他汀类药物减少冠心病患者支架术后再狭窄的影响因素及意义

Statin Reduces In-stent Restenosis in Patients with Coronary Heart Disease; Influencing Factors and Implications

目的通过大样本的临床病历回顾性研究来进一步证实他汀类药物减少再狭窄的作用并阐明各种血脂指标水平的变化在其中的意义.方法对2002年7月至2003年12月行冠状动脉支架术并在术后3～6个月复查冠状动脉造影的948例患者的临床资料行回顾性分析.根据患者术后是否持续服用他汀类药物分为他汀组及对照组.所有患者均按常规方法行冠状动脉内支架植入术,再狭窄判定标准为原支架内管径狭窄≥50%.首次入院时及复查造影前1天空腹测定的血清甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、载脂蛋白A、载脂蛋白B及非高密度脂蛋白胆固醇行统计分析.结果他汀组及对照组再狭窄率分别为20.1%和26.3%(P<0.05).两组间甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和载脂蛋白A无显著差异(均P>0.05),而非高密度脂蛋白胆固醇(P<0.05)及载脂蛋白B(P<0.05)差异显著.Spearman等级相关分析发现再狭窄患者非高密度脂蛋白胆固醇水平的变化值与再狭窄程度明显相关(r=0.207,P<0.05).其余血脂指标水平变化与再狭窄程度间无相关关系(均P>0.05).应用多因素Logistic回归模型对非血脂类冠心病危险因素及随访时各项血脂指标与再狭窄之间的关系进行多因素分析,发现随访时所有血脂指标中只有非高密度脂蛋白胆固醇进入方程.结论冠状动脉支架术后持续服用他汀类药物可能会减少再狭窄的发生,这一作用可能与血清非高密度脂蛋白胆固醇的降低有关.

Aim To elucidate whether Statin can reduce in-stent restenosis （ISR） and what kind of role plasma lipid parameters plays during ISR process. Methods 948 patients who had undergone successful stent implantation were studied, and they all received angiograph 3-6 months after stenting procedures. Blood samples after ovemight fasting were collected one day before angiography for determination of serum lipids including cholesterol （TC）, triglyeerides （TG）, low density lipoprotein cholesterol （LDLC）, high density lipoprotein （HDL）, apolipoprotein A （apoA） and apolipoprotein B （apoB）. The non-HDL- Cequals the plasma total cholesterol concentration minus the HDLC concentration. Results Restenosis was significantly lower in the stafin group （20.13%） compared with the control group （26.28%） （ P = 0.037）. There was no significant differenoes of TC, TC, LDLC, HDLCand apoA concentrations （ all P 〉 0.05）between the two groups except the concentration of non-HDLC （ P = 0.049） and apoB （ P = 0. 035 ）. There was a significant association between the changes of plasma concentrations of nonHDLCand extent of ISR （ r = 0.207, P = 0.02）. Multiple logistic regression analysis reveals that non-I-IDLCwere only independent predictors of ISR among all follow up lipid parameters. Conclusions This study demonstrates that non-HDLCprobably plays an important role during ISR-redueing process by statius.