| Background:In recent years,the incidence rate of Coronary Atherosclerotic Heart Disease(CHD)is increasing,which seriously endangers human life and health.Percutaneous coronary intervention(PCI)has become the main treatment for coronary heart disease,but the postoperative in-stent restenosis(ISR)is a big problem restricting the development of cardiac interventional therapy technology.Although the application of drug-eluting stent(DES)makes the incidence of ISR greatly reduced,but ISR seriously affects the surgical effect and the patients’ life and health.Therefore,prevention of ISR is particularly important.Many studies have shown that some inflammatory factors and blood biochemical indicators are closely related to the occurrence and development of coronary heart disease and ISR.Objective:1.To analyze the relationship between neutrophil-to-lymphate ratio(NLR),serum total bilirubin level(TBIL)and in-stent restenosis;2.To explore the predictive value and clinical value of NLR combined with TBIL for ISR.Subjects and methods:Collecting 266 cases of patients who had a history of drug-eluting stents(DES)implantation and were hospitalized in the Department of Cardiology of Subei people’s Hospital of Jiangsu Province from June 2016 to December 2019,they all received coronary angiography(CAG)examination.According to the results of CAG,the patients were divided into ISR group(126 cases)and non ISR group(140 cases).The differences of NLR and TBIL between the two groups were compared,and the general clinical information,the data of the first PCl operation(diseased vessel,coronary artery with stent,Stent in series or not and the number,length,diameter of the stent),the data of CAG examination(interval time,in stent restenosis or not,restenosis coronary artery,restenosis stent in series or not and the length,diameter of restenosis stent)and relevant examination indexes(including Neutrophil count,lymphocyte count,monocyte count,hemoglobin level,platelet count,serum total bilirubin level,fasting plasma glucose,glycated hemoglobin level,uric acid,serum creatinine,cholesterol,triglycerides,high density lipoprotein cholesterol,low density lipoprotein cholesterol,troponin I,BNP,LVEF)were used to analyze the relationship between each factor and ISR by statistical methodsResults:1.A total of 266 cases were included in the study,there were 126 cases in ISR group and 140 cases in non-ISR group.There was no significant difference between the two groups in gender,age,hypertension,hyperlipidemia,history of alcoholism,family history of coronary heart disease and medication condition(statins,ACEI/ARB,β receptor blockers,calcium channel blockers)(P>0.05).It has statistical significance in BMI,diabetes mellitus,smoking history and administration of antiplatelet drugs between the two groups(P<0.05).2.There was no significant difference between the two groups in diseased vessel,coronary artery with stent,Stent in series or not,maximum length of single stent and interval time(P>0.05).It has remarkable statistical significance between the two groups in the Minimum diameter of stent(P<0.01).3,After screening for collinear factors(such as diabetes mellitus,FPG and HbA1C,only HbA1C was retained),factors with P<0.1 were included in the multivariate binary Logistic regression analysis,and factors with insignificant P value(P>.05)were removed by the forward progression method.It could be concluded that NLR,HbA1C,smoking history,uric acid and BMI was a risk factor for ISR,while TBIL,stent diameter was negatively correlated with ISR.4.The factors with P<0.1 were selected.After the col linearity factors(such as diabetes,FPG,HbA1c,only HbA1c)were screened,they were included in the multivariate logistic regression analysis.The factors with P value of no significance(P>0.05)were eliminated by the forward method.It has statistical significance in NLR,HbAlc,smoking,uric acid,BMI,TBIL and minimum stent diameter between the two groups(P<0.05).It was found that NLR,HbA1c,smoking,uric acid,BMI were risk factors of ISR,while serum TBIL and stent diameter were negatively correlated with ISR.5.By drawing the ROC curve,we know that both NLR and serum TBIL have predictive value for ISR.When the optimal cutoff value of NLR is 2.79,the AUC is 0.613,the sensitivity is 67.5%,and the specificity is 50.7%.When the optimal cutoff value of TBIL is 13.05,the AUC is 0.655,the sensitivity is 75.7%,and the specificity is 53.2%.When the predictive value of NLR and TBIL to ISR was tested jointly,the AUC was 0.676,the parallel test had higher sensitivity,and the series tests had higher specificity.Conclusions:1.Neutrophil-to-lymphocyte ratio is positively correlated with in-stent restenosis,which is a risk factor for in-stent restenosis.2.Serum total bilirubin was negatively correlated with in-stent restenosis.3.Neutrophil-to-lymphocyte ratio and serum total bilirubin can predict in-stent restenosis,and their combined predictive value is higher.4.Patients with obesity,smoking,implantation of small-diameter stents,high uric acid and poor glycemic control of diabetes are more likely to occur in-stent restenosis. |
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