经皮冠状动脉介入术后冠脉病变进展的危险因素分析  

Risk factors for progression of coronary artery lesions after percutaneous coronary intervention

作　　者：温哲琦 陈璘[1] 汤磊乐 税星[1] 郑坚锐 WEN Zheqi;CHEN Lin;TANG Leile;SHUI Xing;ZHENG Jianrui(Department of Cardiovascular Medicine,the Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510630,Guangdong,China)

机构地区：[1]中山大学附属第三医院心血管内科,广东省广州市510630

出　　处：《微创医学》2020年第1期35-39,共5页Journal of Minimally Invasive Medicine

摘　　要：目的探讨经皮冠状动脉介入术(PCI)后冠脉病变进展的危险因素。方法选择经冠状动脉造影(CAG)确诊为冠心病并行PCI治疗的421例患者,根据术后冠脉影像复查结果分为进展组(263例)和非进展组(158例)。对比分析两组患者的性别、年龄、吸烟史、高血压病史,以及总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白水平等资料,以筛查PCI后冠脉病变进展的危险因素。结果进展组的基线及复查LDL-C异常率、TC水平及LDL-C水平,以及复查TC异常率、载脂蛋白B(ApoB)水平均高于非进展组(均P<0.05)。经多因素Logistic回归分析,植入支架数、基线及复查LDL-C异常、复查ApoB高水平为PCI后冠脉病变进展的独立危险因素(均P<0.05)。复查LDL-C达标者行PCI后冠脉病变进展率及进展程度更低;基线及复查LDL-C均达标的患者中,复查LDL-C水平较基线进一步下降者的病变进展程度更低(均P<0.05)。结论支架植入数、LDL-C异常、ApoB水平高是冠心病行PCI后病变进展的独立危险因素。LDL-C水平达标后进一步下降可能延缓冠脉病变进展。PCI术后患者应尤为重视血脂调控。Objective To investigate the risk factors for the progression of coronary artery lesions after percutaneous coronary intervention(PCI).Methods A total of 421 patients who were diagnosed as coronary heart disease by coronary angiography(CAG)and underwent PCI were selected,then they were divided into progressive group(263 cases)and non-progressive group(158 cases)according to the results of postoperative coronary angiography review.Gender,age,smoking history,hypertension history,as well as the levels of total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-H),low-density lipoprotein cholesterol(LDL-C)and apolipoprotein of the two groups were analyzed and compared so as to screen out the risk factors for the progression of coronary artery lesions after PCI.Results The progressive group yielded higher rates of abnormal baseline and review LDL-C,higher levels of TC and LDL-C,as well as a higher rate of abnormal review TC and a higher apolipoprotein B(ApoB)level compared to the non-progressive group(all P<0.05).Multivariate logistic regression analysis showed that number of stents implanted,abnormal LDL-C at baseline and review,and high ApoB level at review were the independent risk factors for progression of coronary artery lesions after PCI(all P<0.05).Patients with normal review LDL-C after PCI obtained lower rate and degree of coronary artery diseases progression;whereas among patients with normal baseline and review LDL-C,those with review LDL-C level lower than the baseline yielded lower lesion progression degree(all P<0.05).Conclusion Number of stents implanted,abnormal LDL-C,and high ApoB level are the independent risk factors for the progression of coronary heart lesions after PCI.Further decline in LDL-C level after normalization may retard the progression of coronary artery lesions.Patients should pay more attention to blood lipid regulation after PCI.

关 键 词：经皮冠状动脉介入 支架内再狭窄 进展 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]