摘要
目的 探讨血纤维蛋白原与白蛋白比值(FAR)和中性粒细胞与淋巴细胞比值(NLR)在冠状动脉粥样硬化性心脏病(CHD)患者行经皮冠状动脉介入治疗(PCI)术后发生冠状动脉药物洗脱支架内再狭窄(DES-ISR)中的评估价值。方法 回顾性选取在新疆医科大学第一附属医院成功置入冠状动脉药物洗脱支架(DES)并自愿接受随访的309例冠心病患者。术后随访6月至3年间再次行冠状动脉造影术(CAG),根据是否发生DES-ISR,将患者分为支架内再狭窄(ISR)组77例及无ISR组232例。收集两组患者的基本信息、一般临床资料、PCI术信息、血常规、血生化及凝血功能等指标。运用单因素及逐步多因素logistic回归模型分析与PCI术后发生DES-ISR相关因素,并使用受试者工作特征曲线(ROC)评价FAR、NLR、支架长度、支架置入时间及四者联合对PCI术后发生DES-ISR的诊断价值。结果 将单因素logistic回归分析中P<0.200的自变量纳入逐步多因素logistic回归分析,结果显示FAR(OR=1.025,95%CI 1.003~1.047,P=0.024),NLR(OR=1.426,95%CI 1.047~1.943,P=0.025),支架长度(OR=1.028,95%CI 1.015~1.041,P=0.000),支架置入时间(OR=1.088,95%CI 1.029~1.151,P=0.003)是冠状动脉DES-ISR的独立危险因素,而支架直径(OR=0.278,95%CI 0.109~0.709,P=0.007)是冠状动脉DES-ISR的保护因素,均与CHD患者PCI术后发生DES-ISR显著相关(均P<0.05)。FAR、NLR、支架长度、支架置入时间及四者联合诊断PCI术后发生DES-ISR的ROC曲线下面积(AUC)分别为0.619(95%CI 0.562~0.673,P=0.001)、0.581(95%CI 0.524~0.637,P=0.029)、0.720(95%CI 0.667~0.770,P<0.0001)、0.543(95%CI 0.486~0.600,P=0.287)、0.749(95%CI 0.697~0.796,P<0.0001),截断值分别为78.72、1.5、50、11、0.212,灵敏度分别为44.16%、83.12%、54.55%、64.94%、68.83%,特异度分别为76.72%、31.90%、81.03%、45.26%、68.97%;四者联合诊断AUC大于FAR、NLR、支架长度、支架置入时间。结论 FAR、NLR、支架长度、支架置入时间是CHD患者发生DES-ISR独立危险因素,四者联合可增加DESISR诊断价值,对DES-ISR的评估及预防性调整治疗方案具有一定参考价值。
Objective To evaluate the value of blood fibrinogen to albumin ratio(FAR)and neutrophil to lymphocyte ratio(NLR)in the assessment of development of coronary drug-eluting stents restenosis(DES-ISR)after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods A total of 309 patients with coronary heart disease who were successfully implanted drug-eluting stents(DES)in the First Affiliated Hospital of Xinjiang Medical University and voluntarily accepted follow-up were retrospectively selected.Coronary angiography(CAG)was performed again during the follow-up period of 6 months to 3 years.According to the occurrence of DES-ISR,the patients were divided into the in stent restenosis(ISR)group(n=77)and the no ISR group(n=232).The basic information,general clinical data,PCI information,blood routine,blood biochemistry and coagulation function of the two groups collected.Univariate and stepwise multivariate logistic regression models were used to analyze the related factors of DES-ISR after PCI.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of FAR,NLR,Stent length,Stent implantation time and their combination for DES-ISR after PCI.Results The independent variables with P<0.200 in univariate logistic regression analysis were included in multivariate stepwise logistic regression analysis,and the results showed that FAR(OR=1.025,95%CI 1.003-1.047,P=0.024),NLR(OR=1.426,95%CI 1.047-1.943,P=0.025),Stent length(OR=1.028,95%CI 1.015-1.041,P=0.000)and Stent implantation time(OR=1.088,95%CI 1.029-1.151,P=0.003)were the independent risk factors for coronary DES-ISR,and the diameter of stent(OR=0.278,95%CI 0.109-0.709,P=0.007)was a protective factor of coronary DES-ISR,which all were significantly correlated with DES-ISR after PCI in CHD patients(all P<0.05).The area under the curve(AUC)of DES-ISR after PCI diagnosis by FAR,NLR,Stent length,Stent implantation time and their combination were respectively 0.619(95%CI 0.562-0.673,P=0.001),0.581(95%CI 0.524-0.637,P=0.029),0.720(95%CI 0.667-0.770,P<0.0001),0.543(95%CI 0.486-0.600,P=0.287),0.749(95%CI 0.697-0.796,P<0.0001);and the cut-off values were respectively 78.72,1.5,50,11,0.212;the sensitivity were respectively 44.16%,83.12%,54.55%,64.94%,68.83%and the specificity were respectively 76.72%,31.90%,81.03%,45.26%,68.97%.The AUC of the four combined diagnosis was larger than that of any single FAR,NLR,Stent length and Stent implantation time.Conclusions FAR,NLR,Stent length and Stent implantation time are the independent risk factors for DES-ISR in CHD patients;the combining detect of which can increase the diagnostic value of DES-ISR.It has certain reference value for the evaluation of DES-ISR and the preventive adjustment of treatment plan.
作者
合孜尔·吐尔孙江
木胡牙提
哈斯达尔
张雷
杨玉春
刘志强
Hezier Tuersunjiang;Muhuyati;Hasidaer;ZHANG Lei;YANG Yu-chun;LIU Zhi-qiang(Department of Cardiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中国心血管病研究》
CAS
2022年第12期1073-1079,共7页
Chinese Journal of Cardiovascular Research
基金
新疆维吾尔自治区自然科学基金杰出青年科学基金(2022D01E23)。
