冠状动脉三支病变患者未干预病变进展的危险因素研究

Risk Factors of Progression of Untreated Lesions in Patients with 3-Vessel Coronary Disease

目的探讨影响冠状动脉三支病变患者未干预病变进展的危险因素。方法选择2009年1月—2012年6月在天津医科大学第二医院行冠状动脉造影术证实为冠状动脉三支病变且行经皮冠状动脉介入治疗(PCI)者108例,均于术后6～36个月复查冠状动脉造影。根据造影结果分为病变进展组(74例)和无变化组(34例)。两组患者均于PCI前及复查冠状动脉造影前空腹测定血清总胆固醇(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)、极低密度脂蛋白胆固醇(VLDL-C);非高密度脂蛋白胆固醇(non-HDL-C)应用公式计算。结果两组患者PCI前TC和non-HDL-C水平间差异均有统计学意义(P<0.05);两组患者复查冠状动脉造影前TC、LDL-C、VLDL-C、non-HDL-C水平间差异均有统计学意义(P<0.05)。Logistic多元回归分析显示,复查造影时的non-HDL-C水平、糖尿病病史及首次以急性心肌梗死入院进入回归方程(P<0.05)。结论 non-HDL-C、糖尿病病史、首次以急性心肌梗死入院是冠状动脉三支病变患者未干预病变进展的独立危险因素,应重视non-HDL-C的控制。

Objective To investigate the risk factors of progression of untreated lesions in patients with three-vessel coronary disease.Methods A total of 108 patients diagnosed by coronary angiography as 3-vessel coronary disease and given stent implantation and reexamination coronary arteriongraphy(CA) after 6~36 months from January 2009 to June 2012 were divided into groups A(n=74,with progression of lesions),B(n=34,without progression).Serum total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(LDL-C),low density lipoprotein cholesterol(LDL-C),very low density lipoprotein cholesterol(VLDL-C) were detected before PCI and reexamination.The formula was used to calculate non-HDL-C.Results There was significant difference in TC and non-HDL-C levels between 2 groups before PCI(P<0.05),and in TC,LDL-C,VLDL-C,non-HDL-C before CA reexamination(P<0.05).By Logistic regression analysis,the independent risk factors of lesion progression were non-HDL-C in CA reexamination,history of diabetes,first hospitalization due to acute myocardial infarction(AMI).Conclusion The level of non-HDL-C,history of diabetes and first hospitalization due to AMI are independent risk factors of untreated lesion progression in patients with 3-vessel coronary disease.Attention should be paid to the control of non-HDL-C.