血清醛固酮对冠心病患者介入术后心血管事件和支架内再狭窄的预测价值  

Reprocedural serum levels of aldosterone predict cardiovascular events and in-stent restenosis after coronary stent implantation

作　　者：吴天源[1] 李韶南[1] 罗义[1] 吕磊[1] 孙少喜[1] 

机构地区：[1]广州市第一人民医院心血管内科,广州510180

出　　处：《实用医学杂志》2018年第2期227-230,共4页The Journal of Practical Medicine

基　　金：广东省医学科学技术研究基金项目(编号:201611119319867)

摘　　要：目的探讨血清醛固酮(ALD)水平对经皮冠脉内介入治疗(PCI)后12个月内心血管事件和支架内再狭窄(ISR)的预测价值。方法选取2014年1月至2016年7月入住心内科的冠心病患者268例[96例稳定型心绞痛(SAP)和172例急性冠脉综合征(ACS)],PCI术前测定基础血清ALD水平。将患者分为ALD<130 pg/m L(127例)和ALD≥130 pg/m L(141例)两组,分析并记录患者术后12个月内心血管事件(心绞痛、心肌梗死及死亡)发生率及ISR(原病变冠脉直径狭窄程度≥50%)等情况。应用Logistic回归分析发生ISR的独立危险因素。结果血清ALD水平在ACS组比SAP组高[(160±58)pg/mL vs.(118±46)pg/m L,P<0.05];PCI术后12个月的心血管事件及ISR发生率ALD高者远高于ALD低者(24.1%vs.3.1%,P<0.05;16%vs.7.4%,P<0.05),Logistic回归分析显示血清ALD水平是发生ISR的最强预测因素(比值比为每10 pg/m L 2.56)。结论基础血清ALD水平是PCI术后12个月内发生心血管事件和ISR的预测指标,这提示PCI术后12个月内心血管事件发生率及支架内再狭窄是和术前肾素-血管紧张素-醛固酮系统被激活密切相关。Objective To investigate the value of baseline levels of aldosterone （ALD） in predicting the cardiovascular events and in-stent restenosisl2 months after coronary stent implantation. Methods 268 patients with coronary heart disease admitted to the department of cardiology from January 2014 to July 2016 were selected （96 cases of stable angina pectoris and 172 cases of acute coronary syndrome）. The ALD level in the preprocedural serum was detected before coronary stent implantation. According to the level of ALD, the patients were divided into two groups： ALD 〈 130 pg/mL （n = 127） and ALD ≥ 130 pg/mL （n = 141）. The cardiovascular events （angina pectoris, myocardial infarction, death） and in-stent restenosis were observed and recorded 12 months after the procedures. Logistic regression analysis was done to analyze the independent risk factors of ISR. Results The baseline levels of ALD in the patients with acute coronary syndrome were significantly higher than those with stable angina pectoris [ （160 ± 58） pg/mL vs. （118 ± 46） pg/mL, P 〈 0.05]. The cardiovascular events and those in in-stent restenosis in the patients with high baseline levels of ALD were significantly higher than those with normal baseline levels of ALD 12 months too （24.1% vs 3.1%; P 〈 0.05; 16% vs 7.4%; P 〈 0.05）. Logistic regression analysis showed that serum ALD levels were the strongest predictors of ISR, with the odds ratio of 2.56 per 10 pg/mL. Conclusions Preprocedural ALD level is a predictor for 12 months outcome of in-stent restenosis for the patents undergoing coronary stent implantation. It indicates that the complications and clinical restenosis in 12 months are markedly influenced by the activation of the rennin angiotensin aldostenone system.

关 键 词：冠心病 醛固酮 支架内再狭窄 经皮冠状动脉介入治疗 心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]