氧化低密度脂蛋白和C反应蛋白与冠状动脉支架置入术后再狭窄的关系研究

doi:10.3969/j.issn.1673-8640.2015.05.018

摘要/Abstract

摘要： 目的探讨氧化低密度脂蛋白(ox-LDL)、C反应蛋白(CRP)对经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的预测价值。方法选择行PCI术并于术后6个月内接受冠状动脉造影复查的患者186例,其中术后发生ISR(ISR组)22例,无ISR发生(非ISR组)164例。检测两组PCI术前和术后血清ox-LDL、CRP水平。结果 ISR组和非ISR组年龄、性别构成、合并症、血脂水平、血管病变情况等一般资料差异均无统计学意义(P>0.05)。ISR组PCI术后ox-LDL、CRP水平明显高于术前(P<0.05),而非ISR组PCI术前和术后ox-LDL、CRP水平无明显改变(P>0.05)。ISR组术前、术后ox-LDL水平均高于非ISR组(P<0.05);术前2组CRP水平差异无统计学意义(P>0.05),术后ISR组明显高于非ISR组(P<0.05)。相关分析显示ISR组、非ISR组无论是PCI术前还是PCI术后,ox-LDL与CRP均呈正相关[ISR组:术前、术后r值(P值)分别为0.392(0.020)、0.431(0.010);非ISR组:术前、术后r值(P值)分别为0.382(0.024)、0.526(0.001)];Logistic回归分析显示术后ox-LDL[优势比(OR)=1.27,95%可信区间(CI):1.05~1.79]和术前CRP水平(OR=1.82,95%CI:1.68~2.30)是ISR的独立危险因子。结论 PCI术后ox-LDL和术前CRP水平升高对预测ISR发生有一定的临床价值。

关键词: 氧化低密度脂蛋白, C反应蛋白, 经皮冠状动脉介入, 再狭窄

Abstract: Objective To investigate the predictive significance of oxidized low-density lipoproteins(ox-LDL) and C reactive protein(CRP)for in-stent restenosis(ISR)after percutaneous coronary intervention(PCI). Methods A total of 186 patients who were given PCI and followed up for 6 months were enrolled. Of them, 22 patients had ISR(ISR group), while the other 164 patients had not ISR(no-ISR group). The pre- and post-PCI serum ox-LDL and CRP were detected. Results There was no statistical significance between the 2 groups in terms of age, sex, morbidity, serum lipid and vessel lesion(P>0.05). Serum ox-LDL and CRP increased significantly in ISR group at post-PCI compared with pre-PCI (P<0.05), while there was no significant change in no-ISR group (P>0.05). Serum ox-LDL were also higher in ISR group compared with no-ISR group at pre- and post-PCI(P<0.05). There was no statistical significance for CRP level between the 2 groups at pre-PCI (P>0.05). However, the significant increase of CRP level in ISR group compared with no-ISR group was present at post-PCI(P<0.05). Correlation analysis revealed that there was positive correlation between pre- and post-PCI for serum ox-LDL and CRP in both ISR and no-ISR groups [ISR group: r(P) values of pre- and post-PCI were 0.392(0.020) and 0.431(0.010); no-ISR group: r(P) values of pre- and post-PCI were 0.382(0.024) and 0.526(0.001)]. The Logistic regression analysis showed that post-PCI ox-LDL[odds ratio (OR)=1.27, 95% confidence interval(CI): 1.05-1.79]and pre-PCI CRP(OR=1.82,95%CI:1.68-2.30)were independent risk factors of ISR. Conclusions Post-PCI ox-LDL and pre-PCI CRP have certain significance in the prediction of ISR.

Key words: Oxidized low-density lipoprotein, C reactive protein, Percutaneous coronary intervention, In-stent restenosis

中图分类号:

R446.1

何文军, 黄家平, 梁伟东, 莫翔, 梁少华. 氧化低密度脂蛋白和C反应蛋白与冠状动脉支架置入术后再狭窄的关系研究[J]. 检验医学, 2015, 30(5): 484-488.

