炎症与血脂指标对经皮冠状动脉介入治疗术后支架内再狭窄及粥样斑块病变不同的影响

目的探讨C反应蛋白（CRP）和血清总胆固醇、低密度脂蛋白胆固醇（LDL C）、非高密度脂蛋白胆固醇对经皮冠状动脉介入（PCI）治疗术后支架内再狭窄及冠状动脉粥样斑块进展的影响。方法收集515例PCI术后患者的病历资料进行回顾性分析，这些患者术后9～12个月行冠状动脉造影复查，在PCI术前及复查冠状动脉造影时检查CRP及血脂指标。冠状动脉造影复查时根据病变程度将患者分为支架内再狭窄（ISR）组（97例）、冠状动脉粥样斑块进展组（病变进展组，66例）及没有支架内再狭窄也没有粥样斑块病变进展组（对照组，317例）。观察CRP、总胆固醇、LDL C、非高密度脂蛋白胆固醇等指标的变化及其与ISR发生的相关性。结果PCI术前ISR组CRP水平高于对照组[1.58（0.65，3.85）mg/L比0.90（0.11，2.29）mg/L]（均P＜0.05）。相关性分析显示无论PCI术前还是随访时，CRP与ISR发生有很大的相关性［PCI术前比值比（OR）=1.010，95%置信区间（CI）：1.007～1.192，P＜0.05；随访时OR=1.158，95%CI：1.057～1.269，P＜0.05]。当CRP以2 mg/L为临界值，CRP＞2 mg/L组Logistic回归分析说明ISR的发生率随着CRP增高而增加[OR=1.83,95%CI：1.034～3.462,P＜0.05]。随访时病变进展组总胆固醇、LDL C、非高密度脂蛋白胆固醇高于对照组[（4.58±1.16）mmol/L比（4.28±1.03）mmol/L，（2.53±0.94）mmol/L比（2.21±0.76）mmol/L，（3.54±1.14）mmol/L比（3.20±0.96）mmol/L]（P＜0.05）。Logistic回归分析说明斑块进展与总胆固醇、LDL C 和非高密度脂蛋白胆固醇相关 （均P＜0.05）。结论PCI术前的CRP水平与ISR明显正相关，而血脂指标（总胆固醇、LDL C和非高密度脂蛋白胆固醇）水平与斑块进展明显正相关。

Different influences of C-reactive protein and lipid profile on coronary lesions after a percutaneous coronary intervention

ObjectiveTo investigate the impacts of inflammation and lipid profile on both in stent restenosis（ISR） and lesion progression in patients receiving PCI and scheduled follow up. MethodsA retrospective analysis of 515 patients was performed in patients who underwent percutaneous coronary intervention（PCI） and received coronary angiography again at an average of 9 months. The data of lipid profile and C reactive protein （CRP） at both pre PCI and follow up were analyzed for all patients; 317 patients with neither ISR nor lesion progression were as a control group. Results CRP levels of pre PCI in the ISR group were higher than those in the control group （P〈0.05）. The multivariate analysis indicated that the CRP levels at both pre PCI and follow up were significantly correlated with ISR [OR=1.010,95%CI：1.007 1.1920,P〈0.05 for pre PCI, OR=1.158,95%CI：1.057 1.269）,P〈0.05 for follow up, P〈0.05,respectively]. When the cut off of CRP was 2 mg/L, logistic regression analysis suggested an increased risk of ISR in patients with CRP greater than 2 mg/L （OR=1.830, 95%CI：1.034 3.462,P〈0.05） at pre PCI CRP. The levels of total cholesterol （TC）, low density lipoprotein cholesterol （LDL C） and non high density lipoprotein cholesterol （non HDL C） during follow up in the progression group were higher than those in the control group （P〈0.05, respectively）. Logistic regression showed that the risk for lesion progression was associated with the concentrations of TC, LDL C and non HDL C （P〈0.05）. ConclusionsThe levels of pre PCI CRP are strongly associated with ISR, whereas serum levels of TC, LDL C and non HDL C are significantly correlated with coronary lesion progression.