冠心病患者经PCI治疗后支架内再狭窄的原因分析

目的了解冠心病患者经皮冠状动脉介入治疗（PCI）后支架内再狭窄的原因，为进一步治疗和预防支架内再狭窄提供临床理论依据。方法对676例经冠状动脉造影（管腔狭窄≥50％）证实为冠心病患者进行PCI治疗，其中254例经冠状动脉造影随访，随访率36．1％，随访时间1～30（9．6±6．2）个月。造影证实原支架内血管直径狭窄≥50％，定为支架内再狭窄。再狭窄组101例，无再狭窄组153例，随访再狭窄率39．8％。入院后详细记录病史，体格检查，于次日晨空腹取静脉血检查血脂（标准酶法）、血浆纤维蛋白原（凝血酶法）水平和肝、肾功能等。高血压、糖尿病入选标准：①既往有明确高血压、糖尿病诊断者；②本次入院确诊者。每日吸烟1支以上，超过1年定为吸烟者。结果再狭窄组与无再狭窄组比较：男性更容易发生支架内再狭窄，P〈0．01。年龄、血脂水平对支架内再狭窄无明显影响，P〉0．05。再狭窄组吸烟、高血压、糖尿病例次和血浆纤维蛋白原水平均高于无再狭窄组，P〈0．05。多支病变患者冠脉内支架置入术后再狭窄率高，P〈0．01。急诊PCI治疗不增加支架内再狭窄发生率，P〉0．05。结论积极控制高血压、糖尿病，提倡戒烟，加强抗凝是预防支架内再狭窄的主要措施。急诊PCI治疗不增加再狭窄。

The Reason of Stent Restenosis After the First Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

Objective To understand the reason of stent restenosis ＇after the first percutaneous coronary intervention in patients with coronary heart disease,Aim to help therapy and prevention in-stent resteno- sis. Methods 676 patients with coronary heart disease were treated with percutaneous coronary intervention, all of them were confirmed by coronary angiography （coronary artery narrow ≥50%）. The second follow-up coronary angiography was performed in 254 patients with coronary heart disease , the follow-up rate was 36. 1% , Clinical follow-up （9.6±6.2） 1-30 months. Stent restenosis was defined by coronary angiography （ in-stene restenosis ≥50% ）and the patients were assigned as restenosis group （n = 101 ） and non- restenosis group（ n = 153 ） , the restenosis rate 39.8%. Plasma fibrinogen levels and blood lipid were simultaneously measured in 254 patients with coronary heart disease. Plasma fibrinogen concentrations（mg/dl） were assayed by thrombin method. Total cholesterol （ TC ）, triglyceride （TG） and high density lipoproteion （HDL） levels （mmol/L） were assayed by standard enzyme method. The patient＇s history was carefully recorded. Diabete mellitus and hypertension have been diagnosis in hospital or there were the case history before. Smoking history is one every day and keeoing over one year. Results in both groups,there were more males in the restenosis group,P 〈0.01. Plasma fibrinogen levels and smorking people were higher in restenosis group than non- restenosis group,P 〈0.05. Age and blood lipids were not significantly difference in both groups,P 〉 0.05. Coronary severity narrow can increase the rate of instent restenosis. Emergency percutaneous coronary inter-vention is very good the same as conventionality,P 〉 0.05. Conclusion there can be good for treated diabete mellitus and hypertension,anticoagulation et al were one of many useful methods in prevention in- stent rest- enosis,it is very important in the patients with severity coronary narrow.