients were divided into restenosis group (n = 12), restenosis group (n = 12), male (n = 65) and female (n = 18). There were 71 cases without restenosis. The clinical indexes included 22 factors, such as clinical data, clinical examination, biochemistry and so on. The correlation between these factors and ISR was analyzed by univariate and multivariate Logistic regression analysis. Finally, the predictive value of related factors to ISR was analyzed by ROC curve. Results among 83 patients with restenosis, 12 were restenosis patients, and the restenosis rate was 14.5.The univariate analysis showed that the restenosis group and non-restenosis group had age, sex, hypertension, hyperlipidemia. Stroke history, coronary heart disease, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, apolipoprotein A, postoperative FIBN FIB difference, postoperative white blood cell, leukocyte difference and neut difference were compared. There was no significant difference between the two groups (P 0.05) and the restenosis group. In the restenosis group, the percentage of diabetes mellitus patients was significantly higher than that in the restenosis group [66.7vs19.7p0. 024]; the level of TBIL was significantly higher [9.27 鹵1.56vs11.00 鹵4.10vs0.030]; the postoperative FIB was obviously increased [5.13 鹵1.46vs3.75 鹵0.78P0.008]; the difference of FIB [2.08 鹵1.50v / s 0.93 鹵0.76vs0.024] was significantly higher after operation [9.52 鹵1.48vs/ 8.23 鹵2.44vs/ 0.020]; the difference of leukocyte was 2.28 鹵1.48vs0.95 鹵1.18vs0.047] [10.79 鹵1.06v0.040] (10.79 鹵1.06vs0.040), and the incidence of restenosis was dependent on the incidence of restenosis [10.79 鹵1.48vs0.40 鹵0.041], and the correlation between the two groups was as follows: (1) the ratio of TBIL in the restenosis group was significantly higher than that in the control group [9.27 鹵1.56 vs 11.00 鹵4.10 鹵4.10 vs 0.030], and the difference between the white blood cell count [2.28 鹵1.48 vs / 0. 047] was 0.95 鹵2.18vs0.047 [10.79 鹵1.50v / 0.040]. The multivariate logistic regression analysis showed that the logistic regression analysis showed that the difference value of logistic was included in the regression equation, in which TBIL [Ori 95CIV 0.379U 0.149-0.964P0.042] was the protective factor of ISR. FIB [OR95CII: 5.1661.315-20.303P0.019] next difference [OR95 CIV: 1.2251.030-1.457P0.022], the final ROC curve was analyzed by ROC curve analysis: the difference between FIBNEN% after operation and the area of ROC curve of the combined predictor was 0.79595CI0.643-0.946 P0.001 0. 06569595 CIV 0.491-0.820P0. 086 0. 086% 0. 88395CI790.970.1P1P0. The combined factors of FIB and FIB could predict the occurrence of ISR. Conclusion: the incidence of restenosis in internal carotid artery stent was 14.5%. Multivariate Logistic regression analysis showed that TBIL level in diabetic history was higher than that in control group. The TBIL level was the protective factor of ISR, the difference of neutrophil and neutrophil was the independent risk factor of ISR in diabetes mellitus, the postoperative FIB and combined predictive factors could predict the occurrence of ISR, and the TBIL level was the protective factor of ISR, and the difference of neutrophil was the independent risk factor of ISR. Among them, the value of joint predictor is higher.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3

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