[Related factors and prediction model of recurrent in-stent restenosis after DES].

摘要

Objective: To investigate the factors associated with recurrent in-stent restenosis (ISR) after drug-eluting stent (DES) implantation and to establish a screening model. Methods: This cross-sectional study enrolled patients who underwent DES implantation and subsequent coronary angiography at the Second Hospital of Dalian Medical University from January 2020 to July 2023, with confirmed ISR. Patients were divided into an ISR group (first episode) and a recurrent ISR (R-ISR) group (≥2 episodes at the same lesion). Clinical data, laboratory parameters, echocardiographic findings, and coronary angiography results were collected. Correlation analysis and multivariate logistic regression were performed to identify independent factors associated with R-ISR. A logistic regression model was constructed using stepwise regression, and its screening value was assessed by the area under the receiver operating characteristic curve (AUC). Results: A total of 292 patients with DES restenosis were included, aged (66.5±9.5) years, with 73.6% male. There were 202 in the ISR group and 90 in the R-ISR group. Correlation analysis showed that R-ISR was associated with lactate dehydrogenase (LDH) (rpb=-0.159, P=0.007), number of stents (rpb=0.256, P0.001), neutrophil-to-lymphocyte ratio (NLR) (rpb=0.350, P0.001), and interleukin-1β (rpb=0.324, P0.001). Multivariate logistic regression identified number of stents (OR=1.271, 95%CI 1.094-1.477, P=0.002), LDH (OR=0.989, 95%CI 0.982-0.996, P=0.002), NLR (OR=1.370, 95%CI 1.131-1.660, P=0.001), and interleukin-1β (OR=1.190, 95%CI 1.019-1.388, P=0.028) as independent factors for R-ISR. The combined model of these four indicators yielded an AUC of 0.742 (95%CI 0.641-0.843). Conclusions: LDH, number of stents, NLR, and IL-1β are independent related factors for R-ISR. The model based on these four variables demonstrates good predictive value for screening R-ISR, providing a reference for early identification and intervention in high-risk patients. 目的： 探究药物洗脱支架（DES）置入术后反复支架内再狭窄（ISR）的相关因素，并构建其筛查模型。 方法： 本研究为横断面研究。入选既往置入DES并于2020年1月至2023年7月在大连医科大学附属第二医院复查冠状动脉造影且诊断ISR的患者。根据是否首次发生ISR分为ISR组及反复ISR组（同一靶病变位置发生再狭窄≥2次）。收集入选患者的一般临床资料、检验指标（血脂、炎症因子等）、超声心动图检查及冠状动脉造影结果。采用Phi相关系数、点二列相关系数探索反复ISR的相关因素；使用多因素logistics回归分析筛选反复ISR的独立影响因素，并通过逐步回归法构建logistics回归模型，依据曲线下面积评价模型的筛查价值。 结果： 共入选292例患者，年龄（66.5±9.5）岁，其中男性215例（73.6%）。ISR组202例、反复ISR组90例。相关性分析结果显示，反复ISR与乳酸脱氢酶（rpb=-0.159，P=0.007）、支架数量（rpb=0.256，P0.001）、中性粒细胞与淋巴细胞的比值（NLR）（rpb=0.350，P0.001）及白细胞介素-1β（rpb=0.324，P0.001）等相关。多因素logistics回归分析显示，支架数量（OR=1.271，95%CI 1.094~1.477，P=0.002）、乳酸脱氢酶（OR=0.989，95%CI 0.982~0.996，P=0.002）、NLR（OR=1.370，95%CI 1.131~1.660，P=0.001）、白细胞介素-1β（OR=1.190，95%CI 1.019~1.388，P=0.028）是反复ISR的独立影响因素。基于上述4个指标构建的模型筛查反复ISR的曲线下面积为0.742（95%CI 0.641~0.843）。 结论： 乳酸脱氢酶、支架数量、NLR、白细胞介素-1β是DES置入术后反复ISR的独立影响因素，且基于4者构建的模型对筛查反复ISR具有一定价值。.