急性冠状动脉综合征患者经皮冠状动脉介入治疗后的血脂变化与冠状动脉非靶病变进展的关系  

Association Between the Changes of Blood Lipids and the Progression of Non-target Lesions After Percutaneous Coronary Intervention

作　　者：马茜[1] 张琳琳[1] 王建龙[1] 王志坚[1] 赵迎新[1] 周玉杰[1] VIA Qian;ZHANG Lin-lin;WANG Jian-long;WANG Zhi-jian;ZHAO Ying-xin;ZHOU Yu-jie.(Geriatric Cardiology Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing（100029）, China)

机构地区：[1]首都医科大学附属北京安贞医院老年心内科,北京市100029

出　　处：《中国循环杂志》2018年第6期545-549,共5页Chinese Circulation Journal

基　　金：国家自然科学基金青年基金(81400324);国家自然科学基金面上项目(81770431); 北京市自然科学基金面上项目(7182048); 北京市医院管理局青年人才培养“青苗”计划(QML20160602); 国家重点研发计划“精准医学研究”重点专项(编号：2017YFC0908800); 北京市医院管理局“登峰”计划专项经费资助(编号：DFL20150601);北京市医院管理局“使命”计划专项经费资助(SML20180601)

摘　　要：目的:探讨经皮冠状动脉介入治疗(PCI)术后急性冠状动脉综合征(ACS)患者的血脂变化与冠状动脉非靶病变进展的关系。方法:选择首都医科大学附属北京安贞医院于2013-01至2016-12期间因ACS住院行冠状动脉造影显示多支血管病变,其中单支血管病变(靶病变)狭窄>75%,对该单支血管行PCI,其余非靶病变狭窄程度均<50%,并于6~24个月内因胸痛再次入院的患者3 071例。根据再次住院时的冠状动脉造影三维重建定量分析(QCA),将上述患者分为A、B两组:A组为非靶病变进展患者(病变狭窄程度由原来的<50%增加至>75%)共计1 541例,B组为非靶病变无进展患者(病变狭窄程度<75%)共计1 530例。对比A、B组患者两次入院血脂水平,血脂变化幅度和达标分布。低密度脂蛋白胆固醇(LDL-C)达标率=(<1.8 mmol/L患者+LDL下降幅度>50%的患者)/患者总数。结果:A组与B组在第1次住院时LDL-C水平相似[(2.68±0.88)mmol/L vs(2.72±0.92)mmol/L,P=0.509],LDL-C达标率也相似(14.0%vs 13.1%,P=0.476);第2次住院时,B组LDL-C水平显著低于A组[(1.91±0.64)mmol/L vs(2.17±0.76)mmol/L,P<0.001],B组患者LDL-C达标率显著高于A组(43.66%vs 35.37%,P<0.001)。B组患者总胆固醇(TC)和甘油三酯(TG)在第2次住院时降幅分别为(0.85±0.81)mmol/L和(0.24±1.58)mmol/L,显著大于A组(P<0.001)。多因素Logistic回归分析结果显示年龄、糖尿病、高血压病、吸烟、冠心病家族史、高脂血症均与非靶病变进展无关;第2次住院LDL-C水平(OR=1.686,95%CI:1.508~1.885;P<0.001)和PCI术后规律他汀服用(OR=0.275,95%CI:0.230~0.328;P<0.001)与非靶病变进展相关。结论:非靶病变有进展的患者的降脂治疗依从性差,血脂控制不佳,这是导致非靶病变进展的原因。Objectives： To investigate the relationship between the changes of blood lipids and the progression of non-target lesions after percutaneous coronary intervention（PCI）.Methods： Consecutive patients hospitalized in Beijing Anzhen Hospital of Capital Medical University from January 2013 to December 2016 for acute coronary syndrome（ACS） with coronary angiography evidence of multivessel disease, in which single vessel disease（Target lesion） stenosis 75%, and the single vessel was treated with PCI, and the remaining non-target lesions with stenosis 50%, and re-hospitalized due to chest pain within 6 to 24 months, were eligible for this study. A total of 3 071 patients met the inclusion criteria were enrolled in this study. According to the quantitative analysis of 3-dimensional reconstruction coronary angiography（QCA）, patients were divided into A, B groups： group A（n=1 541） refers patients with progressive non-target lesions（stenosis from 50% to 75%）, group B（n=1530） refers progression-free non-target lesions（stenosis 75%）. Blood lipid levels at two hospitalizations, blood lipid changes and the lipid control rate, LDL-C control rate =（1.8 mmol/L patients ＋ LDL-C decline 50%）/total number of patients, were compared between the two groups. Results：The LDL-C level [group A：（2.68 ± 0.88） mmol/L vs group B：（2.72 ± 0.92） mmol/L, P=0.509] and the LDL-C control rate（group A： 14% vs group B： 13.1%, P=0.476） at the first hospitalization were similar between the two groups. At the second hospitalization, the level of LDL-C was significantly lower in group B than that in group A（[1.91 ± 0.64] mmol/L vs [2.17 ± 0.76] mmol/L, P〈0.001）. The LDL-C control rate was significantly higher in group B than in the group A（43.66% vs 35.37%, P〈0.001）. Moreover, the reduction of total cholesterol and triglyceride was more significant in group B（[0.85±0.81] mmol/L and [0.24±1.58] mmol/L） compared to group A（[0.58±1.01] mmol/L and [0.17±1.37] mmol/L, bot

关 键 词：经皮冠状动脉介入治疗 血脂 低密度脂蛋白胆固醇 非靶病变 

分 类 号：R54[医药卫生—心血管疾病]