基线低密度脂蛋白胆固醇和脂蛋白(a)浓度升高预示冠状动脉支架术后高风险  

Concentration elevation of baseline LDL-C and Lp(a) elevations portend a high risk of coronary revascularization in patients after stent placement

作　　者：张莹[1] 周颖玲[1] 蔡安平[1] 李志根[1] 莫与京[1] 孙硕[1] 

机构地区：[1]广东省心血管病研究所心内科广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2014年第4期405-408,共4页South China Journal of Cardiovascular Diseases

基　　金：广东省自然科学基金项目S2012010009532;S2013010016575;广东省科技攻关项目2011B061300034

摘　　要：目的观察冠状动脉粥样硬化性心脏病(冠心病)患者基线脂蛋白(a)浓度升高是否可预测冠状动脉支架植入术后高风险。方法本研究入选832例行冠状动脉支架植入术的患者,于冠状动脉支架植入术前收集患者的基线临床资料,依据基线脂蛋白(a)浓度分为脂蛋白(a)浓度较高组(≥300 mg/L)和脂蛋白(a)浓度较低组(<300 mg/L)。另外,依据基线的低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)浓度,将两组患者分别分为LDL-C<1.8 mmol/L和LDL-C≥1.8 mmol/L两个亚组。对所有入选患者,于出院后进行电话随访,比较各组的临床终点(主要心血管事件),包括心血管死亡,非致死性心肌梗死,缺血性脑卒中和冠状动脉血运重建。结果高脂蛋白(a)组急性冠状动脉综合征和3支血管病变患者比例显著高于低脂蛋白(a)组,差异有统计学意义(67%vs.78%,P=0.001;35.5%vs.48.2%,P=0.001)。另外,在LDL-C<1.8 mmol/L亚组,脂蛋白(a)高和低浓度组之间临床预后比较,差异无统计学意义(P>0.05)。而在LDL-C≥1.8 mmol/L亚组,脂蛋白(a)高浓度组的主要心血管事件和冠状动脉重建的发生率显著高于脂蛋白(a)低浓度组,差异有统计学意义(26.1%vs.16.6%,P=0.018;15.4%vs.7.5%,P=0.006),且冠状动脉重建的危险比为2.05。结论基线LDL-C和脂蛋白(a)浓度较高的冠心病患者冠状动脉支架植入术后冠状动脉重建术的发生率显著增加。Objectives To investigate whether baseline lipoprotein （a）[Lp （a）] concentration elevation was potential for predicting worse outcome after stent placement.Methods Totally 832 participants who received stent placement were enrolled and followed up for monitoring clinical end points via outpatient visits or/and telephone call.Baseline characteristics were collected before stent placement.According to the baseline concentration of Lp （a）,participants were divided into low Lp （a） group [Lp （a） 〈300 mg/L] and high Lp （a） group [Lp （a） ≥ 300 mg/L].Based on baseline concentration of low-density lipoprotein cholesterol （LDL-C）,each group were further divided into LDL-C〈1.8 mmol/L and ≥ 1.8 mmol/L subgroups.Clinical end points in terms of major adverse cardiovascular events （MACE）,including cardiovascular death,non-fatal myocardial infarction,ischemic stroke and coronary revascularization （CR） were compared.Results Percentage of patients in high Lp （a） group more frequently presented with acute coronary syndrome and three-vessel disease than patients in low Lp（a） group （67% vs.78%,P=0.001 ; 35.5% vs.48.2%,P=0.001）.In LDLC〈 1.8 mmol/L subgroup,no significant differences of cardiovascular outcomes were found between low and high Lp （a） groups （P〉0.05）.While in LDL-C ≥ 1.8 mmol/L subgroup,incidences of MACE and CR were significantly higher in high Lp（a） group than those in low Lp（a） group （26.1% vs.16.6%,P=0.018; 15.4% vs.7.5%,P=0.006）,and the odds ratio for CR was 2.05.Conclusions In patients with elevated baseline concentration of LDL-C and Lp （a）,incidence of CR significantly increases after stent placement.

关 键 词：冠状动脉疾病 支架植入 脂蛋白(a) 低密度脂蛋白胆固醇 冠状动脉血运重建 

分 类 号：R541.4[医药卫生—心血管疾病]