FT4/FT3与急性冠脉综合征患者术后支架内再狭窄的相关性研究

Study on the Correlation of FT4/FT3 with Postoperative In-Stent Restenosis in Patients with Acute Coronary Syndromes

摘要: 目的：探讨甲状腺素/游离三碘甲状腺原氨酸(free thyroxine/free triiodothyronine, FT4/FT3)与急性冠脉综合征(acute coronary syndrome, ACS)患者接受经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗后发生支架内再狭窄(in-stent restenosis, ISR)的相关性，为ACS患者PCI术后出现支架内再狭窄提供一定的参考。方法：回顾性分析于济宁医学院附属医院行冠状动脉支架置入术，并于2021年1月至2022年12月来院复查造影的476例患者的临床资料，根据复查冠脉造影结果将其分为ISR组257例和非ISR组219例。比较两组患者基础资料，通过多因素Logistic回归分析明确冠心病患者发生ISR的影响因素，采用受试者工作特征(ROC)曲线分析FT4/FT3对冠脉支架置入后患者发生ISR的预测价值。结果：ISR组中高血压的患者比例、LDL、FT4/FT3水平高于非ISR组(P < 0.05)，而ISR组中FT3、FT4、LVEF值、支架直径低于非ISR组(P < 0.05)；经多因素Logistic回归分析证实，FT4/FT3、LDL、支架直径均是ISR的独立危险因素；在预测模型中利用多因素Logistic回归分析，校正各种混杂因素后结果显示，FT4/FT3与ISR独立相关。经ROC分析证实，FT4/FT3预测ISR的AUC为0.703 (95% CI: 0.652~0.751, P < 0.05)，灵敏度为0.792，特异度为0.558。结论：FT4/FT3、LDL、支架直径是PCI术后支架内再狭窄的独立危险因素；FT4/FT3可单独预测PCI术后支架内再狭窄的发生。

Abstract: Objective: To investigate the correlation between thyroxine/free triiodothyronine (FT4/FT3) and in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The correlation between PCI and ISR in patients with ACS was analyzed to provide a reference for the occurrence of in-stent restenosis in ACS patients after PCI. Methods: We retrospectively analyzed the clinical data of 476 patients who underwent coronary stenting at the Affiliated Hospital of Jining Medical College and came to the hospital for follow-up angiography from January 2021 to December 2022, and classified them into 257 cases in the ISR group and 219 cases in the non-ISR group according to the results of follow-up coronary angiography. Comparing the basic data of patients in the two groups, we clarified the influencing factors for the occurrence of ISR in patients with coronary artery disease by multifactorial Logistic regression analysis, and analyzed the predictive value of FT4/FT3 for the occurrence of ISR in patients after coronary stent placement by using the subject's work characteristics (ROC) curve. Results: The proportion of patients with hypertension, LDL, and FT4/FT3 levels were higher in the ISR group than in the non-ISR group (P < 0.05), whereas FT3, FT4, LVEF values, and stent diameters were lower in the ISR group than in the non-ISR group (P < 0.05); multifactorial Logistic regression analysis confirmed that FT4/FT3, LDL, and stent diameters were independent risk factors; after correcting for various confounders using multifactorial Logistic regression analysis in the prediction model, the results showed that FT4/FT3 was independently associated with ISR. ROC analysis confirmed that FT4/FT3 predicted ISR with an AUC of 0.703 (95% CI: 0.652~0.751, P < 0.05), a sensitivity of 0.792, and a specificity of 0.558. Conclusions: FT4/FT3, LDL, and stent diameter were the independent risk factors for post-PCI in-stent restenosis; FT4/FT3 alone predicted the risk of in-stent restenosis after PCI.