HE Wenjun, HUANG Jiaping, LIANG Weidong, MO Xiang, LIANG Shaohua. Relationships of oxidized low-density lipoproteins and C reactive protein with in-stent restenosis after PCI[J]. Laboratory Medicine, 2015, 30(5): 484-488.

图/表 3

参考文献 16

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组别	例数	性别(男/女)	年龄	糖尿病(例)	吸烟(例)	高血压病(例)
ISR组	22	15/7	68.3±9.6	9	5	17
非ISR组	164	128/36	65.8±10.2	28	32	122
统计量		t=1.086	χ²=1.062	t=5.501	t=0.004	t=0.085
P值		0.278	0.302	0.019	0.943	0.770
组别	例数	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)	血管狭窄长度(mm)
ISR组	22	5.4±0.3	2.5±0.8	1.2±0.4	3.3±0.7	20.4±2.3
非ISR组	164	5.3±0.2	2.3±0.9	1.1±0.3	3.2±0.6	16.8±1.5
统计量		t=2.060	t=0.990	t=1.407	t=0.719	t=9.838
P值		0.413	0.323	0.161	0.472	<0.01
组别	例数	最小管径(mm)	参考段血管径(mm)	病变部位(例)
组别	例数	最小管径(mm)	参考段血管径(mm)	前降支	右冠状动脉	回旋支
ISR组	22	0.6±0.2	3.3±0.8	11	5	6
非ISR组	164	0.6±0.3	3.2±0.7	87	46	31
统计量		t=0.000	t=0.558		χ²=0.918
P值		1.000	0.577		0.632

组别	例数	性别(男/女)	年龄	糖尿病(例)	吸烟(例)	高血压病(例)
ISR组	22	15/7	68.3±9.6	9	5	17
非ISR组	164	128/36	65.8±10.2	28	32	122
统计量		t=1.086	χ²=1.062	t=5.501	t=0.004	t=0.085
P值		0.278	0.302	0.019	0.943	0.770
组别	例数	TC(mmol/L)	TG(mmol/L)	HDL-C(mmol/L)	LDL-C(mmol/L)	血管狭窄长度(mm)
ISR组	22	5.4±0.3	2.5±0.8	1.2±0.4	3.3±0.7	20.4±2.3
非ISR组	164	5.3±0.2	2.3±0.9	1.1±0.3	3.2±0.6	16.8±1.5
统计量		t=2.060	t=0.990	t=1.407	t=0.719	t=9.838
P值		0.413	0.323	0.161	0.472	<0.01
组别	例数	最小管径(mm)	参考段血管径(mm)	病变部位(例)
组别	例数	最小管径(mm)	参考段血管径(mm)	前降支	右冠状动脉	回旋支
ISR组	22	0.6±0.2	3.3±0.8	11	5	6
非ISR组	164	0.6±0.3	3.2±0.7	87	46	31
统计量		t=0.000	t=0.558		χ²=0.918
P值		1.000	0.577		0.632

组别	例数	术前		术后
组别	例数	ox-LDL(μg/L)	CRP(mg/L)	ox-LDL(μg/L)	CRP(mg/L)
ISR组	22	623.7±151.2	3.4±1.3	810.9±188.7^*	4.4±1.2^*
非ISR组	164	534.5±133.6^#	3.0±0.9	522.6±104.7^#	3.1±1.0^#

组别	例数	术前		术后
组别	例数	ox-LDL(μg/L)	CRP(mg/L)	ox-LDL(μg/L)	CRP(mg/L)
ISR组	22	623.7±151.2	3.4±1.3	810.9±188.7^*	4.4±1.2^*
非ISR组	164	534.5±133.6^#	3.0±0.9	522.6±104.7^#	3.1±1.0^#

项目	OR值	95%可信区间	P值
糖尿病	0.51	0.16~1.62	0.254
狭窄血管长度	0.23	0.06~0.83	0.025
术前ox-LDL	1.32	0.42~4.15	0.630
术后ox-LDL	1.27	1.05~1.79	0.020
术前CRP	1.82	1.68~2.30	0.043
术后CRP	0.96	0.32~2.82	0.936