目的探索超声影像组学在预测颈动脉支架置入(carotid artery stent,CAS)术后再狭窄(in-stent restenosis,ISR)发生的能力。方法回顾性收集广州中医药大学第二临床医学院接受CAS术治疗患者共206例病例。将入组患者按7∶3的比例随机分为训练集(144例)和测试集(62例),使用达尔文智能科研平台提取超声影像组学特征,从每个感兴趣区域中提取的1125个超声影像组学特征中筛选特征,使用不同的机器学习算法构建诊断模型,选择模型表现最好的分类器,建立了不同的预测模型,包括临床-超声特征模型、超声影像组学模型、临床-超声-超声影像组学的联合模型。结果在训练集中多因素逻辑回归分析显示,高血压病、高尿酸血症、甘油三酯和斑块位置是CAS术后发生ISR的独立危险因素。对于临床-超声模型,训练集和测试集的曲线下面积(area under the curve,AUC)分别为0.896和0.644。超声影像组学模型对应的AUC值分别为0.961和0.715,联合模型对应的AUC值分别为0.947和0.727。结论超声影像组学模型预测ISR的能力优于传统的临床-超声模型。联合模型能够更好地预测ISR发生,从而提高传统评估的诊断性能。
综述近年来中医药在冠脉支架术后再狭窄治疗中的应用和研究进展。考虑到此类疾病的治疗多以西医为主,可能存在患者依从性差、药物副作用大等问题,从中医药角度出发,总结现阶段中医药对冠脉支架术后再狭窄的临床技术手段,观察疗效,思考不足,以期为临床工作者提供防治冠脉支架术后再狭窄的研究思路。To summarize the application and research progress of Chinese medicine in the treatment of restenosis after coronary stenting in recent years. Considering that the treatment of such diseases is mostly based on Western medicine, which may have problems such as poor patient compliance and large drug side effects, from the perspective of traditional Chinese medicine, we summarize the clinical technical means of traditional Chinese medicine for post-coronary stenting restenosis at the present stage, observe the therapeutic efficacy, and reflect on the shortcomings, with a view to providing clinical workers with research ideas on preventing and treating post-coronary stenting restenosis.
经皮冠状动脉介入治疗(PCI)作为冠心病(CHD)的重要治疗方法,尽管药物洗脱支架取得了重大进展,但支架内再狭窄(ISR)仍然是PCI后具有挑战性的临床问题,其中炎症反应和血小板的激活至关重要,而糖尿病病程长短是否会影响体内炎症表达,临床尚无确切说明,因此,本文旨在讨论血浆炎症指标对糖尿病患者冠脉支架术后再狭窄的预测作用,为糖尿病患者冠脉支架术后管理和治疗策略提供科学依据。Percutaneous coronary intervention (PCI) is an important treatment method for coronary heart disease (CHD). Although drug-eluting stents have made significant progress, in stent restenosis (ISR) is still a challenging clinical problem after PCI. Inflammatory response and platelet activation are crucial, and whether the duration of diabetes will affect the expression of inflammation in vivo has not yet been clearly explained in clinical practice. Therefore, this article aims to discuss the predictive effect of plasma inflammatory indicators on the restenosis of diabetes patients after coronary stenting, and provide scientific basis for the management and treatment strategies of diabetes patients after coronary stenting.
