作者：杨全明，郭文怡

单位：

710032 陕西省西安市，空军军医大学第一附属医院心内科；通信作者：郭文怡，E-mail：guowenyi@tom.com

关键词：

冠心病；冠状动脉非靶血管病变；经皮冠状动脉介入治疗；血脂指标；非高密度脂蛋白胆固醇；总胆固醇；高密度脂蛋白胆固醇

Keywords：

Coronary heart disease；Non-target lesions of coronary artery；Percutaneous coronary intervention；Blood lipid indexes；Non-high density lipoprotein cholesterol；Total cholesterol；High density lipoprotein cholesterol

CLC：

R 541.4

DOI：

DOI：10.3969/j.issn.1008-5971.2020.05.004

Funds：

摘要：

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。

Abstract：

Background　Although percutaneous coronary intervention（PCI） has a significant effect in thetreatment of coronary heart disease（CHD），there are still problems with stent restenosis in target vessels and progression ofnon-target vessel lesions.Objective　To discuss the relationship between dynamic changes of blood lipid indexes and progressionof non-target vascular lesions in patients with CHD after elective PCI.Methods　From January 2017 to May 2019，150 patientswith CHD who were admitted for the second time after elective PCI in the Department of Cardiology，the First Affiliated Hospitalof Air Force Military Medical University were selected，and they were divided into progression group（n=45） and non-progression group（n=105） according to the progression of non-target vascular lesions.Gender，age，nationality（includingHui and Han nationality），smoking，past history（including hypertension，diabetes），family history of CHD，body massindex （BMI），follow-up time and syntax score，blood lipid indexes of the 1st and 2nd 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 regressionanalysis was used to analyse the influencing factors of non-target vascular lesions progression in patients with CHD after electivePCI.ROC curve was drawn to evaluate the predictive value of non-HDL-C on the progression of non-target vascular lesions inpatients with CHD after elective PCI.Results　Female ratio，incidence of diabetes and syntax score in progression group werehigher than those in non-progression group，TC，TG，non-HDL-C of 1st admission in progression group were lower than thosein non-progression group，the differences of TC，TG，LDL-C，non-HDL-C，TG/HDL-C，non-HDL-C/HDL-C betweentwo admissions in progression group were higher than those in non-progressive group（P<0.05）.Multivariate Logistic regressionanalysis 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 afterelective PCI（P<0.05）.ROC curve analysis showed that，there was no significant difference in the AUC between the dynamicchanges of non-HDL-C and TG/HDL-C in predicting the progression of non-target vascular lesions progression in patientswith CHD after elective PCI（P>0.05）.Conclusion　The dynamic changes of non-HDL-C and TG/HDL-C are independentrisk factors of non-target vascular lesions progression in patients with CHD after elective PCI，and they have a certain value inpredicting the progression of non-target vascular lesions.

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