红细胞参数与冠状动脉支架植入术后支架内再狭窄的关系研究

背景　冠状动脉支架植入术后支架内再狭窄（ISR）是影响接受冠状动脉支架植入术治疗患者长短期预后的重要因素，寻找有效评估ISR的临床指标具有重要的临床价值。既往研究发现红细胞分布宽度与ISR的发生有关，但是目前针对红细胞参数与ISR之间关系的研究较少。目的　对外周血红细胞相关参数与ISR之间的关系进行研究。 方法　对2010-2016年于首都医科大学附属北京世纪坛医院心血管内科接受冠状动脉支架植入术并且接受冠状动脉造影随访的冠心病患者外周血血常规结果进行收集，对可能与ISR有关的临床数据进行分析。结果　共纳入患者170例，平均年龄（65.1±10.5）岁，经皮冠状动脉介入治疗（PCI）血管213条，平均随访时间为（25.38±9.91）个月，发生ISR患者21例，发生ISR血管27条，发生比例为12.7%。单因素分析结果显示，与非ISR组相比，ISR组患者平均红细胞体积（MCV）更小〔（89.11±3.70）fl比（91.64±4.07）fl，P=0.008〕，中位红细胞血红蛋白量（MCH）更低（29.76 pg比31.10 pg，P=0.001），平均血红蛋白浓度（MCHC）更低〔（332.67±11.62）g/L比（338.21±10.55）g/L，P=0.027〕；两组患者红细胞总数、血红蛋白浓度及红细胞分布宽度比较，差异无统计学意义（P>0.05）。与非ISR组相比，ISR组患者女性比例更高、血肌酐水平更高（P<0.05）。冠状动脉造影及PCI结果显示，两组病变血管数量、PCI血管分布、是否为分叉病变、支架数量、支架长度及支架释放后是否应用后扩张球囊、后扩张压力方面比较，差异均无统计学意义（P>0.05）。二分类Logistic回归分析结果显示，女性和血肌酐水平高是PCI患者术后发生ISR的独立危险因素（P<0.05），红细胞参数均不是PCI患者术后发生ISR的独立危险因素（P>0.05）。受试者工作特征曲线显示，MCV、MCH、MCHC对于PCI患者术后发生ISR预测价值的曲线下面积分别为0.328、0.276、0.385。结论　外周静脉血红细胞参数与冠心病患者PCI术后ISR的发生有关，但不是ISR发生的独立危险因素，同时这些指标对于ISR的诊断价值有限。

Relationship between Red Blood Cell Parameters and Coronary In-stent Restenosis

Background　In-stent restenosis（ISR） is an important factor associated with the short-term and long-term prognosis of patients undergoing precutaneous coronary intervention（PCI）. Finding clinical indicators to effectively evaluate ISR has the important clinical value. Some previous studies have found that red blood cell distribution width（RDW） is related to the occurrence of ISR，but there are few studies on the relationship between red blood cell parameters and ISR. Objective　To investigate the relationship between peripheral red blood cell parameters and the incidence of ISR. Methods　Peripheral blood routine results of patients with coronary atherosclerotic heart disease who underwent PCI and received coronary angiography follow up in Cardiovascular Medicine Department in Beijing Shijitan Hospital of Capital Medical University were collected，and clinical data may be related to ISR were analyzed. Results　One hundred and seventy patients were enrolled with an average age of（65.1±10.5） and an average follow-up period of（25.38±9.91） months. There were 213 PCI vessels，and among them，21 vessels were with ISR，with an incidence rate of 12.7%. The univariate analysis results showed that patients with ISR had smaller mean corpuscular volume（MCV）〔（89.11±3.70） fl vs.（91.64±4.07） fl，P=0.008〕，lower mean corpuscular hemoglobin（MCH）（29.76 pg vs. 31.10 pg，P=0.001），and lower mean corpuscular hemoglobin concentration（MCHC）〔（332.67±11.62） g/L vs.（338.21±10.55） g/L，P=0.027〕. There were no significant differences in the total number of red blood cells，hemoglobin concentration，and red blood cell distribution width in two groups（P>0.05）. Other test results showed that patients with ISR had a higher proportion of women and higher serum creatinine levels（P<0.05）. The results of coronary angiography and PCI showed that there was no significant difference in terms of the types of lesions，the involvement of blood vessels，the number of stents，the length of the stents，whether the lesion type was a bifurcation lesion，and whether the inflatable balloon tamp was used after the stent was released and pressure after ballon dilatation（P>0.05）. Binary Logistic regression analysis revealed that women and high serum creatinine levels were the independent risk factor for ISR after PCI（P<0.05），and neither red blood cell parameters were independent risk factors for ISR after PCI（P>0.05）. Analysis of ROC curve indicated that the areas under the curve of MCV，MCH，and MCHC for predictive value of ISR after PCI were 0.328，0.276，and 0.385，respectively. Conclusion　Venous red blood cell parameters are associated with the incidence of ISR in patients with coronary heart disease，but are not the independent risk factors for ISR. At the same time，the predictive value of these indicators is limited for ISR.