CAJ | 학술논문

目的分析冠心病合并糖尿病患者首次置入药物洗脱支架(DES)后发生支架内再狭窄(ISR)的预测因素,并建立预测模型.方法回顾性分析2005年1月至2012年12月在我院置入DES的冠心病合并糖尿病患者的临床资料.应用SPSS 17.0软件产生的随机数字,将3 073例患者随机分为模型产生队列和模型验证队列.模型产生队列(2 048例)又分为再狭窄组和对照组,对2组之间差异有统计学意义的临床指标进行单因素和多因素logistic回归分析;按β回归系数所占的比重给多因素logistic回归分析中有统计学意义的指标赋予分值,并建立评分模型.在模型验证队列(1 025例)中进行模型预测能力的验证.结果 217例(7.1％)糖尿病患者在首次置入DES后2年诊断ISR,模型产生队列中ISR患者共149例(7.3％).多因素logistic回归分析显示,糖尿病患者首次置入DES后2年发生ISR的预测因素为多支病变(OR=3.69,95％CI:2.65 ～ 8.93,P=0.000)、弥漫病变(OR =2.92,95％ CI:2.03～6.46,P=0.000)、肾小球滤过率＜60 ml·min-1·1.73 m-2(OR =4.73,95％ CI:3.51 ～10.62,P=0.000)、吸烟(OR=3.37,95％CI:2.39～8.46,P=0.000)、年龄＜ 60岁(OR=1.44,95％CI:1.26～4.63,P=0.024)以及糖化血红蛋白≥6.3％(OR=2.48,95％ CI:1.84～4.27,P=0.002).模型验证队列患者的评分显示,ISR发生率随评分增加而增加;评分为5.5时,模型预测的灵敏度和特异度分别为76.5％(95％ CI:64.6％～85.9％)和76.1％(95％ CI:73.2％～78.7％),受试者工作特征(ROC)曲线下面积为0.851(95％CI:0.813～0.890,P=0.000).结论冠心病合并糖尿病患者置入DES后2年的ISR发生率较低,多种预测因素与其相关.评分模型对DES置入后的ISR有较好的预测能力.
목적 분석관심병합병당뇨병환자수차치입약물세탈지가(DES)후발생지가내재협착(ISR)적예측인소,병건립예측모형.방법 회고성분석2005년1월지2012년12월재아원치입DES적관심병합병당뇨병환자적림상자료.응용SPSS 17.0연건산생적수궤수자,장3 073례환자수궤분위모형산생대렬화모형험증대렬.모형산생대렬(2 048례)우분위재협착조화대조조,대2조지간차이유통계학의의적림상지표진행단인소화다인소logistic회귀분석;안β회귀계수소점적비중급다인소logistic회귀분석중유통계학의의적지표부여분치,병건립평분모형.재모형험증대렬(1 025례)중진행모형예측능력적험증.결과 217례(7.1％)당뇨병환자재수차치입DES후2년진단ISR,모형산생대렬중ISR환자공149례(7.3％).다인소logistic회귀분석현시,당뇨병환자수차치입DES후2년발생ISR적예측인소위다지병변(OR=3.69,95％CI:2.65 ～ 8.93,P=0.000)、미만병변(OR =2.92,95％ CI:2.03～6.46,P=0.000)、신소구려과솔＜60 ml·min-1·1.73 m-2(OR =4.73,95％ CI:3.51 ～10.62,P=0.000)、흡연(OR=3.37,95％CI:2.39～8.46,P=0.000)、년령＜ 60세(OR=1.44,95％CI:1.26～4.63,P=0.024)이급당화혈홍단백≥6.3％(OR=2.48,95％ CI:1.84～4.27,P=0.002).모형험증대렬환자적평분현시,ISR발생솔수평분증가이증가;평분위5.5시,모형예측적령민도화특이도분별위76.5％(95％ CI:64.6％～85.9％)화76.1％(95％ CI:73.2％～78.7％),수시자공작특정(ROC)곡선하면적위0.851(95％CI:0.813～0.890,P=0.000).결론 관심병합병당뇨병환자치입DES후2년적ISR발생솔교저,다충예측인소여기상관.평분모형대DES치입후적ISR유교호적예측능력.
Objective To determine predictors for in-stent restenosis (ISR) within 2 years after drug-eluting stent (DES) implantation in coronary heart disease patients complicating with diabetes mellitus and to establish predictive model.Methods We retrospectively analyzed clinical data of patients underwent DES implantation in our hospital between January 2005 and December 2012.Using random number generated by SPSS 17.0,a total of 3 073 cases were randomly divided into two cohort,model derivation cohort (MDC) and model validation cohort (MVC).MDC (2 048 cases) was divided into in-stent restenosis (ISR) group and control group.Predictors were identified using univariable and multivariable logistic regression analysis in MDC.Integer point values were assigned to each predictor based upon their β coefficient in multivariable logistic regression model to establish scoring model.The summed scores of each case in MVC (1 025 cases) were calculated to test predictive ability of the model.Results Of all these 3 073 cases,217 cases (7.1％) were diagnosed with ISR within 2 year after DES implantation.The incidence of ISR within 2 year after DES implantation was 7.3％ (149 cases) in MDC and logistic regression analysis identified six ISR risk factors:multiple target vessels (OR =3.69,95％ CI:2.65-8.93,P =0.000),diffused lesions (OR =2.92,95％ CI:2.03-6.46,P =0.000),GFR ＜60 ml · min-1 1.73 m-2 (OR=4.73,95％CI:3.51-10.62,P=0.000),smoking (OR=3.37,95％CI:2.39-8.46,P =0.000),age ＜ 60 years old (OR =1.44,95％ CI:1.26-4.63,P =0.024),HbAlc ≥ 6.3％ (OR =2.48,95％ CI:1.84-4.27,P =0.002).Risk score was well associated with the rate of ISR in MVC.Sensitivity was 76.5％ (95％ CI:64.6％-85.9％),specificity was 76.1％ (95％ CI:73.2％-78.7％),and areas under the ROC curve was 0.851 (95％ CI:0.813-0.890,P =0.000) when score was set at 5.5.Conclusions The incidence of ISR in coronary heart disease patients complicating with diabetes mellitus within 2 years after DES implantation is relatively low.Several factors are associated with ISR in these patients and risk for ISR could be reliably identified by the established scoring model.