Abstract:

Objective　To approach the risk factors of target vessel restenosis after drug-coated balloon (DCB) angioplasty in patients with coronary artery disease, and develop a predictive model. Methods　A total of 108 CAD patients admitted to Ankang Central Hospital from January 2020 to March 2024 was selected as the study objects. All patients had underwent DCB angioplasty. Coronary angiography was used to evaluate restenosis of the target vessel six months after the operation. The patients were divided into a stenosis group (30 cases)and a non-stenosis group (78 cases). In the stenosis group, there were 18 males and 12 females, aged (64.30±6.10) years. In the non-stenosis group, there were 42 males and 36 females, aged (63.15±6.58) years. Clinical data, preoperative laboratory results, echocardiography findings and intraoperative coronary angiography characteristics were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was performed to explore independent risk factors for target vessel restenosis. R software and rms packages were used to construct the nomogram model. The predictive efficacy of the model for target vessel restenosis in patients with coronary heart disease after DCB formation was analyzed by using calibration curve, receiver operating characteristic curve (ROC) and decision analysis curve. Results　The proportions of smoking and diabetes in the stenosis group were higher than those in the non-stenosis group, the proportion of using pre-dilated balloons was lower than that in the non-stenosis group, the length of target vascular lesions was longer than that in the non-stenosis group, the postoperative residual stenosis rate and the levels of low-density lipoprotein cholesterol (LDL-C) and cystatin C (CysC) were higher than those in the non-stenosis group, the levels of matrix metalloproteinase inhibitor-1 (TIMP-1) and secreted frizzled-related protein 5 (SFRP-5) were lower than those in the non-stenosis group (all P<0.05). The results of multivariate logistic regression analysis indicated that smoking (OR=5.697, 95%CI: 1.332-24.359), diabetes (OR=5.169, 95%CI: 1.241-21.532), preoperative high LDL-C levels (OR=5.163, 95%CI: 1.271-20.976), low TIMP-1 levels (OR=0.151, 95%CI: 0.023-0.990), low SFRP-5 levels (OR=0.149, 95%CI: 0.025-0.892), no use of pre-dilated balloons during the operation (OR=0.308, 95%CI: 0.104-0.910), and high residual stenosis rate after the operation (OR=4.901, 95%CI: 1.014-23.673) were all independent risk factors for target vessel restenosis (all P<0.05). Based on the results of multivariate logistic regression analysis, a nomogram model influencing target vessel restenosis in patients with coronary heart disease after DCB angioplasty was constructed. The results showed that coronary heart disease patients who smoked, had diabetes, had high preoperative LDL-C levels, low TIMP-1 levels, low SFRP-5 levels, did not use pre-dilated balloons during the operation, and had a high postoperative residual stenosis rate had a higher risk of target vessel restenosis after DCB angioplasty. The area under the curve of the nomogram model was 0.981, with a sensitivity of 96.67% and a specificity of 92.31%. Conclusion　Smoking, diabetes, high preoperative LDL-C levels, low TIMP-1 levels, SFRP-5 levels, no use of pre-dilated balloons during the operation, and high postoperative residual stenosis rate are independent risk factors for target vessel restenosis after drug-coated balloon angioplasty.

Key words: Drug-coated balloon,  , Coronary artery disease,  , Target vessel restenosis,  , Risk factors,  , Predictive model

摘要：

目的　探讨药物涂层球囊（DCB）成形术后冠心病患者靶血管再狭窄的危险因素，并构建预测模型。方法　选取2020年1月至2024年3月安康市中心医院收治的108例冠心病患者作为研究对象。所有患者均采用DCB成形术治疗。术后6个月，采用冠脉造影检查评估靶血管再狭窄。根据靶血管再狭窄发生情况，将患者分为狭窄组（30例）和未狭窄组（78例）。狭窄组男18例，女12例；年龄（64.30±6.10）岁。未狭窄组男42例，女36例；年龄（63.15±6.58）岁。比较两组临床资料、术前实验室检查结果、心脏超声结果及术中冠脉造影特征等。采用独立样本t检验、χ2检验进行统计学分析；采用多因素logistic回归分析DCB成形术后冠心病患者靶血管再狭窄的影响因素；采用R软件和rms程序包构建列线图模型；采用校准曲线、受试者操作特征曲线（ROC）和决策分析曲线分析该模型对DCB成形术后冠心病患者靶血管再狭窄的预测效能。结果　狭窄组吸烟、糖尿病占比高于未狭窄组，使用预扩张球囊占比低于未狭窄组，靶血管病变长度长于未狭窄组，术后残余狭窄率及低密度脂蛋白胆固醇（LDL-C）、胱抑素C（CysC）水平均高于未狭窄组，基质金属蛋白酶抑制剂-1（TIMP-1）、分泌型卷曲相关蛋白5（SFRP-5）水平均低于未狭窄组（均P<0.05）。多因素logistic回归分析结果显示，吸烟（OR=5.697，95%CI：1.332～24.359）、糖尿病（OR=5.169，95%CI：1.241～21.532）、术前高LDL-C（OR=5.163，95%CI：1.271～20.976）、低TIMP-1（OR=0.151，95%CI：0.023～0.990）、低SFRP-5水平（OR=0.149，95%CI：0.025～0.892）、术中未使用预扩张球囊（OR=0.308，95%CI：0.104～0.910）、术后残余狭窄率高（OR=4.901，95%CI：1.014～23.673）均是靶血管再狭窄的独立危险因素（均P<0.05）。根据多因素logistic回归分析结果，构建影响DCB成形术后冠心病患者靶血管再狭窄的列线图模型。结果显示，吸烟、糖尿病、术前高LDL-C、低TIMP-1、低SFRP-5水平、术中未使用预扩张球囊、术后残余狭窄率高的冠心病患者DCB成形术后靶血管再狭窄风险较高。列线图模型曲线下面积为0.981，灵敏度为96.67%，特异度92.31%。结论　吸烟、糖尿病、术前高LDL-C、低TIMP-1、低SFRP-5水平、术中未使用预扩张球囊、术后残余狭窄率高均是靶血管再狭窄的独立危险因素。

关键词: 药物涂层球囊,  ,  , 冠心病,  ,  , 靶血管再狭窄,  ,  , 危险因素,  ,  , 预测模型