血管内超声联合单核细胞/高密度脂蛋白胆固醇比值对非左主干临界病变患者行经皮冠状动脉介入治疗预后的评估  

Prediction by intravascular ultrasound with monocyte to high density lipoprotein-cholesterol ratio of prognosis in patients with intermediate non-left main coronary lesions underwent percutaneous coronary intervention

作　　者：龚晓璇[1] 应良红[2] 李江津[3] 张清[3] 田晓沂[3] 马树人[3] 张喜文[3] 李振 GONG Xiao-xuan;YING Liang-hong;LI Jiang-jin;ZHANG Qing;TIAN Xiaoyi;MA Shu-ren;ZHANG Xi-wen;LI Zhen(Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心内科,江苏南京210029 [2]淮安市第二人民医院心内科 [3]南京医科大学附属淮安第一医院心内科

出　　处：《中国介入心脏病学杂志》2019年第1期45-51,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的评估血管内超声(intravascular ultrasound,IVUS)联合单核细胞/高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)比值(monocyte to HDL-C ratio,MHR)对非左主干临界病变患者行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)12个月的预后。方法连续入选2017年1月至2018年1月在南京医科大学附属淮安第一医院经冠状动脉造影明确诊断为非左主干临界病变且需要行PCI的冠状动脉粥样硬化性心脏病患者共184例,检测入院时单核细胞计数与HDL-C水平并计算MHR。行IVUS检查判断罪犯病变处斑块稳定性,根据结果将患者分为斑块稳定组(44例)与斑块不稳定组(140例)。所有患者均至少满足斑块不稳定或最小管腔面积<4 mm2中的一项,对上述患者行PCI。随访患者PCI术后12个月的主要不良心血管事件发生情况。结果斑块不稳定组的MHR值[(22.6±8.4)比(14.1±7.2),P<0.001]显著高于斑块稳定组,差异有统计学意义。ROC曲线结果显示,MHR切点值为16.05时对非左主干临界病变患者PCI术后12个月发生主要不良心血管事件的预测价值最大(AUC 0.78,95%CI 0.71～0.85,P<0.001),敏感度为74.2%,特异度为77.0%。斑块不稳定且MHR值>16.05是PCI术后12个月发生主要不良心血管事件的独立危险因素(调节HR 3.26,95%CI 2.48～4.14,P=0.020)。结论 IVUS联合MHR对非左主干临界病变行PCI的患者预后判断具有一定临床价值。Objective To investigate the prediction by intravascular ultrasound(IVUS)with monocyte to high density lipoprotein-cholesterol(HDL-C)ratio(MHR)of 12-month prognosis in patients with intermediate non-left main coronary lesions after percutaneous coronary intervention(PCI).Methods Patients with intermediate non-left main coronary lesions diagnosed by coronary angiography were tested of monocyte counts and HDL-C levels at admission with MHRs calculated.IVUS was used to examine plaque stability in target lesions.Patients were divided into stable plaque group(n=44)and unstable plaque group(n=140)according to the IVUS results.PCI was then operated in patients with unstable plaque or with minimum lumen area<4 mm^2.The major adverse cardiovascular events(MACE)were recorded during the follow-up period of 12 months after PCI.Results MHR was significantly higher in unstable plaque group than that in stable plaque group[(22.6±8.4)vs.(14.1±7.2),P<0.001].Receiver-operating characteristic(ROC)analysis revealed that an MHR cut-off of 16.05 had 74.2%sensitivity and 77.0%specificity for prediction of 12-month MACE after PCI(AUC 0.78,95%CI 0.71–0.85,P<0.001).Besides,unstable plaque with MHR over 16.05 was an independent risk factor for 12-month MACE after PCI(adjusted HR 3.26,95%CI 2.48–4.14,P=0.020).Conclusions IVUS combined with MHR is a valuable index predicting the prognosis of patients with intermediate non-left main coronary lesions who underwent PCI.

关 键 词：冠状动脉临界病变 血管内超声 单核细胞/高密度脂蛋白胆固醇 经皮冠状动脉介入治疗 

分 类 号：R543.3[医药卫生—心血管疾病]