本文選題：經(jīng)皮冠狀動脈內(nèi)介入治療 + 再狹窄　； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：當(dāng)前心血管疾病已經(jīng)成為威脅人類健康的頭號殺手，盡管隨著醫(yī)療技術(shù)的進一步發(fā)展與提高，冠心病患者的病死率大幅度降低，但隨著人民生活水平的提高、生活節(jié)奏的加快，人群血壓、血清總膽固醇、血糖、體重指數(shù)均呈上升趨勢，冠心病的發(fā)病率隨之上升。世界衛(wèi)生組織總干事陳馮富真曾表示：“如果中國近5-10年不加強對心血管疾病等慢性病的防控，那么中國改革開放成果的一半將被消耗殆盡”。因此，廣泛開展冠心病的防治工作十分重要。1977年Gruntzig第一例經(jīng)皮腔內(nèi)冠狀動脈成形術(shù)(Percutaneous transluminal coronary angioplasty,PTCA)的誕生[1]，開創(chuàng)了介入性心臟病學(xué)的新紀元。1986年Sigwart等首次將網(wǎng)狀金屬支架用于冠狀動脈[2]，揭開了支架治療血管性疾病的新篇章。盡管設(shè)備和藥物治療在不斷地進步與完善，但支架術(shù)后再狹窄(In-stent stenosis,ISR)仍是經(jīng)皮冠狀動脈介入治療(Percutaneous coronary intervention,PCI)術(shù)后的一大缺陷[3]。ISR是冠狀動脈支架術(shù)后的重要并發(fā)癥，術(shù)后3-6個月多發(fā)[4]，金屬裸支架(Bare-metal stents,BMS)術(shù)后1年內(nèi)再狹窄的發(fā)生率為20%-30%，使用藥物涂層支架(Drug-eluting stents,DES)的置入可使術(shù)后1年內(nèi)再狹窄發(fā)生率降至7%[5]以下，但其遠期再狹窄率與普通金屬裸支架并無差別[6]，仍有超過15%的冠狀動脈支架置入患者在一年內(nèi)因再狹窄的發(fā)生而接受再次介入治療[7]。目前認為與ISR相關(guān)的臨床危險因素包括：年齡偏小(低于60歲)、糖尿病、高血壓病、不穩(wěn)定性心絞痛、合并外周血管病變；與冠狀動脈病變部位相關(guān)的危險因素包括：分叉病變、多支病變、彌漫性病變、前降支病變[8]等；另外病變血管直徑、長度、狹窄程度、置入支架類型、數(shù)目、總長度、支架重疊等也對ISR的發(fā)生具有明顯影響[10,11]。尤其糖尿病者和有介入術(shù)后再狹窄發(fā)生史者ISR的發(fā)生率更高[9]。本研究通過觀察PCI術(shù)后患者再狹窄發(fā)生情況，結(jié)合其臨床和冠脈造影特點，探討經(jīng)皮冠狀動脈介入術(shù)后再狹窄的相關(guān)因素，為預(yù)防和治療支架再狹窄提供理論基礎(chǔ)。 方法：入選2010年2月至2013年11月間在河北醫(yī)科大學(xué)第三醫(yī)院心內(nèi)科行PCI治療，，并有術(shù)后一年冠狀動脈造影(Coronaryangiography,CAG)復(fù)查資料的患者250例。根據(jù)冠脈造影復(fù)查結(jié)果，將患者分為再狹窄組(支架置入段內(nèi)徑狹窄≥50%)和對照組(無再狹窄或狹窄50%)，其中再狹窄組130例，對照組120例�；仡櫺苑治鰞山M患者的臨床資料及冠狀動脈造影特點，找出支架術(shù)后再狹窄的高危因素，并采用Logistic回歸分析其與冠脈支架內(nèi)再狹窄的相關(guān)關(guān)系。 結(jié)果：再狹窄組與對照組對比結(jié)果顯示：男性、吸煙、糖尿病史、白細胞計數(shù)、前降支病變、分叉病變、支架長度、支架重疊在兩組之間具有統(tǒng)計學(xué)差異，采用Logistic回歸分析發(fā)現(xiàn)吸煙史(OR=2.423,95%CI=1.365-4.302,P=0.003)、糖尿病史(OR=2.175,95%CI=1.021-4.634,P=0.044)、支架長度(OR=1.029,95%CI=1.002-1.057,P=0.033)、分叉病變(OR=2.159,95%CI=1.035-4.506,P=0.040)與支架術(shù)后再狹窄相關(guān)。 結(jié)論：吸煙、糖尿病病史、支架較長、分叉病變，提示為支架術(shù)后再狹窄的高危因素，應(yīng)對這類患者強化藥物治療及高危因素的控制。
[Abstract]:Objective: at present, cardiovascular disease has become the leading killer of human health. Although with the further development and improvement of medical technology, the mortality of patients with coronary heart disease has been greatly reduced, but with the improvement of the people's living standard, the pace of life, blood pressure, serum total cholesterol, blood sugar and body mass index are on the rise. The incidence of coronary heart disease is rising. Chen Fengfuzhen, director general of the WHO, said: "if China does not strengthen the prevention and control of chronic diseases such as cardiovascular disease in the last 5-10 years, then half of the results of China's reform and opening up will be depleted." therefore, the prevention and treatment of coronary heart disease is very important in.1977 year Gruntzig first. Percutaneous transluminal coronary angioplasty (PTCA) was born [1]. The new era of interventional cardiology, the new era of.1986 Sigwart, was first used to use reticular metal stents for coronary artery [2], uncovering a new chapter of stent treatment for vascular disease. Although equipment and drug treatment are constantly being treated Progress and improvement, but after stent restenosis (In-stent stenosis, ISR) remains a major defect after percutaneous