脂蛋白a、残余胆固醇与下肢动脉硬化闭塞症腔内治疗术后支架内再狭窄的相关性研究  

Association of lipoprotein(a)and residual cholesterol with in-stent restenosis after endovascular treatment of lower extremity atherosclerotic obliterans disease

作　　者：胡斌 赵文军[1] 陈光[1] 李翔[1] 褚海伟 李栋林[2] HU Bin;ZHAO Wenjun;CHEN Guang;LI Xiang;CHU Haiwei;LI Donglin(Department of Vascular Surgery,Taizhou Hospital of Zhejiang Province,Taizhou 317000,China;不详)

机构地区：[1]浙江省台州医院血管外科,317000 [2]浙江大学医学院附属第一医院血管外科

出　　处：《心电与循环》2024年第6期568-573,578,I0003,共8页Journal of Electrocardiology and Circulation

基　　金：台州市科技计划项目(1901ky09)。

摘　　要：目的探讨脂蛋白a[Lp(a)]、残余胆固醇(RC)与下肢动脉硬化闭塞症(LEASO)腔内治疗术后支架内再狭窄的相关性。方法回顾性分析2019年6月至2022年6月浙江省台州医院血管外科收治并行腔内治疗的LEASO患者268例,根据1年随访期间内是否出现支架内再狭窄分为狭窄组68例和对照组200例。记录两组对象的年龄、性别、手术资料等基本数据及Lp(a)、RC、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(Apo)B、ApoA1等血脂指标,分析以上指标与LEASO腔内治疗术后支架内再狭窄的相关性,并分析各血脂指标的预测价值及诊断效能。结果狭窄组Lp(a)、RC、TC、TG、LDL-C、TC/HDL-C水平高于对照组,差异均有统计学意义(均P<0.05),HDL-C、ApoA1、ApoB/ApoA1比较差异均无统计学意义(均P>0.05)。糖尿病(OR=5.078)、Lp(a)(OR=23.267)、TC/HDL-C(OR=1.065)、LDL-C/HDL-C(OR=0.915)均为腔内治疗术后支架内再狭窄的独立危险因素(均P<0.05)。ROC曲线显示Lp(a)联合RC及Lp(a)、RC的AUC为0.826、0.764、0.749,而Lp(a)联合RC较二者单独诊断的灵敏度增高,为0.897。结论Lp(a)、RC与LEASO腔内治疗术后支架内再狭窄有关,Lp(a)联合RC对腔内治疗术后支架内再狭窄有更好的预测价值和诊断效能。Objective To investigate the association of lipoprotein(a)and remnant cholesterol(RC)with in-stent restenosis after endovascular treatment of lower extremity atherosclerotic obliterans disease.Methods The data of 268 patients with lower extremity atherosclerotic obliterans disease who underwent endovascular treatment in the Department of Vascular Surgery,Taizhou Hospital of Zhejiang Province from June 2019 to June 2022 were retrospectively analyzed.According to whether restenosis occurred during 1-year follow-up period,the patients were divided into stenosis group(n=68)and non-stenosis group(n=200).Lp(a),RC,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),apolipoprotein(Apo),high-density lipoprotein cholesterol(HDL-C)and ApoA1 were compared between the two groups.The correlation between these measures and in-stent restenosis after endovascular treatment in the lower limbs was analyzed.Results Lp(a),RC,TC,TG,LDL-C and TC/HDL-C in stenosis group were significantly higher than those in the non-stenosis group(all P<0.05).There was no significant difference in HDL-C,ApoA1,ApoB/ApoA1.Diabetes(OR=5.078),Lp(a)(OR=23.267),TC/HDL-C(OR=1.065),and LDL-C/HDL-C(OR=0.915)were independent risk factors for in-stent restenosis after endovascular treatment(all P<0.05).The Receiver operating characteristic(ROC)curve showed that the area under the curve of Lp(a)combined with RC,Lp(a)and RC were 0.826,0.764 and 0.749,respectively.The sensitivity of Lp(a)combined with RC for diagnosis was 0.897,higher than that of the two alone.Conclusion Lp(a)and RC are associated with in-stent restenosis after endovascular treatment.Lp(a)combined with RC has better capacity for prediction of in-stent restenosis.

关 键 词：脂蛋白A 残余胆固醇 下肢动脉硬化闭塞症 脂蛋白比率 支架内再狭窄 

分 类 号：R654.4[医药卫生—外科学]