血脂控制水平与冠状动脉支架置入术后支架内再狭窄的相关性研究  

Relationship Between Lipid Control Level and In-stent Restenosis in Patients After Percutaneous Coronary Intervention

作　　者：赵存瑞 白明[1] 张博[1] 王东[1] 彭瑜[1] 张艳[1] 庞军[2] 王燚[2] 张钲[1] 

机构地区：[1]兰州大学第一医院心脏中心甘肃省心血管疾病重点实验室,甘肃省兰州市730000 [2]兰州大学第一临床医学院

出　　处：《中国循环杂志》2015年第7期644-646,共3页Chinese Circulation Journal

摘　　要：目的：探讨血脂控制水平与经皮冠状动脉介入治疗（PCI）术后支架内再狭窄（ISR）的相关性。方法：收集2012-01至2012-12在兰州大学第一医院心脏中心住院首次行PCI的冠心病患者211例,所有患者均常规口服双联抗血小板、他汀类药物,并于术后3～12个月再次入院行冠状动脉造影,根据造影结果分为两组,其中ISR组25例,无ISR组186例,所有入选患者于PCI术前及复查造影时采集外周静脉血,全自动生化分析仪检测总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇,定量分析两次血脂水平,探讨其与冠状动脉ISR的关系。结果：两组患者中年龄、性别、高血压患病率、冠心病家族史、术前诊断急性冠状动脉综合征、吸烟、饮酒比例等方面的差异均无统计学意义（P〉0.05）,PCI术前总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇水平差异均无统计学意义（P〉0.05）;ISR组合并2型糖尿病的患者比例（36.0%）较无ISR组（17.7%）差异有统计学意义（P=0.03）。Logistic多因素逐步回归分析显示,PCI术后总胆固醇未下降（比值比=1.07,95%可信区间：0.38～2.62,P=0.04）、低密度脂蛋白胆固醇未控制在1.8 mmol/L以下或较PCI术前未下降50%（比值比=11.33,95%可信区间：3.62～35.52,P〈0.01）以及合并2型糖尿病（比值比=3.00,95%可信区间：1.04～8.67,P=0.04）与ISR呈正相关。结论：PCI术后总胆固醇未下降、低密度脂蛋白胆固醇未达标是后期ISR发生的高危因素,合并2型糖尿病的患者PCI术后发生ISR的风险明显增高。Objective： To investigate the relationship between lipid control level and in-stent restenosis（ISR） in patients after percutaneous coronary intervention（PCI）. Methods： A total of 211 coronary artery disease（CAD） patients who received primary PCI in our hospital from 2012-01 to 2012-12 were studied. All the patients took oral dual anti-platelet therapy and statins routinely, and they received coronary angiography（CAG） re-examination at（3-12） months after PCI. According to CAG findings, the patients were divided into 2 groups： ISR group, n=25 and Non-ISR group, n=186. Blood levels of TC, TG, HDL-C, LDL-C were detected and compared before primary PCI and after CAG re-examination between 2 groups.Results： The baseline information such as age, gender, hypertension, family history of CAD, pre-operative diagnosis of coronary syndrome, smoking and drinking conditions were similar between 2 group, P〉0.05; the pre-operative TC, TG, HDL-C, LDL-C were similar between 2 group, P〉0.05. CAD patients combining with diabetes mellitus（DM） in ISR group（36.0%） was higher than that in Non-ISR group（17.7%）, P=0. 03. Multivariate logistic regression analysis showed that at post PCI, no TC reduction（OR=1.07, 95% CI 0.38-2.62, P=0.04）, LDL-C ≥ 1.8 mmol/L or the reduction less than 50%（OR=11.33, 95% CI 3.62-35.52, P〈0.01）, combining with DM（OR=3.00,95% CI 1.04-8.67, P=0.04） were positively related to ISR.Conclusion： Without TC reduction and nonstandard LDL-C level were the risk factors of ISR occurrence in CAD patients after PCI, DM complication may significantly increase the risk of ISR.

关 键 词：血脂 冠状动脉支架置入术 支架内再狭窄 

分 类 号：R54[医药卫生—心血管疾病]