脂质变化与性别交互作用对老年内膜增生的关联研究  

Relationship of interaction between lipid profile and gender with stent intimal hyperplasia in elderly CHD patients

作　　者：张冠龙 浮志坤[1] 马云飞 王明杰 赵学忠[2] Zhang Guanlong;Fu Zhikun;Ma Yunfei;Wang Mingjie;Zhao Xuezhong(Department of Cardiology,Zhengzhou No.7 People's Hospital,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州市第七人民医院心内科,450000 [2]吉林大学第一医院心血管疾病诊疗中心

出　　处：《中华老年心脑血管病杂志》2021年第11期1146-1149,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省科技攻关计划项目(2018020861)。

摘　　要：目的探讨老年冠心病患者PCI后血脂谱变化跟性别交互作用与支架内膜增生的关联。方法选择行PCI成功置入支架的老年冠心病患者385例,女性130例,男性255例。其中支架内膜轻度增生190例、中度增生137例和重度增生58例。分别于PCI前、复查冠状动脉造影前检测TC、TG、LDL-C、HDL-C水平,其中非HDL-C为TC与HDL-C的差值。用多因素logistic回归模型分析内膜增生的影响因素。结果女性TC、TG、LDL-C、HDL-C和非HDL-C水平均显著高于男性(P<0.05,P<0.01)。全体、轻度增生、中度增生患者随访TC、LDL-C和非HDL-C水平较基线明显降低(P<0.01);重度增生患者非HDL-C水平较基线明显降低(P<0.05,P<0.01)。多因素logistic回归模型调整混杂因素后,女性内膜增生风险较男性减少50.0%(OR=0.500);TC和非HDL-C每下降1 mmol/L,内膜增生风险可分别减少63.7%(OR=0.333)和58.2%(OR=0.418);HDL-C每下降1 mmol/L,内膜增生风险可增加76.7%(OR=1.767)。TC、TG和非HDL-C降低对女性内膜增生保护效能最高(P_(交互作用)<0.01),老年男性HDL-C水平未降低者内膜增生程度更高(P_(交互作用)<0.01)。结论老年患者血脂谱跟性别交互作用与PCI后内膜增生程度相关,降低TC、非HDL-C水平和保持HDL-C水平对防治PCI后内膜增生有性别差异。Objective To study the relationship of interaction between lipid profile and gender with stent intimal hyperplasia in elderly CHD patients after PCI.Methods Three hundred and eighty-five elderly CHD patients(130 females and 255 males,190 with mild stent intimal hyperplasia,137 with moderate stent intimal hyperplasia and 58 with severe stent intimal hyperplasia)who underwent successful stent implantation after PCI were included in this study.Their serum levels of TC,TG,LDL-C,HDL-C were measured before PCI and during the follow-up period.The influencing factors of stent intimal hyperplasia in elderly CHD patients were analyzed by multivariate logistic regression analysis.Results The mean serum level of TC,TG,LDL-C,HDL-C and non-HDL-C was significantly higher in female CHD patients than in male CHD patients(P<0.05,P<0.01).The serum levels of TC,LDL-C and non-HDL-C were significantly lower in elderly CHD patients and in those with mild and moderate stent intimal hyperplasia after PCI than before PCI(P<0.01).The serum non-HDL-C level was significantly lower in elderly CHD patients with severe stent intimal hyperplasia after PCI than before PCI(P<0.05,P<0.01).Multivariate logistic regression analysis showed that the risk of stent intimal hyperplasia reduced 50.0%(OR=0.500),63.7%(OR=0.333)and 58.2%(OR=0.418)respectively when the serum level of TC and non-HDL-C reduced per 1 mmol/L and increased 76.7%(OR=1.767)when th serum level of HDL-C reduced per 1 mmol/L in female CHD patients after adjustment of the confounding factors.The reduced serum levels of TC,TG and non-HDL-C could effectively prevent stent intimal hyperplasia in elderly female CHD patients(P<0.01).The normal serum HDL-C level could more effectively prevent stent intimal hyperplasia in elderly male CHD patients(P<0.01).Conclusion The interaction between lipid profile and gender is related with the severity of sent intimal hyperplasia in elderly CHD patients after PCI.The gender difference can be detected in reduced serum TC and non-HDL-C levels and normal se

关 键 词：冠心病 经皮冠状动脉介入治疗 血脂异常 性别因素 支架 

分 类 号：R541.4[医药卫生—心血管疾病]