血清Hcy、sCD40L及LDL-C与冠状动脉支架内再狭窄的相关性研究

目的:探讨血清同型半胱氨酸(Hcy)、LDL-C、可溶性白细胞表面抗原40配体(sCD40L)等因素在冠状动脉支架内再狭窄发生过程中的临床意义。方法:收集冠状动脉药物涂层支架植入术后因胸痛再发/术后6个月常规行冠状动脉造影随访患者共120例,其中88例造影未出现支架内再狭窄(对照组),32例出现再狭窄(再狭窄组),回顾分析两组患者的年龄、性别、高血压病史、糖尿病史、心肌梗死病史及冠心病家族史,收集患者支架植入术后1周以及胸痛再发/术后6个月冠状动脉造影检查这两个时间点的BMI、肾小球滤过率(GFP)、甘油三酯、总胆固醇、糖化血红蛋白(GHbA1c)、LDL-C、HDL-C、Hcy、sCD40L等指标。结果:两组患者在支架植入术后1周各指标比较差异无统计学意义,因胸痛再发/术后6个月行冠状动脉造影随访时发现再狭窄组的LDL-C、Hcy、sCD40L和对照组比较差异有统计学意义(P<0.01),二分类变量Logistic回归分析显示,LDL-C、sCD40L及Hcy的升高会增加再狭窄的风险,且Hcy与LDL-C(r=0.36,P=0.002)、sCD40L(r=0.27,P=0.001)呈正相关。结论:支架植入术后LDL-C、Hcy、sCD40L升高是支架内再狭窄的危险因子,并且Hcy与LDL-C、sCD40L呈正相关。

Postprocedural serum Hcy, sCD40L and LDL-C are associated with coronary in-stent restenosis in patients with drug-coated stent implantation

Objective： To evaluate the roles of serum homocysteine（Hcy）,low density lipoprotein cholesterol（LDL-C） and soluble leukocyte surface antigens 40 ligand（sCD40L） in in-stent restenosis（ISR） after successful primary percutaneous coronary intervention（PCI）.Methods： Body mass index（BMI）,glomerular filtration rate（GFP）,total triglycerides（TG）,total cholesterol（TC）,glycosylated hemoglobin（GHbA1c）,LDL-C,high density lipoprotein（HDL-C）,Hcy and sCD40L levels were measured in 120 consecutive patients 1 week and 6 months（or chest pain occurred） after PCI.These patients were grouped as ISR and non-ISR based on angiography during follow-up time.Besides,age,sex,hypertension,diabetes mellitus,myocardial infarction family history and coronary heart disease were also compared.Results： There was no significant difference revealed in all parameters between two groups 1 week after PCI.However,6 months after PCI（or chest pain occurred）,serum Hcy,sCD40L and LDL-C levels were significantly higher in patients in ISR group than those in non-ISR（P〈0.01）.Hcy,sCD40L and LDL-C were significantly correlated with ISR（P〈0.01）.Furthermore,Hcy wag positively correlated with LDL-C（r= 0.36,P=0.002） and sCD40L（r=0.27,P=0.001）.Conclusion： Hcy,sCD40L and LDL-C are significantly associated with the risk of ISR.Furthermore,Hcy is positively correlated with LDL-C and sCD40L