残余胆固醇与LDL-C达标的冠心病患者PCI术后支架内再狭窄的相关性

目的：探讨低密度脂蛋白胆固醇（LDL-C）达标的冠心病PCI术后患者远期支架内再狭窄（ISR）的危险因素及其与残余胆固醇（RC）的相关性。方法：采用病例对照研究方法，选择2015年01月至2022年10月于宜兴市人民医院心内科住院的冠心病患者共239例，所有患者均为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。根据住院期间冠脉造影结果分为ISR组和non-ISR组。采用IBM SPSS Statistics 16.0软件进行分析，根据不同数据类型分别使用t检验，Mann-whitney 检验或Kruskal-Wallis秩和检验；相关分析采用Spearman相关分析法；绘制ROC曲线确定RC的最佳截断值；采用多因素二分类Logistic回归分析ISR的相关危险因素。结果：两组间一般资料比较显示，non-ISR与ISR组在性别、高血压、支架植入时间、TG、HDL-C、LDL-C、Lp-a均无明显差异，无统计学意义（p＞0.01），而年龄、糖尿病、吸烟、TC、RC、多支病变、支架个数、支架总长度在两组间有统计学意义（p＜0.05）。计算RC四分位间距，根据四分位间距分为四组（Q1-Q4），四组间ISR的发病率分别为20%、14.8%、22%、40.7%，有统计学意义（p＜0.05）；进一步采用Spearman相关分析发现，RC与ISR存在相关，相关系数为0.179，p＜0.05；受试者工作曲线（ROC）分析表明，RC的ROC为0.636（95%CI 0.572~0.697，p＜0.05）。通过计算约登指数，得出RC的最佳阶段点为0.47mmol/L，对应的灵敏度和特异度分别为51.72%，75.14%；二分类logistic回归分析：年龄、吸烟、多支病变、支架总长度以及RC＞0.47mmol/L是ISR的危险因素（p＜0.05），其中RC＞0.47mmol/L的患者发生ISR的风险是≤0.47mmol/L的患者的3.416倍（p=0.003）。结论：在LDL-C达标的PCI术后的冠心病患者中，RC与ISR存在相关性，且RC是PCI术后发生ISR的独立危险因素。

Correlation between residual cholesterol and in-stent restenosis in coronary heart disease with LDL-C compliance after PCI

Objective To investigate the risk factors of in-stent restenosis (ISR) and its correlation with residual cholesterol (RC) in coronary heart disease (CHD) with LDL-C compliance after PCI. Methods A total of 239 patients with coronary heart disease hospitalized in the Department of Cardiology, Yixing People''s Hospital from January 2015 to October 2022 were recruited. All patients had a previous stent placement and coronary angiography will be reviewed in this hospitalization. Fasting blood routine and biochemical indicators were tested. According to the results of coronary angiography during hospitalization, they were divided into ISR group and non ISR group. IBM SPSS Statistics 16.0 software was used to be tested. According to different data types, t-test, Mann-whitney test, or Kruskal-Wallis rank sum test were used; The Spearman correlation analysis method was used for correlation analysis; Receiver operating characteristic(ROC) curve to determine the optimal cutoff value of RC;Multivariate dichotomous logistic regression was used to analyze the relevant risk factors for ISR. Results The comparison of general data between the two groups showed that there were no significant differences between non ISR and ISR groups in gender, hypertension, stent implantation time, TG, HDL-C, LDL-C, Lp-a (p>0.01), but there were significant differences between the two groups in age, diabetes, smoking, TC, RC, multi vessel lesions, number of stents, and total length of stents (p<0.05). Calculate the RC interquartile spacing and divide it into four groups (Q1-Q4) based on the interquartile spacing. Statistical analysis showed that the incidence rate of ISR among the four groups was 20%, 14.8%, 22% and 40.7%, respectively, with statistical significance (p<0.05); Further using Spearman correlation analysis, it was found that there was a correlation between RC and ISR, with a correlation coefficient of 0.179, p<0.05; The ROC of RC was 0.636 (95% CI 0.572 to 0.697, p<0.05). By calculating the Joden index, it is found that the optimal stage point for RC is 0.47 mmol/L, with corresponding sensitivity and specificity of 51.72% and 75.14%, respectively; Two-class logistic regression analysis: Age, smoking, multiple vessel lesions, total stent length, and RC were risk factors for ISR (p<0.05). Patients with RC higher than 0.47 mmol/L were 3.416 times more likely to develop ISR than those with RC lower than 0.47 mmol/L (p=0.003). Conclusion There is a correlation between RC and ISR in CHD with LDL-C compliance after PCI, and RC is an independent risk factor for the occurrence of ISR after PCI.