上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

冠状动脉介入术后血清低密度脂蛋白胆固醇水平与预后的关系

毕春辉，魏盟，沈虹，马士新   

  1. 上海交通大学附属第六人民医院心内科， 上海 200233
  • 出版日期:2015-06-28 发布日期:2015-07-30
  • 通讯作者: 魏盟, 电子信箱: mrweei@medmail.com.cn。
  • 作者简介:毕春辉（1976—）， 女， 主治医师， 硕士; 电子信箱: beechunhui@163.com。

Relationship between serum low-density lipoprotein cholesterol level and prognosis of patients undergoing percutaneous coronary intervention

BI Chun-hui, WEI Meng, SHEN Hong, MA Shi-xin   

  1. Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2015-06-28 Published:2015-07-30

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摘要：

目的 研究经皮冠状动脉介入术（PCI）治疗的冠状动脉粥样硬化性心脏病(简称冠心病)患者血清低密度脂蛋白胆固醇（LDL-C）与预后的关系。方法 收集492例冠心病患者临床资料及PCI术后1 d及1、6、12 和24个月5个时间节点的LDL-C数据，在每一时间节点按照LDL-C＜1.81、1.81~2.58、2.59~3.36和≥3.37 mmol/L（＜70、70~99、100~129 和≥130 mg/dL）标准将患者分组，分析随访期间终点事件（包括心源性死亡、再发心肌梗死、靶血管再次血运重建、再发心绞痛、新发或原有心力衰竭加重和脑卒中等再次入院）发生情况与LDL-C的关系。结果 患者在术后1 d及1、6、12和24个月时血清LDL-C均值分别为（3.07±1.05）、（2.03±0.75）、（2.06±0.71）、（2.13±0.82）和（2.17±0.89）mmol/L。术后12和24个月时不同LDL-C水平分组患者间终点事件发生率差异有统计学意义（P<0.01）。Logistic回归分析结果显示，年龄、糖尿病、脑卒中史、术后12及24个月LDL-C水平为终点事件发生的独立预测因素；相对于LDL-C＜1.81 mmol/L患者，PCI术后12和24个月时LDL-C水平在2.59~3.36和≥3.37 mmol/L患者发生终点事件的危险度更大。结论 年龄较高者、有糖尿病及脑卒中史患者PCI术后发生心脑血管事件的风险较高。相对于LDL-C＜1.81 mmol/L患者，术后12和24个月血清LDL-C＞2.59 mmol/L者心脑血管事件的危险度更高。

关键词: 冠状动脉粥样硬化性心脏病, 经皮冠状动脉介入术, 低密度脂蛋白胆固醇, 预后

Abstract:

Objective To explore the relationship between serum low-density lipoprotein cholesterol (LDL-C) and prognosis of patients with coronary atherosclerotic heart disease (CHD) who undergo the percutaneous coronary intervention (PCI). Methods Clinical data and LDL-C levels of 492 patients with CHD 1 d and 1, 6, 12, and 24 months after PCI were collected. Patients were divided into groups according to LDL-C levels (＜1.81, 1.81-2.58, 2.59-3.36, and ≥3.37mmol/L or ＜70, 70~99, 100~129, and ≥130 mg/dL) at each time point. The relationship between end-point events (include cardiac death, recurrence of myocardial infarction, revascularization of target blood vessel, recurrence of angina, recently developed heart failure or existing heart failure becoming severe, and stroke, etc) during follow-up period and LDL-C levels were analyzed. Results The mean levels of LDL-C of patients 1 d and 1, 6, 12, and 24 months after PCI were (3.07±1.05), (2.03±0.75), (2.06±0.71), (2.13±0.82), and (2.17±0.89)mmol/L, respectively. The differences of incidence of end-point events of patients with different LDL-C levels 12 and 24 months after PCI were statistically significant (P<0.01). Results of logistic regression analysis showed that age, diabetes, stroke, LDL-C levels 12 and 24 months after PCI were independent predicting factors of the incidence of end-point events. Compared with patients whose LDL-C levels were below 1.81 mmol/L, the risk of developing end-point events of patients whose LDL-C levels were between 2.59-3.36 and above 3.37 mmol/L 12 and 24 months after PCI was higher. Conclusion The risk of developing cardio-cerebrovascular events of old patients or patients with diabetes or stroke after PCI is high. Compared with patients whose LDL-C levels are below 1.81 mmol/L, the risk of developing cardio-cerebrovascular events of patients whose LDL-C levels are above 2.59 mmol/L 12 and 24 months after PCI is higher.

Key words: coronary atherosclerotic heart disease, percutaneous coronary intervention, low-density lipoprotein cholesterol, prognosis