收稿日期: 2020-04-25
网络出版日期: 2020-06-25
基金资助
上海交通大学医工交叉课题(YG2013MS31);中华医学会2014高胆固醇研究课题(14010120549)
Correlation of estimated glomerular filtration rate with incidence of in-stent restenosis in patients with drug-elu-ting stent
Received date: 2020-04-25
Online published: 2020-06-25
目的： 探索冠状动脉（冠脉）药物洗脱支架植入（以下简称支架植入）术后随访期估算肾小球滤过率（estimated glomerular filtration rate, eGFR）与支架植入术后再狭窄（in-stent restenosis, ISR）间的关系。方法： 以中国冠状动脉斑块进展多因素回顾分析研究中的患者为对象,病例均于2010年1月至2016年7月间在各中心进行冠脉造影检查,并在之后12~24个月（平均为13个月）内进行冠脉造影复查,采用二元Logistics回归分析评估随访期eGFR与ISR间的关系,初步探索导致ISR发生的危险因素。结果： 本研究共纳入符合标准的冠心病患者1 790例,随访期全体患者eGFR平均值为89.97 mL/（min·1.73m2）,按照随访期复查冠脉造影有无ISR,分为ISR组（n=200）和无ISR组（n=1590）。其中,ISR组患者在随访期间的eGFR低于无ISR组[（86.50±25.69） mL/（min·1.73 m2）比（90.64±26.59） mL/（min·1.73 m2）,P=0.038]。二元Logistics回归分析提示,导致ISR的危险因素包括植入支架的个数（OR=1.478, 95% CI 1.177~1.855, P=0.001）、基线期C反应蛋白升高（OR=1.006, 95%CI 1.002~1.011, P=0.007）,而随访期间相对较高的eGFR是ISR的保护性因素（OR=0.990,95%CI 0.982~0.999, P=0.022）。结论： 在eGFR基本正常的冠心病患者中,较低的随访期eGFR水平与其接受冠脉药物洗脱支架植入术后的ISR发生率密切相关。
关键词： 肾小球滤过率; 药物洗脱支架; 再狭窄; Logistics回归
刘圣均, 刘莉莉, 朱政斌, 孙宜, 朱天奇, 冯硕, 陈馨, 权薇薇, 张瑞岩 . 肾小球滤过率与冠状动脉支架内再狭窄的相关性分析[J]. 诊断学理论与实践, 2020 , 19(03) : 297 -302 . DOI: 10.16150/j.1671-2870.2020.03.017
Objective: To evaluate correlation of estimated glomerular filtration rate with occurrence of in-stent restenosis (ISR) in patients treated with drug-eluting stent(DES) implantation during follow-up period. Methods: Patients undergone DES implantation in the RIPPER study between January 2010 and July 2016 were enrolled, and coronary angiography was performed again to detect ISR after 12-24 months (with the average time of 13 months). Binary Logistics regression were used to assess the risk factors for in-stent restenosis (ISR), and evaluate the correlation of eGFR with ISR in patients. Results: A total of 1 790 patients meeting the inclusion criteria, with the average eGFR of 89.97 mL/(min·1.73 m2) during follow-up, were divided into ISR group (n=200) and No-ISR group (n=1 590). The eGFR in ISR group was significantly lower than No-ISR group [(86.50±25.69) mL/(min·1.73 m2) vs. (90.64±26.59) mL/(min·1.73 m2), P=0.038]. Binary Logistics regression showed that the risk factors for ISR were number of implanted stent[OR=1.478, 95% CI 1.177-1.855, P=0.001] and increased baseline C-reactive protein level [OR=1.006, 95%CI 1.002-1.011, P=0.007], while relatively elevated eGFR during follow-up was protective factor（OR=0.990, 95%CI 0.982-0.999, P=0.022.Conclusions: In patients with nearly normal eGFR after DES implantation, relatively lower eGFR is correlated with the incidence of ISR.
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