小而密低密度脂蛋白胆固醇与冠心病患者PCI术后围术期心肌损伤研究

摘要] 目的 探讨小而密低密度脂蛋白胆固醇（sdLDL-C）与冠心病患者经皮冠状动脉介入治疗（PCI）围术期心肌损伤（PMI）的相关性及其预测价值。 方法 选取2021年1月至2022年6月在江苏大学附属宜兴医院行择期PCI治疗的冠心病患者141例，包括98例心绞痛和43例急性心肌梗死；以及同期非冠心病66例。收集临床基线资料及术中冠脉病变情况，常规检测术前血脂以及术前术后肌钙蛋白I（cTnI）等指标。接受PCI治疗的患者根据术后cTnI是否升高分为观察组（cTnI升高，n=86）和对照组（cTnI正常，n=55），对比两组间各项指标的差异。比较非冠心病，心绞痛，急性心肌梗死三组间sdLDL-C水平的差异。 结果 观察组sdLDL-C、总胆固醇(TC)、低密度脂蛋白胆固醇（LDL-C）、植入支架数、支架总长度均高于对照组，差异有统计学意义（P<0.05）。运用Logistic回归分析显示，sdLDL-C(OR=14.798，95%CI=1.112-196.904)，LDL-C(OR=3.074，95%CI=1.138-8.302)是冠心病患者PCI术后PMI的独立危险因素，P<0.05。sdLDL-C在受试者工作特征曲线（ROC）下面积是0.727（95%CI=0.637-0.817，P<0.05）,最佳截断值为0.518mmol/L，诊断PMI灵敏度为86%，特异度为56.4%，约登指数0.424。非冠心病、心绞痛、急性心肌梗死三组的sdLDL-C分别是 (0.541?0.144)， (0.621?0.257)，( 0.776?0.289)mmol/L，两两比较差异有统计学意义，呈显著上升趋势，P<0.05。 结论 术前高水平sdLDL-C是冠心病患者PCI术后围术期心肌损伤的危险因素；sdLDL-C与疾病严重程度呈正相关。

Correlation between small and dense low density lipoprotein cholesterol and perioperative myocardial injury in patients with coronary heart disease after PCI

Abstract] Objective To investigate the relationship between small and dense low density lipoprotein cholesterol (sdLDL-C) and perioperative myocardial injury (PMI) in patients with coronary heart disease after PCI, and to discuss the predictive value of sdLDL-C for PMI. Methods A total of 141 patients with CHD, including the angina group (n=98) and the acute myocardial infarction group (n=43), who were admitted to our hospital and received elective PCI during the period from January 2021 to June 2022, were retrospectively collected as the research subjects. And 66 cases of non-CHD were collected during the same time. The clinical baseline data and the distribution pattern of coronary lesions were collected. The preoperative serological examination such as lipid index, preoperative and postoperative cardiac tropomom I (cTnI) were routinely tested. According to the postoperative cTnI value, the PCI patients were divided into the observation group with elevated cTnI level (n=86) and the control group with normal cTnI level (n=55). All the collected parameters were analyzed between the two groups. The differences in sdLDL-C levels between each other among the non-CHD group, angina group and acute myocardial infarction group were analyzed. Results The sdLDL-C, TC, LDL-C, numbers of implanted stents, total length of the stents in the observation group were significant higher than those in the control group(P<0.05). The logistic regression analysis revealed that sdLDL-C(OR=14.798, 95%CI=1.112-196.904), LDL-C(OR=3.074, 95%CI=1.138-8.302) were the independent risk factors of PMI(P<0.05). The area under ROC curve of sdLDL-C was 0.727(95%CI=0.637-0.817, P<0.05), the best cut-off point was 0.518mmol/L, and the sensitivity and specificity for the diagnosis of PMI were 86% and 56.4%, respectively. And the Youden index was 0.424. The level of sdLDL-C in the non-CHD group, angina group and acute myocardial infarction group was (0.541?0.144), (0.621?0.257) and (0.776?0.289)mmol/L, respectively, with significant differences among the three group (P<0.05). And there was a significant upward trend among the three groups in the level of sdLDL-C (P<0.05). Conclusions The preoperative high level of sdLDL-C is a risk factor of PMI after PCI in the patients with CHD. And sdLDL-C has a positive relationship with the severity of disease.