【摘要】 目的 探讨TyG指数与冠心病患者药物洗脱支架(DES)植入术后发生支架内再狭窄(ISR)的关联性及其联合其他危险因素所构建的列线图模型对于ISR的预测价值。方法 回顾性招募在新疆医科大学第一附属医院成功植入DES并在术后6个月至2年间再次行冠状动脉造影术(CAG)的294例冠心病患者，根据是否发生ISR,将患者分为支架内再狭窄(ISR)组98例及非支架内再狭窄(非ISR)组196例。收集两组患者的基本信息、一般临床资料、经皮冠状动脉介入术(PCI)手术相关信息、血生化、血常规等指标。运用单因素及多因素Logistic回归分析选择PCI术后发生ISR相关预测因素，对筛选出的相关因素通过R语言进行整合分析、构建列线图模型，采用决策曲线分析(Decision curve analysis, DCA)、ROC曲线下面积(Area under the curve,AUC)、校准曲线等进行模型的内部验证。结果 单因素Logistic回归分析结果显示，年龄、心肌梗死病史、吸烟史、尿酸、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、TyG指数、冠脉病变支数、Gensini评分与PCI术后发生ISR相关。将单因素Logistic分析中P值小于0.05的自变量纳入多因素Logistic分析，结果显示，年龄、心肌梗死病史、吸烟史、尿酸、LDL-C、TyG指数及Gensini评分均与PCI术后发生ISR相关，为DES-ISR的独立危险因素。最后对以上因素进行整合分析并绘制列线图，列线图模型AUC为0.783(0.731,0.835),区分度较好，校准曲线拟合程度高，DCA曲线表明较高的临床适用性。结论 年龄、心梗病史、吸烟史、尿酸、LDL-C、TyG指数、Gensini评分是DES-PCI术后发生ISR的独立危险因素，而整合上述指标所构建的列线图模型对于ISR的发生风险有较好的预测价值。更多还原

【Abstract】 Objective To explore the correlation between triglyceride-glucose index(TyG) index and in-stent-restenosis(ISR) after drug-eluting stent(DES) implantation in coronary heart disease patients, and the predictive value of a column chart model constructed in combination with other risk factors for ISR. Methods This study retrospectively recruited 294 coronary heart disease patients who successfully implanted DES in the hospital and underwent coronary angiography(CAG) again between 6 months and 2 years after the surgery. Based on the occurrence of ISR, the patients were divided into an ISR group of 98 cases and a non ISR group of 196 cases. Collect basic information, general clinical data, PCI related information, blood biochemistry, blood routine and other indicators from 2 groups of the patients. Using univariate and multivariate Logistic regression analysis to select predictive factors for ISR after PCI, integrating and analyzing the selected factors using R language, constructing a column chart model, and conducting internal validation of the model using DCA, AUC, calibration curve, etc. Results The results of univariate Logistic regression analysis showed that age, history of myocardial infarction, smoking history, uric acid, HDL-C, LDL-C, TyG index, number of coronary lesions and Gensini score were correlated with the occurrence of ISR after PCI. The independent variables with a P-value less than 0.05 in the univariate Logistic analysis were included in the multivariate Logistic analysis. The results showed that age, history of myocardial infarction, smoking history, uric acid, LDL-C, TyG index and Gensini score were all correlated with the occurrence of ISR after PCI, making them independent risk factors for DES-ISR. Finally, the above factors were integrated and analyzed, and a column chart was drawn. The AUC of the column chart model was 0.783(0.731,0.835), with good discrimination and high fitting of the calibration curve. The decision curve analysis curve showed high clinical applicability. Conclusion Age, history of myocardial infarction, smoking history, uric acid, LDL-C, TyG index and Gensini score are independent risk factors for the occurrence of ISR after DES-PCI. The column chart model constructed by integrating the above indicators has good predictive value for the risk of ISR occurrence.更多还原