首页|残余胆固醇与低密度脂蛋白胆固醇达标的冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的相关性

残余胆固醇与低密度脂蛋白胆固醇达标的冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的相关性

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目的 探讨低密度脂蛋白胆固醇(LDL-C)达标的冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后远期支架内再狭窄(ISR)的危险因素及其与残余胆固醇(RC)的相关性.方法 回顾性分析 2015 年 1 月至 2022 年 10 月于宜兴市人民医院心血管内科住院的 239 例CHD患者的临床资料,所有患者均于支架植入术后复查冠状动脉造影,入院次日空腹检测血常规、血生化等指标.根据住院期间冠状动脉造影结果将患者分为支架内再狭窄组(ISR组,58 例)和非支架内再狭窄组(non-ISR组,181 例).采用SPSS 16.0 统计软件进行数据分析.根据数据类型,分别采用t检验或 χ2 检验进行组间比较.采用Spearman相关分析RC与ISR的相关性.绘制受试者工作特征(ROC)曲线确定RC的最佳截断值.采用多因素logistic回归分析ISR的危险因素.结果 两组患者年龄、总胆固醇(TC)、RC、支架个数、支架总长度及糖尿病、吸烟、多支病变比例比较,差异有统计学意义(P<0.05).计算RC四分位间距,根据四分位间距将患者分为 4 组(Q1~Q4),4 组患者(Q1~Q4)ISR的发病率分别为 20.0%、14.8%、22.0%和 40.7%,差异有统计学意义(P<0.05).进一步采用Spearman相关分析发现,RC与ISR呈正相关(r=0.179;P<0.05).ROC分析结果表明,RC的ROC曲线下面积为 0.636(95%CI 0.572~0.697;P<0.05).通过计算约登指数,得出RC的最佳截断值为0.47 mmol/L,对应的灵敏度和特异度分别为51.72%与75.14%.多因素logistic回归分析结果显示:年龄(OR=1.041,95%CI 1.005~1.078;P<0.05)、吸烟(OR=5.797,95%CI 1.617~20.774;P<0.05)、多支病变(OR=3.937,95%CI 1.258~12.326;P<0.05)、支架总长度(OR=1.034,95%CI 1.001~1.070;P<0.05)及RC>0.47 mmol/L(OR=3.416,95%CI 1.535~7.602;P<0.05)是ISR的危险因素.结论 在LDL-C达标的PCI术后的CHD患者中,RC与ISR呈正相关,且RC是PCI术后发生ISR的独立危险因素.
Correlation between remnant cholesterol and in-stent restenosis in coronary heart disease patients with low-density lipoprotein cholesterol compliance after percutaneous coronary intervention
Objective To investigate the risk factors of long-term in-stent restenosis(ISR)and its correlation with remnant choles-terol(RC)in coronary heart disease(CHD)with low-density lipoprotein cholesterol(LDL-C)compliance after percutaneous coronary intervention(PCI).Methods A retrospective study was conducted of the clinical data of 239 CHD inpatients in the Department of Cardiology of Yixing People's Hospital from January 2015 to October 2022.All patients had a previous stent placement and underwent coronary angiography after hospitalization.Fasting blood routine and biochemical indicators were tested on the day following admission.According to the results of coronary angiography,they were divided into ISR group(n= 58)and non-ISR group(n= 181).SPSS statistics 16.0 was used for data analysis.According to the data types,t test or Chi-square test was used for intergroup comparison.The Spearman correlation was used to analyze the correlation between RC and ISR.Receiver operating characteristic(ROC)curve was drawn to determine the optimal cutoff value of RC.Multivariate logistic regression was used to analyze the risk factors of ISR.Results The two groups showed statistical significant differences in age,total cholesterol(TC),RC,number of stents,total stent length and proportion of diabetes mellitus,smoking and multiple vessel lesions(P<0.05).The RC interquartile range was calculated,and the patients were divided into four groups(Q1-Q4)accordingly with an ISR rate of 20.0%,14.8%,22.0%,and 40.7%,respectively,showing statistically significant differences(P<0.05).Further Spearman correlation analysis revealed a positive correlation between RC and ISR(r=0.179;P<0.05).ROC analysis showed an area under ROC curve of 0.636(95%CI 0.572-0.697;P<0.05)for RC.By calculating the Youden index,the optimal cutoff value for RC was 0.47 mmol/L with a sensitivity of 51.72%and a specificity of 75.14%.Multivariate logistic regression analysis showed that age(OR=1.041,95%CI 1.005-1.078;P<0.05),smoking(OR= 5.797,95%CI 1.617-20.774;P<0.05),multiple vessel lesions(OR=3.937,95%CI 1.258-12.326;P<0.05),total stent length(OR=1.034,95%CI 1.001-1.070;P<0.05),and RC>0.47 mmol/L(OR=3.416,95%CI 1.535-7.602;P<0.05)were risk factors of ISR.Conclusion There is a positive correlation between RC and ISR in CHD patients with LDL-C compliance after PCI,and RC is an independent risk factor of ISR after PCI.

coronary heart diseaseremnant cholesterolin-stent restenosis

陆赟、翁嘉懿、徐亮、陈燕春、殷云杰

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宜兴市人民医院心血管内科,江苏 宜兴 214200

南京医科大学附属苏州医院心血管内科,江苏 苏州 215008

冠心病 残余胆固醇 支架内再狭窄

国家自然科学基金宜兴市社会发展项目

8210036082100360

2024

中华老年多器官疾病杂志
中国人民解放军总医院老年心血管病研究所

中华老年多器官疾病杂志

CSTPCD
影响因子:0.728
ISSN:1671-5403
年,卷(期):2024.23(1)
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