低密度脂蛋白胆固醇累积暴露对经皮冠状动脉介入术后心血管结局的影响研究  

Impact of cumulative exposure to low-density lipoprotein cholesterol on cardiovascular outcomes postpercutaneous coronary intervention

作　　者：兰文达 孙亚召 李向华 孟庆兰 LAN Wen-da;SUN Ya-zhao;LI Xiang-hua;MENG Qing-lan(Department of Cardiology Cangzhou People’s Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市人民医院心内科,河北省沧州市061000

出　　处：《中国心血管病研究》2025年第2期164-169,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的评估低密度脂蛋白胆固醇(LDL-C)累积暴露值对经皮冠状动脉介入(PCI)术后心血管结局的影响。方法纳入2018年1月至2018年6月在沧州市人民医院接受经皮冠状动脉介入(PCI)治疗的260例冠心病患者。以首次住院期间的临床资料和2019年、2020年2次血脂复查结果,计算LDL-C的累积暴露值(cumLDL-C)。同时,记录随访期间发生的主要心血管事件。结果随访期间共有48例患者出现心力衰竭、非致死性心肌梗死、支架内再狭窄、原有病变进展或新发冠状动脉病变。预后不良组与预后良好组相比,预后不良组的吸烟比例、糖尿病比例和冠状动脉总斑块负荷、非钙化斑块负荷、钙化斑块负荷、尿酸、总胆固醇(TC)、LDL-C、cumLDL-C水平均较高(均P<0.05),ACER/ARB药物使用比例较低(P<0.05)。以cumLDL-C最低四分位数作为参照组,调整混杂因素后,多因素Logistic回归分析显示,cumLDL-C为5.01~5.72 mmol/L和>5.72 mmol/L的患者,发生主要心血管事件的风险分别升高了4.28倍(95%CI 1.045~17.496,P=0.043)和4.94倍(95%CI 1.209~20.149,P=0.026)。受试者工作特征曲线(ROC)分析显示,cumLDL-C预测PCI术后主要心血管事件的曲线下面积(AUC)为0.812,敏感度和特异度分别为79.17%和82.08%。同时,cumLDL-C预测价值明显高于基线LDL-C(Z=2.207,P=0.027)。Spearson相关性分析显示,cumLDL-C与冠状动脉总斑块负荷、非钙化斑块负荷呈显著正相关(r=0.249,P<0.001;r=0.189,P=0.001)。结论较高的cumLDL-C与PCI术后主要心血管事件的风险显著增加有关。在PCI术后患者管理中,需特别关注和控制LDL-C的长期累积暴露,以降低心血管不良事件的发生风险。Objective To evaluate the impact of cumulative exposure to low-density lipoprotein cholesterol(LDL-C)on cardiovascular outcomes after percutaneous coronary intervention(PCI).Methods 260 patients with coronary artery disease who underwent percutaneous coronary intervention(PCI)at Cangzhou People’s Hospital from January 2018 to June 2018 were included.The cumulative exposure value of LDL-C(cumLDL-C)was calculated based on clinical data collected during the initial hospitalization and the results of lipid profile assessments conducted in 2019 and 2020.The major cardiovascular events occurring during the follow-up period were also recorded.Results During the follow-up period,a total of 48 patients experienced heart failure,non-fatal myocardial infarction,in-stent restenosis,progression of existing lesions or new coronary artery lesions.Compared to the group with good prognosis,the poor prognosis group had higher proportions of smoking and diabetes,as well as elevated levels of total coronary plaque burden,non-calcified plaque burden,calcified plaque burden,uric acid,total cholesterol(TC),LDL-C and cumLDL-C(all P<0.05),while the proportion of ACEI/ARB medication use was lower(P<0.05).Using the lowest quartile of cumLDL-C as the reference group and adjusting for confounding factors,the multivariate Logistic regression analysis showed that patients with cumLDL-C levels of 5.01-5.72 mmol/L and>5.72 mmol/L had a 4.28-fold(95%CI 1.045-17.496,P=0.043)and 4.94-fold(95%CI 1.209-20.149,P=0.026)increased risk of major cardiovascular events,respectively.The receiver operating characteristic(ROC)curve analysis indicated that the area under the curve(AUC)for cumLDL-C in predicting major cardiovascular events post-PCI was 0.812,with a sensitivity and specificity of 79.17%and 82.08%,respectively.Additionally,the predictive value of cumLDL-C was significantly higher than that of baseline LDL-C(Z=2.207,P=0.027).Spearman correlation analysis showed that cumLDL-C was significantly positively correlated with both the total coronary pla

关 键 词：冠心病 累积暴露 低密度脂蛋白胆固醇 经皮冠状动脉介入 心血管结局 

分 类 号：R541.4[医药卫生—心血管疾病]