广西医学

目的探讨全身免疫炎症指数（SII）、SYNTAX评分和脂蛋白a水平对老年冠心病患者经皮冠状动脉介入（PCI）术后发生支架内再狭窄（ISR）的评估价值。方法回顾性分析504例PCI术后复查冠状动脉造影（CAG）的老年冠心病患者的临床资料。根据PCI术后1年有无发生ISR，将患者分为非ISR组（n=410）和ISR组（n=94）。比较两组患者的一般资料、实验室指标、SII及SYNTAX评分。采用多因素Logistic回归模型分析老年冠心病患者PCI术后发生ISR的影响因素，绘制受试者工作特征（ROC）曲线分析SII、SYNTAX评分和脂蛋白a水平对老年冠心病患者PCI术后发生ISR的评估价值。结果共有94例患者发生ISR，发生率为18.7%。与非ISR组相比，ISR组患者的脉压差更大，慢性肾功能不全病史比例更高，SII、SYNTAX评分、白细胞计数及总胆固醇、脂蛋白a、HbA1c、纤维蛋白酶原、肌钙蛋白I水平更高（P<0.05）。多因素Logistic回归分析结果显示，高SII、高SYNTAX评分、高脂蛋白a水平是老年冠心病患者PCI术后发生ISR的独立危险因素（P<0.05）。ROC曲线分析结果显示，SII、SYNTAX评分、脂蛋白a水平及三者联合评估老年冠心病患者PCI术后发生ISR的曲线下面积分别为0.725、0.753、0.701、0.829，且三者联合的曲线下面积大于单一指标（P<0.05）。结论高SII、高SYNTAX评分、高脂蛋白a水平是老年冠心病患者PCI术后发生ISR的独立危险因素。SII、SYNTAX评分、脂蛋白a水平对老年冠心病患者PCI术后发生ISR具有一定的评估效能，且三者联合的评估效能更佳。

Objective To investigate the evaluation value of systemic immune⁃inflammation index (SII), SYNTAX score, and lipoprotein a level on the occurrence of in⁃stent restenosis (ISR) in elderly patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods A retrospective analysis was conducted on the clinical data of 504 elderly patients with coronary heart disease who underwent PCI and subsequent coronary angiography (CAG). According to whether ISR one year after PCI occurred or not, patients were divided into non-ISR group (n=410) or ISR group (n=94). The general data, laboratory indices, SII, and SYNTAX score were compared between patients of the two groups. The multivariate Logistic regression model was used to analyze the influencing factors for the occurrence of ISR after PCI in elderly patients with coronary heart disease. The receiver operating characteristic (ROC) curve was drawn to analyze the evaluation value of SII, SYNTAX score, and lipoprotein a level on the occurrence of ISR in elderly patients with coronary heart disease after PCI. Results A total of 94 patients suffered from ISR, with the incidence rate in 18.7%. Compared with the non⁃ISR group, the ISR group exhibited a higher pulse pressure difference, a higher proportion of patients with a history of chronic renal insufficiency, and higher SII, SYNTAX score, white blood cell counts, as well as higher levels of total cholesterol, lipoprotein a, HbA1c, fibrinogen, and troponin I (P<0.05). The results of multivariate Logistic regression analysis revealed that high SII, high SYNTAX score, and high lipoprotein a level were the independent risk factors for the occurrence of ISR in elderly patients with coronary heart disease after PCI (P<0.05). The results of ROC curve analysis indicated that areas under the curve of SII, SYNTAX score, and lipoprotein a level for alone and jointly evaluating the occurrence of ISR in elderly patients with coronary heart disease after PCI were 0.725, 0.753, 0.701, and 0.829, respectively, and area under the curve of the combination of the three was larger than that of single index (P<0.05). Conclusion High SII, high SYNTAX score, and high lipoprotein a level are the independent risk factors for the occurrence of ISR in elderly patients with coronary heart disease after PCI. SII, SYNTAX score, and lipoprotein a level exert evaluation efficiency on the occurrence of ISR in elderly patients with coronary heart disease after PCI to a certain extent, and their combination exhibits superior evaluation efficiency.