颅内支架置入术治疗颅内动脉粥样硬化性狭窄近远期疗效观察及再狭窄危险因素分析(1)
[摘要] 目的 探讨分析颅内支架置入术治疗颅内动脉粥样硬化性狭窄近远期疗效及再狭窄的危险因素。 方法 回顾性分析2013年3月～2015年3月石家庄市第一医院收治的78例颅内动脉粥样硬化性狭窄且行颅内支架置入术患者的临床资料，通过影像学检查判断术后再狭窄的发生率，同时随访36个月，评估术后终点事件的发生情况。根据随访结果分为再狭窄组(21例)和非再狭窄组(57例)，对比分析术后发生再狭窄的危险因素。 结果 所选的78例患者中，手术成功率为94.87%。术前与术后狭窄率比较差异有统计学意义(P < 0.05)。所选的78例患者中，再狭窄率为26.92%;单因素分析结果示：年龄>55岁、有糖尿病史、有高血压病史、置入支架直径≥ 4.5 mm、hs-CRP> 3 mg/L是架内再狭窄发生的危险因素(P < 0.05);多因素Logistic回归分析结果显示，有糖尿病史(OR = 3.87， 95%CI：1.68～5.37，P = 0.043)、有高血压病史(OR = 1.81，95%CI：0.23～2.06，P = 0.037)、置入支架直径≥ 4.5 mm(OR = 1.41， 95%CI：0.61～2.48，P = 0.003)、hs-CRP> 3 mg/L(OR = 5.01，95%CI：1.26～8.04，P = 0.016)是颅内支架置入术后再狭窄的独立危险因素。 结论 颅内支架置入术治疗颅内动脉粥样硬化性狭窄的手术成功率高，近期疗效确切，但其远期预后并不理想，有糖尿病史、有高血压病史、置入支架直径≥4.5 mm、hs-CRP> 3 mg/L均是颅内支架置入术后再狭窄的独立危险因素，针对这些危险因素進行合理的干预，可以有效控制颅内支架置入术后再狭窄的风险。
[关键词] 支架置入术;颅内动脉粥样硬化;近远期疗效;危险因素
[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210(2018)12(b)-0110-04
[Abstract] Objective To investigate the short and long term effect of intracranial stenting in the treatment of intracranial atherosclerotic stenosis and the risk factors of restenosis. Methods The clinical data of 78 patients with intracranial atherosclerotic stenosis and intracranial stent implantation admitted to the First Hospital of Shijiazhuang City from March 2013 to March 2015 were retrospectively analyzed. The incidence rate of postoperative restenosis was determined by imaging examination， and the incidence of postoperative end-point events was evaluated after 36 months of follow-up. According to the follow-up results， the patients were divided into restenosis group (21 cases) and non-restenosis group (57 cases)， and the risk factors of postoperative restenosis were compared and analyzed. Results Among the 78 patients selected， the success rate of operdtion was 94.87%， preoperative and postoperative stenosis rates were significantly different (P < 0.05). Among the 78 patients selected， the restenosis rate was 26.92%， the results of univariate analysis showed that age > 55 years old， history of diabetes， history of hypertension， diameter of stent implantation ≥ 4.5 mm， hs-CRP > 3 mg/L were risk factors for in-rack restenosis (P < 0.05). Multivariate Logistic regression analysis showed that patients had a history of diabetes (OR = 3.87， 95%CI： 1.68-5.37， P = 0.043)， a history of hypertension (OR = 1.81， 95%CI： 0.23-2.06， P = 0.037)， stent diameter ≥ 4.5 mm (OR = 1.41， 95%CI： 0.61-2.48， P = 0.003)， and hs-CRP > 3 mg/L (OR = 5.01， 95%CI： 1.26-8.04， P = 0.016) was an independent risk factor for restenosis after intracranial stent implantation. Conclusion The success rate of intracranial stenting in the treatment of intracranial atherosclerotic stenosis is high， and the recent curative effect is definite， but its long-term prognosis is not satisfactory. With a history of diabetes， hypertension， stent diameter ≥ 4.5 mm and hs-CRP > 3 mg/L are independent risk factors for restenosis after intracranial stent implantation. Reasonable intervention against these risk factors can effectively control the risk of restenosis after intracranial stent implantation., http://www.100md.com(王菁 解燕昭 刘云娥 秦世杰 朱倩)
[关键词] 支架置入术;颅内动脉粥样硬化;近远期疗效;危险因素
[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210(2018)12(b)-0110-04
[Abstract] Objective To investigate the short and long term effect of intracranial stenting in the treatment of intracranial atherosclerotic stenosis and the risk factors of restenosis. Methods The clinical data of 78 patients with intracranial atherosclerotic stenosis and intracranial stent implantation admitted to the First Hospital of Shijiazhuang City from March 2013 to March 2015 were retrospectively analyzed. The incidence rate of postoperative restenosis was determined by imaging examination， and the incidence of postoperative end-point events was evaluated after 36 months of follow-up. According to the follow-up results， the patients were divided into restenosis group (21 cases) and non-restenosis group (57 cases)， and the risk factors of postoperative restenosis were compared and analyzed. Results Among the 78 patients selected， the success rate of operdtion was 94.87%， preoperative and postoperative stenosis rates were significantly different (P < 0.05). Among the 78 patients selected， the restenosis rate was 26.92%， the results of univariate analysis showed that age > 55 years old， history of diabetes， history of hypertension， diameter of stent implantation ≥ 4.5 mm， hs-CRP > 3 mg/L were risk factors for in-rack restenosis (P < 0.05). Multivariate Logistic regression analysis showed that patients had a history of diabetes (OR = 3.87， 95%CI： 1.68-5.37， P = 0.043)， a history of hypertension (OR = 1.81， 95%CI： 0.23-2.06， P = 0.037)， stent diameter ≥ 4.5 mm (OR = 1.41， 95%CI： 0.61-2.48， P = 0.003)， and hs-CRP > 3 mg/L (OR = 5.01， 95%CI： 1.26-8.04， P = 0.016) was an independent risk factor for restenosis after intracranial stent implantation. Conclusion The success rate of intracranial stenting in the treatment of intracranial atherosclerotic stenosis is high， and the recent curative effect is definite， but its long-term prognosis is not satisfactory. With a history of diabetes， hypertension， stent diameter ≥ 4.5 mm and hs-CRP > 3 mg/L are independent risk factors for restenosis after intracranial stent implantation. Reasonable intervention against these risk factors can effectively control the risk of restenosis after intracranial stent implantation., http://www.100md.com(王菁 解燕昭 刘云娥 秦世杰 朱倩)