血脂指标动态变化与冠心病患者择期经皮冠状动脉介入术后非靶血管病变进展的关系研究

背景冠心病(CHD)患者采用经皮冠状动脉介入治疗(PCI)具有确切效果,但存在靶血管支架再狭窄和非靶血管病变进展问题。目的探讨血脂指标动态变化与CHD患者择期PCI后非靶血管病变进展的关系。方法选取2017年1月-2019年5月空军军医大学第一附属医院心内科择期PCI后二次入院的CHD患者150例,根据非靶血管病变进展情况分为进展组45例和无进展组105例。比较两组患者性别、年龄、民族(包括回族、汉族)、吸烟情况、既往史(高血压、糖尿病)、CHD家族史、体质指数(BMI)、随访时间及syntax积分及第1次入院、第2次入院血脂指标〔包括总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、TG/HDL-C及non-HDL-C/HDL-C〕;CHD患者择期PCI后非靶血管病变进展的影响因素分析采用多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线以评价non-HDL-C对CHD患者择期PCI后非靶血管病变进展的预测价值。结果进展组患者女性比例、糖尿病发生率、syntax积分高于无进展组,第1次入院TC、TG、non-HDL-C低于无进展组,两次入院TC、TG、LDL-C、non-HDL-C、TG/HDL-C、non-HDL-C/HDL-C差值高于无进展组(P<0.05)。多因素Logistic回归分析结果显示,性别〔OR=0.302,95%CI(0.122,0.751)〕、糖尿病〔OR=2.946,95%CI(1.222,7.102)〕、non-HDL-C动态变化〔OR=1.900,95%CI(1.131,3.192)〕、TG/HDL-C动态变化〔OR=1.506,95%CI(1.024,2.215)〕是CHD患者择期PCI后非靶血管病变进展的独立影响因素(P<0.05)。ROC曲线分析结果显示,non-HDL-C动态变化与TG/HDL-C动态变化预测CHD患者择期PCI后非靶血管病变进展的曲线下面积(AUC)比较,差异无统计学意义(P>0.05)。结论 non-HDL-C动态变化、TG/HDL-C动态变化是CHD患者择期PCI后非靶血管病变进展的独立影响因素,且其对CHD患者择期PCI后非靶血管病变进展有一定的预测价值。

Relationship between Dynamic Changes of Blood Lipid Indexes and Progression of Non-target Vascular Lesions in Patients with Coronary Heart Disease after Elective Percutaneous Coronary Intervention

Background Although percutaneous coronary intervention(PCI) has a significant effect in the treatment of coronary heart disease(CHD),there are still problems with stent restenosis in target vessels and progression of non-target vessel lesions.Objective To discuss the relationship between dynamic changes of blood lipid indexes and progression of non-target vascular lesions in patients with CHD after elective PCI.Methods From January 2017 to May 2019,150 patients with CHD who were admitted for the second time after elective PCI in the Department of Cardiology,the First Affiliated Hospital of Air Force Military Medical University were selected,and they were divided into progression group(n=45) and nonprogression group(n=105) according to the progression of non-target vascular lesions.Gender,age,nationality(including Hui and Han nationality),smoking,past history(including hypertension,diabetes),family history of CHD,body mass index(BMI),follow-up time and syntax score,blood lipid indexes of the 1 st and 2 nd admission〔including total cholesterol(TC),triacylglycerol(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),non-HDL-C,TG/HDL-C and non-HDL-C/HDL-C〕 were compared between the two groups.Multivariate Logistic regression analysis was used to analyse the influencing factors of non-target vascular lesions progression in patients with CHD after elective PCI.ROC curve was drawn to evaluate the predictive value of non-HDL-C on the progression of non-target vascular lesions in patients with CHD after elective PCI.Results Female ratio,incidence of diabetes and syntax score in progression group were higher than those in non-progression group,TC,TG,non-HDL-C of 1 st admission in progression group were lower than those in non-progression group,the differences of TC,TG,LDL-C,non-HDL-C,TG/HDL-C,non-HDL-C/HDL-C between two admissions in progression group were higher than those in non-progressive group(P<0.05).Multivariate Logistic regression analysis showed that,gender〔OR=0.302,95%CI(0.122,0.751)〕,diabetes〔OR=2.946,95%CI(1.222,7.102)〕,dynamic changes of non-HDL-C〔OR=1.900,95%CI(1.131,3.192)〕 and dynamic changes of TG/HDL-C〔OR=1.506,95%CI(1.024,2.215)〕 were independent influencing factors of non-target vascular lesions in patients with CHD after elective PCI(P<0.05).ROC curve analysis showed that,there was no significant difference in the AUC between the dynamic changes of non-HDL-C and TG/HDL-C in predicting the progression of non-target vascular lesions progression in patients with CHD after elective PCI(P>0.05).Conclusion The dynamic changes of non-HDL-C and TG/HDL-C are independent risk factors of non-target vascular lesions progression in patients with CHD after elective PCI,and they have a certain value in predicting the progression of non-target vascular lesions.