非高密度脂蛋白胆固醇对冠状动脉病变的影响

目的 通过回顾性研究探讨不同血脂指标的控制对冠状动脉粥样硬化病变加重的影响.方法 入选在我院成功行支架植入术并于3个月后至1年内回院复查冠状动脉造影的患者,复查时间平均为7.4 ±2.2个月.未行介入治疗的其它冠状动脉若发生狭窄加重大于原来的25%以上定为粥样硬化病变加重.发生冠状动脉粥样硬化病变加重者95例,无变化者307例.患者于入院即介入手术前及复查冠状动脉造影前均测定了血清总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇,非高密度脂蛋白胆固醇应用公式(总胆固醇-高密度脂蛋白胆固醇)计算.结果 复查时病变加重组和无变化组总胆固醇(4.62±1.14 mmol/L比4.26±1.01 mmol/L)、低密度脂蛋白胆固醇(2.51±0.93 mmol/L比2.25±0.75 mmol/L)及非高密度脂蛋白胆固醇水平(3.52±1.12mmoL/L比3.20±0.98 mmol/L),三者差异均有显著性(P<0.05),应用Logistic多因素分析显示均与病变加重发生 相关.结论 总胆固醇、低密度脂蛋白胆目醇及非高密度脂蛋白胆固醇水平是未行介入治疗的其它冠状动脉粥样硬化病变加重的重要危险因素,应重视冠心病患者非高密度脂蛋白胆固醇水平的有效控制.

Effect of Non High Density Lipoprotein Cholesterol Levels on Coronary Lesion Progression

Aim To assess effect of different lipid levels on coronary lesion progression. Methods Patients were studied who successfully underwent PCI and were received coronary angiography again after three months to one year(average 7.4±2.2 months).95 patients had coronary lesion progression. 307 cases had no restenosis and lesion progression.Total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDLC) and low density lipoprotein-cholesterol(LDLC) were determined before perscutaneous coronary intervention(PCI) and re-angiography.Non high density lipoprotein-cholesterol(non-HDLC)=TC-HDLC. Results The levels of TC,LDLC and non-HDLC with follow-up angiography in lesion progression group were higher than those in control group(TC: 4.62±1.14 mmol/L vs 4.26±1.01 mmol/L,LDLC: 2.51±0.93 mmol/L vs 2.25±0.75 mmol/L,non-HDLC: 3.52±1.12 mmol/L vs 3.20±0.98 mmol/L,respectively,P><0.05).Logistic regression showed that the risk of lesion progression was markedly associated with concentrations of TC,LDLC and non-HDLC. Conclusion The levels of TC,LDLC and non-HDLC are the important risk factors for coronary lesion progression.Secondary prevention should be long-term emphasized and strengthened and non HDLC level should be controlled for patients with coronary artery disease.