ApoB100/ApoA1比值对老年冠心病患者经皮冠状动脉介入治疗后的预测作用  

Predictive value of ApoB100/ApoA1 ratio in elderly patients with coronary artery disease after percutaneous coronary intervention

作　　者：周典华[1] 杨峻青[1] 彭迳英[1] 张莹[1] 罗德谋[1] 李志根[1] 余丹青[1] 周颖玲[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院,广州510100

出　　处：《岭南心血管病杂志》2012年第6期572-575,580,共5页South China Journal of Cardiovascular Diseases

基　　金：广东省科技项目基金(项目编号:B060900105.B061300034);广东省自然科学基金(项目编号:S2011010002091)

摘　　要：目的探讨ApoB100/ApoA1比值对于老年冠状动脉粥样硬化性心脏病(冠心病)患者在经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心血管事件的预测价值。方法入选2009年9月至2012年5月在广东省人民医院住院首次确诊为冠心病并行支架植入的年龄大于或等于65岁的患者271例为研究对象。根据载脂蛋白(apoprotein,Apo)B100/ApoA1比值的平均值(0.76)分为高比值组(n=127)和低比值组(n=144);根据低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)浓度(2.06 mmol/L)是否达标,分为达标组(n=213)和非达标组(n=58);根据血运是否完全重建分为完全重建组(n=158)和不完全重建组(n=113)。术后均按要求进行冠心病二级预防,阿司匹林及氯吡格雷双联抗血小板药物服用一年,常规服用他汀类降脂药物,进行一年的电话随访。分析患者心血管事件(死亡、卒中、再血管化、再住院)的发生情况,根据年龄、脂蛋白(a)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、LDL-C、ApoB100、ApoA1、ApoB100/ApoA1、LDL-C/HDL-C、总胆固醇/HDL-C、non-HDL-C的水平分为高低两组,作为自变量,心血管事件的总体发生情况以及各个亚组为因变量,进行Logistic回归分析。结果在再血管化方面,ApoB100/ApoA1高比值组的发生率高于低比值组,两者间比较差异有统计学意义(11.02%vs.2.78%,P<0.01)。在不完全血运重建患者中,ApoB100/ApoA1高比值组再血管化发生率高于低比值组,差异有统计学意义(16.39%vs 3.85%,P=0.036)。Logistic回归分析结果显示,总体心血管事件的发生和各单个事件的发生与年龄、脂蛋白(a)、HDL-C、LDL-C、ApoB100、ApoA1、ApoB100/ApoA1、LDL-C/HDL-C、总胆固醇/HDL-C、non-HDL-C无统计学的相关性。结论 ApoB100/ApoA1作为一个脂蛋白相关的指标,在预测老年人PCI治疗后心血管事件的发生有一定的价值,尤其是在不完全血运重建患者再血管化方面Objectives To investigate the predictive value of apoprotein （Apo） B100/ApoA1 ratio for cardiovascular events in elderly patients with coronary artery disease after percutaneous coronary intervention（PCI）. Methods A total of 271 elderly patients aged 65 or more, diagnosed coronary artery disease for the first time in Guangdong General Hospital from September 2009 to May 2012 were enrolled in the study. All the patients were implanted drug-eluting stents. According to the mean value of ApoB100/ApoA1 ratio （0.76）, the patients were divided into high ratio group （n=127） and low ratio group （n=144）. Again, according to the level of low density lipoprotein cholesterol （LDL-C） （standard level： 2.06 mmol/L）, the patients were divided into up to standard group （n=213） and not up to standard group （n=58）. According to the type of revascularization, we also classified the participants into complete revascularization group （n= 158） and incomplete revascularization group （n=l13）. All the patients were required to follow the treatment for secondary prevention of coronary artery disease ： treatment with aspirin and clopidogrel, in combination with statin regularly. They were followed up for 1 year by phone,analyzing the cardiovascular event rates （death, stroke, revascularization, rehospitalization）. High-level group and low-level group were defined on the basis of age, lipoprotein （a）, high density lipoprotein cholesterol （HDL-C）, LDL-C, ApoBl00, ApoAl, ApoB100/ApoA1, LDL-C/HDL-C, total cholesterol （TC）/HDL-C, non-HDL-C. The two groups as independent variables, cardiovascular event rates and the subgroups as dependent variables, logistic regression was performed. Results Incidence of revascularization in high ApoB100/ ApoA1 ratio group was higher than that in low ratio group, there was a significant statistical difference （11.02% vs. 2.78%,P〈0.01 ）. Of patients with incomplete revascularization, incidence of revascularization in high ApoB100/ApoAl ratio gro

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 老年人 预测作用 载脂蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]