中文摘要：

目的探讨冠状动脉慢性完全闭塞病变（chronic total occlusion,CTO）经皮介入治疗（percutaneous coronary intervention,PCI）术后早期发生支架内再狭窄（in-stent restenosis,ISR）的影响因素。方法分析2003年11月-2015年7月于解放军总医院接受冠状动脉造影（coronary angiography,CAG）并成功置入药物涂层支架后发生支架内再狭窄的54例患者的临床资料。根据心肌缺血症状和造影证据显示的发生支架内再狭窄的时间分为早期支架内再狭窄和晚期支架内再狭窄。采用单因素及Logistic多因素分析CTO病变PCI术后发生ISR的影响因素。结果 54例CTO患者共76个支架内再狭窄,其中早期支架内再狭窄7个（9.2%）,晚期支架内再狭窄69个（90.8%）。早期支架内再狭窄组纤维蛋白原水平（P=0.001）、尿酸水平（P=0.023）高于晚期支架内再狭窄组;早期支架内再狭窄组血清总胆红素水平（P=0.041）、血清直接胆红素水平（P=0.035）低于晚期支架内再狭窄组。Logistic多元回归分析显示,血清纤维蛋白原（OR=0.314,95%CI：0.138~0.714,P=0.006）,尿酸（OR=0.988,95%CI：0.978~0.999,P=0.028）和血清总胆红素（OR=1.453,95%CI：1.113~1.896,P=0.006）是早期冠脉支架内再狭窄的独立危险因素。结论高血清纤维蛋白原、高尿酸、低总胆红素促进早期冠脉支架内再狭窄形成。

英文摘要：

Objective To investigate the influential factors of early in-stent restenosis（ISR） in patients with coronary chronic total occlusion（CTO） after percutaneous coronary intervention（PCI）. Methods Clinical data about 54 patients who had undergone coronary angiography（CAG） and implanted drug-eluting stents（DES） with ISR in Chinese PLA General Hospital from November 2003 to July 2015 were analyzed retrospectively. All patients were divided into two groups by time of ISR. The risk factors of ISR were analyzed by univariate analysis and multiple Logistic regression analysis. Results There were 76 ISR in 54 patients with CTO, with early ISR rate of 9.2%（7） and late ISR rate of 90.8%（69）. Compared with late ISR group, the level of fibrinogen and uric acid（UA） in early ISR group was significantly higher（P=0.001, P=0.023）, while the level of serum total bilirubin and serum direct bilirubin was significantly lower（P=0.041, P=0.035）. Multiple Logistic regression analysis showed fibrinogen [OR=0.314, 95% CI（0.138-0.714）]（P=0.006）, uric acid（UA） [OR=0.988, 95% CI（0.978-0.999）]（P=0.028） and total bilirubin [OR=1.453, 95% CI（1.113-1.896）]（P=0.006） were independent predictors for early ISR after PCI. Conclusion Elevated fibrinogen level, elevated uric acid level, and low total bilirubin level are risk factors of early ISR after PCI.