冠心病患者经皮冠状动脉介入治疗术后非靶病变进展危险因素的巢式病例对照研究  

A nested case-control study of risk factors for non-target lesion progression after percutaneous coronary intervention in patients with coronary artery disease

作　　者：韩国栋 姚康 魏志粱 蔺鹏阳 杨旭龙 李典 刘艳 张小卫[1] 孙守刚[1] HAN Guo-dong;YAO kang;WEI Zhi-liang;LIN Peng-yang;YANG Xu-long;LI Dian;LIU Yan;ZGANG Xiao-wei;SUN Shou-gang(Department of Cardiology,The Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院心内科,甘肃省兰州市730000

出　　处：《中国心血管病研究》2025年第3期260-265,共6页Chinese Journal of Cardiovascular Research

基　　金：甘肃省心脏康复工程研究中心项目(CRQI-C00535);兰州大学学生创新创业行动计划(20240050148)。

摘　　要：目的探讨经皮冠状动脉介入治疗(PCI)术后非靶病变进展危险因素,为防治冠心病非靶病变进展提供科学依据。方法采用巢式病例对照研究设计,前瞻性构建队列并纳入2020年1月至2023年4月在兰州大学第二医院行PCI术并复查造影的1568例患者,识别冠状动脉非靶病变进展的83例病例作为进展组,通过倾向得分匹配对照组,最终匹配成功进展组75例,对照组150例。通过定量冠状动脉造影(QCA)测量非靶病变数据,并采用多变量Logistic回归分析识别与非靶病变进展相关的独立危险因素。结果与对照组相比,进展组具有较高的体重指数(BMI)(P<0.001)、低密度脂蛋白胆固醇(LDL-C)(P<0.01)、血小板(P=0.01)、C-反应蛋白(CRP)水平(P<0.01),较低的高密度脂蛋白胆固醇(HDL-C)(P<0.01)、白细胞(WBC)(P=0.04)、间接胆红素(P=0.03)、血糖水平(P<0.01)。多因素Logistic回归分析显示,BMI值(P<0.01)、血糖浓度(P=0.02)、CRP水平(P=0.04)、WBC水平(P=0.03)是非靶病变进展的独立危险因素。诊断试验表明,BMI值(P<0.01,AUC=0.68)、血糖浓度(P=0.02,AUC=0.59)、WBC水平(P=0.02,AUC=0.59)对非靶病变进展具有预测价值。结论血糖浓度、BMI值和CRP水平、WBC水平与PCI术后非靶病变进展之间存在显著相关性,在临床实践中对这些因素的严格控制对于改善非靶病变进展患者临床转归至关重要。血糖浓度、BMI值和WBC水平是PCI术后非靶病变进展的预测指标。研究结果为冠心病的PCI术后患者个体化管理策略提供了新的视角。Objective To explore the risk factors for non-target lesion progression after percutaneous coronary intervention(PCI),and to provide a scientific basis for the prevention and treatment of non-target lesion progression in coronary artery disease.Methods A nested case-control study design was used to prospectively construct a cohort of 1568 patients who underwent PCI and underwent follow-up imaging from January 2020 to April 2023 at the Second Hospital of Lanzhou University.A total of 83 cases with progression of non-target coronary lesions were identified as the progression group,and the control group was matched by propensity score,with 75 cases in the progression group and 150 cases in the control group successfully matched.Non-target lesion data were measured by quantitative coronary angiography(QCA),and independent risk factors associated with non-target lesion progression were identified by multivariate Logistic regression analysis.Results Compared with the control group,the progression group had higher body mass index(BMI)(P<0.001),low-density lipoprotein cholesterol(LDL-C)(P<0.01),platelet(P=0.01)and C-reactive protein(CRP)(P<0.01)levels,and lower high-density lipoprotein cholesterol(HDL-C)(P<0.01),white blood cell(WBC)(P=0.04),indirect bilirubin(P=0.03)and blood glucose levels(P<0.01).Multifactorial Logistic regression analysis showed that BMI(P<0.01),blood glucose(P=0.02),CRP(P=0.04)and WBC(P=0.03)were independent risk factors for non-target lesion progression.Diagnostic tests showed that BMI(P<0.01,AUC=0.68),blood glucose concentration(P=0.02,AUC=0.59)and WBC level(P=0.02,AUC=0.59)had a predictive value for the progression of non-target lesions.Conclusion There is a significant correlation between blood glucose concentration,BMI and CRP,WBC levels and non-target lesion progression after PCI,and strict control of these factors in clinical practice is essential to improve clinical regression in patients with non-target lesion progression.Blood glucose concentration,BMI and WBC levels are predictors of non-

关 键 词：冠心病 非靶病变 经皮冠状动脉介入治疗术 危险因素 巢式病例对照研究 

分 类 号：R541.4[医药卫生—心血管疾病]