coronary intervention (Percutaneous coronary intervention, PCI). [3].ISR is an important complication after coronary artery stenting, and more [4] after 3-6 months of operation, and restenosis within 1 years after the operation of bare metal stents (Bare-metal stents, BMS). The incidence of 20%-30% and the use of drug coated stent (Drug-eluting stents, DES) could reduce the incidence of restenosis to less than 7%[5] within 1 years after the operation, but the long-term restenosis rate was not different from that of the ordinary bare metal stent, and more than 15% of the patients with coronary stent implantation were again accepted in one year for restenosis. The clinical risk factors associated with ISR in the treatment of [7]. include younger age (less than 60 years), diabetes, hypertension, unstable angina, and peripheral vascular lesions. The risk factors associated with the site of coronary artery disease include bifurcation lesions, multiple lesions, diffuse lesions, [8] in the anterior descending branch, and other diseases. Vascular diameter, length, stenosis, stent type, number, length, and overlap of stents also have a significant impact on the occurrence of ISR, [10,11]. especially diabetes and the incidence of ISR in patients with restenosis after intervention. The incidence of restenosis in patients after PCI was observed, combined with clinical and coronary angioplasty. To explore the related factors of restenosis after percutaneous coronary intervention, and to provide a theoretical basis for preventing and treating stent restenosis.
Methods: from February 2010 to November 2013, 250 patients were treated with PCI in the Department of Cardiology, Third Hospital of Hebei Medical University, and 250 cases were rechecked by coronary angiography (CAG) after one year. The patients were divided into restenosis group (the stenosis of stent diameter more than 50%) and the control group (no group). Restenosis or stenosis was 50%), of which 130 cases were restenosis group and 120 cases in control group. The clinical data and coronary arteriography characteristics of the two groups were analyzed retrospectively. The high risk factors for restenosis after stenting were found, and the correlation between the restenosis and the coronary stent restenosis was analyzed by Logistic regression.
Results: the comparison between the restenosis group and the control group showed that smoking, diabetes history, leukocyte count, anterior descending lesion, bifurcation lesion, stent length, and stent overlap were statistically different among the two groups, and the history of smoking (OR= 2.423,95%CI=1.365-4.302, P=0.003) and diabetes history were found by Logistic regression analysis (OR=2.175,95%CI=1.021 -4.634 (P=0.044), length of stent (OR=1.029,95%CI=1.002-1.057, P=0.033), and OR=2.159,95%CI=1.035-4.506 (P=0.040) were associated with restenosis after stent placement.
Conclusion: smoking, diabetes history, long stents and bifurcated lesions are the high risk factors for restenosis after stenting, and should be used to strengthen the control of drug treatment and high risk factors in these patients.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R541.4

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