摘要
目的:探讨纤维蛋白原/白蛋白比值(FAR)与急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后发生支架内再狭窄(ISR)的关系。方法:选取2015-12-2016-12于我院心内科就诊的STEMI患者162例,根据术后复查造影结果分为ISR组和非ISR组,比较两组患者临床资料、实验室检查结果、心脏超声指标、冠状动脉病变情况、既往支架置入情况、服药情况等。采用多因素Logistic回归分析发生ISR的相关因素,受试者工作曲线(ROC)用于评价FAR对ISR的预测价值。结果:与非ISR组比较,ISR组患者血清低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)与三酰甘油(TG)水平明显增高(均P<0.05),高密度脂蛋白胆固醇(HDL-C)、白蛋白水平与左心室射血分数(LVEF)明显降低(均P<0.05)。两组患者年龄、性别、吸烟、高血压、糖尿病、术后服用β受体拮抗剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)、他汀类药物、抗血小板药物、病变血管及置入支架类型、数目和直径比较均差异无统计学意义,但ISR组置入支架的长度显著高于非ISR组(P<0.05)。多因素Logistic回归分析显示,FAR(P=0.028,OR=19.092)、置入支架的长度(P=0.008,OR=1.214)、TC(P=0.012,OR=1.873)是ISR发生的独立危险因素,而LVEF(P=0.013,OR=0.915)、支架直径(P=0.047,OR=0.203)可能是ISR发生的保护因素。ROC曲线下面积为0.658(95%CI:0.579～0.731,P=0.0013),FAR的诊断临界值为1.19,此时敏感性为64.29%,特异性为70.15%。结论:FAR升高可独立预测冠状动脉支架置入术后ISR的发生,是ISR发生的危险因素。此外,TC与置入支架的长度也是ISR发生的危险因素。
Objective：To study the relationship between fibrinogen albumin ratio（FAR）and in-stent restenosis（ISR）after primary percutaneous coronary intervention（PCI）in patients with acute ST segment elevation myocardial infarction（STEMI）.Method：A total of 162 patients with STEMI in Department of Cardiology at our Hospital from December 2015 to December 2016 were divided into ISR group and non-ISR group.The clinical data,laboratory test results,echocardiographic indicators,coronary artery disease,previous stent placement and medications between two groups were compared.Logistic regression analysis was used to analyze factors related to ISR,receiver operating curve（ROC）was used to evaluate the predictive value of FAR for ISR.Result：Levels of serum LDL-C,TC and TG in ISR group were significantly higher than those in non-ISR group（all P〈0.05）.Levels of HDL-C,albumin and LVEF were significantly lower in ISR group than those in non-ISR group（all P〈0.05）.There was no significant difference in age,gender,smoking,hypertension,diabetes,postoperative administration ofβreceptor blockers,ACEI/ARB,statins,antiplatelet drugs,diseased vessels,typles of stents,number of stents and stent diameter between two groups,but the length of the stent in ISR group was significantly higher than that in non-ISR group（P〈0.05）.Multivariate Logistic regression analysis showed that FAR（P=0.028,OR=19.092）,stent length（P=0.008,OR=1.214）,TC（P=0.012,OR=1.873）were independent risk factors for ISR,LVEF（P=0.013,OR=0.915）and stent diameter（P=0.047,OR=0.203）may be protective factors for ISR.The area under the ROC curve was 0.658（95%CI：0.579-0.731,P=0.0013）,the diagnostic threshold was 1.19,the sensitivity was 64.29% and the specificity was 70.15%.Conclusion：The increase of FAR can independently predict the occurrence of ISR after coronary stent implantation,which is a risk factor for the development of ISR.In addition,TC and stent length are also risk factors for ISR.
作者
崔佳佳
金卫东
韩明磊
王俊霞
赵一品
CUI Jiajia;JIN Weidong;HAN Minglei;WANG Junxia;ZHAO Yipin(Department of Cardiology,the Central Hospital of Xinxiang,Xinxiang,Henan,453000,China;Department of Coronary Heart Disease Intensive Care Unit,Fuwai Huazhong Cardiovascular Hospital)
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2018年第11期1099-1103,共5页
Journal of Clinical Cardiology
