高密度脂蛋白胆固醇水平对冠状动脉病变严重程度及介入治疗预后的影响  

Association between plasma HDL-C levels and coronary artery severity and impact on outcomes of patients underwent percutaneous coronary intervention

作　　者：宋莹[1] 姜琳[1] 陈艳[1] 宋雷[1] 张茵[1] 高立建[1] 许连军[1] 陈珏[1] 高润霖[1] 乔树宾[1] 杨跃进[1] 徐波[1] 袁晋青[1] Song Ying;Jiang Lin;Chen Yan;Song Lei;Zhang Yin;Gao Lijian;Xu Lianjun;Chen Jue;Gao Runlin;Qiao Shubin;Yang Yuejin;Xu Bo;Yuan Jinqing(Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心内科,100037

出　　处：《中华心血管病杂志》2020年第2期123-129,共7页Chinese Journal of Cardiology

基　　金：国家重点研发计划项目(2016YFC1301300,2016YFC1301301)。

摘　　要：目的探讨冠心病患者高密度脂蛋白胆固醇(HDL-C)水平与冠状动脉病变严重程度以及对经皮冠状动脉介入治疗(PCI)预后的影响。方法连续纳入2013年1至12月在阜外医院行PCI治疗的10458例患者,根据HDL-C水平分为3组:低三分位组(HDL-C≤0.89 mmol/L,3525例)、中三分位组(HDL-C>0.89~1.11 mmol/L,3570例)和高三分位组(HDL-C>1.11 mmol/L,3363例)。采用线性回归分析HDL-C水平与冠状动脉病变严重程度(SYNTAX积分)的关系。使用Kaplan-Meier生存分析比较3组间的预后差别。同时采用多因素Cox回归分析HDL-C水平对预后的影响。结果总体人群平均HDL-C水平为(1.03±0.28)mmol/L,平均SYNTAX积分为(11.7±8.1)分。HDL-C高三分位组患者年龄更大、男性更少、左心室射血分数更高,LDL-C水平更高,更少合并糖尿病、高脂血症、陈旧心肌梗死及吸烟史,稳定性心绞痛患者更多,左主干及三支病变比例更少,介入治疗成功率更高(P均<0.05)。HDL-C高三分位组SYNTAX积分更低[低、中、高三分位组分别为(12.2±8.4)、(11.7±8.1)和(11.2±7.8)分,P<0.001]。单因素及多因素线性回归分析均显示,HDL-C水平与SYNTAX积分呈负相关(单因素:β=-0.046,P<0.001;多因素:β=-0.058,P=0.001)。10400(99.4%)例患者完成了2年随访,3组在全因死亡、心原性死亡、心肌梗死、卒中、血运重建、主要心脑血管不良事件以及支架内血栓发生率差异均无统计学意义(趋势检验P均>0.05)。高三分位组BARC 2型以上出血事件发生率更高(趋势检验P=0.018)。Kaplan-Meier生存分析显示,3组间全因死亡、心原性死亡、心肌梗死、卒中、血运重建、主要心脑血管不良事件及支架内血栓发生率差异均无统计学意义(P均>0.05),而高三分位组BARC 2型以上出血风险更高(P=0.017)。多因素Cox回归分析发现HDL-C水平不是2年全因死亡等缺血事件及出血事件的独立危险因素(P>0.05)。结论冠心病行PCI治疗的患者,HDL-C水平与SYNObjective To analyze the association between plasma high-density lipoprotein cholesterol(HDL-C)levels and the severity of coronary artery disease,and to evaluate the impact of HDL-C levels on long-term outcomes in patients underwent percutaneous coronary intervention(PCI).Methods A total of 10458 consecutive patients underwent PCI from January 2013 to December 2013 at Fuwai hospital were enrolled in this study.Patients were divided into three groups according to HDL-C tertiles:low HDL-C group(HDL-C≤0.89 mmol/L,n=3525),median HDL-C group(HDL-C>0.89-1.11 mmol/L,n=3570)and high HDL-C group(HDL-C>1.11 mmol/L,n=3363).SYNTAX score was used to evaluate the severity of coronary artery disease,linear regression was used to analyze the relationship of HDL-C and SYNTAX score.Kaplan-Meier survival analysis was used to compare the outcomes among the three groups.Multivariate Cox regression was used to define the potential associations of HDL-C and outcomes.Results The HDL-C level was(1.03±0.28)mmol/L and the SYNTAX score was 11.7±8.1.Patients were older,proportion of female,stable angina pectoris,successful PCI and left ventricular eject fraction value were higher,while incidence of diabetes mellitus was lower,hyperlipidemia,old myocardial infraction,smoking history and left main and three vessels disease were lower in high HDL-C group(all P<0.05).Patients in high HDL-C group also had the lowest SYNTAX score(12.2±8.4 vs.11.7±8.1 vs.11.2±7.8,P<0.001).Both univariate and multivariate linear regression analysis showed that HDL-C was negatively associated with SYNTAX score,e.g.Univariate analysis:β=-0.046,P<0.001;Multivariate analysis:β=-0.058,P=0.001.And 10400(99.4%)patients completed 2-year follow up.At 2-year follow-up,there were no difference in all-cause death,cardiac death,myocardial infarction,revascularization,stroke,major adverse cardiovascular and cerebral events(MACCE)and stent thrombosis among three groups(P for trend>0.05),while patient in high HDL-C group experienced the highest BARC type 2 bleeding events(

关 键 词：冠状动脉疾病 高密度脂蛋白胆固醇 经皮冠状动脉介入治疗 预后 

分 类 号：R541.4[医药卫生—心血管疾病]