颈动脉斑块相关参数在PCI术后冠心病患者非罪犯血管病变进展预测中的应用  

Application of parameters of carotid plaques in prediction of progression of non-culprit coronary lesions in patients with coronary heart disease after PCI

作　　者：苏鑫辉 车旭 姚德山 焦云根[1] SU Xinhui;CHE Xu;YAO Deshan;JIAO Yungen(Department of Cardiology,The Affiliated Hospital of Yangzhou University,Yangzhou 225000,China)

机构地区：[1]扬州大学附属医院心血管内科,江苏扬州225000

出　　处：《山东医药》2023年第33期22-26,共5页Shandong Medical Journal

基　　金：扬州市“十三五”科教强卫专项经费(ZDRC201817)。

摘　　要：目的分析颈动脉斑块相关参数对PCI术后冠心病患者非罪犯血管病变(NCCLs)进展的预测价值。方法选取首次行PCI术并间隔≥6个月复查冠状动脉造影(CAG)的冠心病患者167例,依据前后两次CAG检查结果分为进展组和非进展组。收集患者的基础信息、相关既往史和入院24 h内晨起空腹外周静脉血的检测结果,包括血常规、肝肾功能、空腹血糖、糖化血红蛋白、血脂指标,并计算单核细胞与高密度脂蛋白胆固醇比值(MHR)、中性粒细胞与高密度脂蛋白胆固醇比值(NHR)。患者均接受超声检查,根据超声报告结果测算颈动脉斑块相关参数,包括最大斑块厚度、最大斑块长度、颈动脉粥样硬化等级积分、斑块易损性积分。采用多因素Logistic回归模型分析NCCLs进展的独立影响因素,绘制ROC评估影响NCCLs进展因素的预测价值。结果进展组患者NHR高于非进展组(P<0.05),其余一般资料及血生化指标差异均无统计学意义(P均>0.05)。进展组患者最大斑块厚度、最大斑块长度、斑块易损性积分均高于非进展组(P<0.05)。斑块易损性积分是PCI术后冠心病患者NCCLs进展的独立危险因素[OR(95%CI)=1.190(1.062~1.335),P=0.003]。斑块易损性积分预测PCI术后冠心病患者NCCLs进展的AUC为0.693(95%CI为0.610~0.776,P<0.001),取截断值为4.5时,斑块易损性积分预测PCI术后冠心病患者NCCLs进展的灵敏度为72.0%、特异度为68.7%。结论颈动脉斑块易损性积分高是PCI术后冠心病患者NCCLs进展的独立危险因素,对PCI术后冠心病患者NCCLs进展有较高的预测价值。Objective To investigate the predictive value of the parameters of carotid plaques for the progression of non-culprit coronary lesions(NCCLs)in the patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods Totally 167 patients with coronary heart disease who underwent PCI for the first time and reviewed cor⁃onary angiography(CAG)over 6 months were selected.According to the results of two CAGs,the subjects were divided in⁃to the progressive group and the non-progressive group of NCCLs.Baseline information,relevant medical history,and lab⁃oratory test results of fasting peripheral venous blood samples taken within 24 h of admission were collected,including blood routine,hepatorenal function,fasting blood glucose,glycosylated hemoglobin,blood lipid levels,and meanwhile the ratio of neutrophil to high density lipoprotein(NHR),ratio of monocyte to high density lipoprotein(MHR)were calcu⁃lated.All patients underwent carotid ultrasound,and the parameters of carotid plaques that included maximum plaque height,maximum plaque length,graded scores of carotid atherosclerosis,plaque vulnerable scores were assessed by the ultrasonic reports.Multivariate Logistic regression model was used to analyze the independent risk factors for the progress of NCCLs,and receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of these factors for the progress of NCCLs.Results The level of NHR in the progressive group was higher than that in the nonprogressive group(P<0.05),while there were no statistical differences in baseline clinical data or biochemical laboratory results between the progressive group and the non-progressive group(all P>0.05).The maximum plaque height,maximum plaque length and plaque vulnerable scores were all higher in the progressive group than those in the non-progressive group(all P<0.05).The plaque vulnerable score was an independent risk factor for the progress of NCCLs in patients with coro⁃nary heart disease after PCI[OR(95%CI)=1.190(1.062

关 键 词：颈动脉斑块 斑块易损性积分 非罪犯血管 冠状动脉粥样硬化性心脏病 

分 类 号：R543.4[医药卫生—心血管疾病] R541.4[医药卫生—内科学]