体外循环与非体外循环下冠状动脉旁路移植术对血脂和载脂蛋白的影响

Comparative studies of the blood lipids and apolipoproteins A_1 and B in patients underwent coronary artery bypass grafting under on-pump and off-pump bypass

目的对比研究常规体外循环冠状动脉旁路移植术(CCABG)和非体外循环冠状动脉旁路移植术(OPCAB)对血脂和载脂蛋白水平影响。方法分析79例冠状动脉旁路移植术(CABG)术前、术后24 h、72 h、7d、10 d、14 d、28 d血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和载脂蛋白A和B(ApoA1和ApoB)水平,测试期间未服用调脂药物。结果(1)CCABG组41例和OPCAB组38例,两组之间无明显差别,术后两组TC、LDL-C在24 h、72 h、7 d、10 d、14 d明显下降(P<0．001),其中术后24 h达最低值,以后各时段逐渐升高但仍低于术前(P<0．001),28 d超过术前基线水平(P<0．05);(2)TG、HDL-C术后24 h达最低值(P< 0．001),72 h、7 d、10 d、14 d与术前无明显差别(P>0．05),TG 28 d超过术前基线水平(P<0．05); (3)两种手术ApoAl术后24 h达最低值(0．82 mmol/L±0．28 mmol/L,0．81 mmol/L±0．24 mmol/L),以后各时段逐渐升高但仍低于术前(1．16 mmol/L±0．26 mmol/L,0．96 mmol/L±0．25 mmol/L,P< 0．001),28 d回升术前水平(1．12 mmol/L±0．32 mmol/L,0．92 mmol/L±0．29 mmol/L,P>0．05), ApoB两组术后24 h达最低值(0．47 mmol/L±0．15 mmol/L,0．59 mmol/L±0．36 mmol／L),以后各时段与术前差异无统计学意义(P>0．05)。结论两种术式对血脂、载脂蛋白代谢均有明显影响,术后宜尽早降脂治疗。

Objective To compare the influences of coronary artery bypass grafting under on-pump （CCABG） and off-pump bypass （OPCAB） on blood lipids and Apolipoproteins A1 and B. Methods 41 patients underwent CCABG and 38 patients OPCAB . the serum levels of total cholesterol（ TC）, triglycerides （TG）, HDL-C cholesterol （HDL-C）, LDL-C cholesterol （LDL-C） and Apolipoproteins A1 and B were monitored before and 24 h, 72 h, 7 d, 10 d, 14 d, 28 d after operation in all patients. None of them received lipid-lowering drug during the test. Results （ 1 ） There were no difference between two groups, the serum levels of TC,LDL-C decreased significantly in 24 h, 72 h, 7d, 10 d, 14 d after operation（P 〈 0. 001）. the level in 24 h was the lowest, then began increasing; until 28 days after operation the serum levels of TC ,LDL-C exceeded preoperative baseline level （ P 〈 0. 05 ）. （ 2 ） the level of TG and HDL-C in 24 h was the lowest（ P 〈 0. 001 ）, then began increasing（ P 〉 0. 05 ）. until 28 days after operation the serum levels of TG exceeded preoperative baseline level （ P 〈 0. 05 ）. （ 3 ） the serum levels of ApoA1 decreased significantly in 24 h, 72 h, 7 day, 10 day, 14 day after operation（P 〈0. 001 ）. the level in 24 h was the lowest, and lasted until 28 days after operation （ P 〉 0. 05 ） ; the serum levels of ApoB in 24 h was the lowest, then began increasing （ P 〉 0. 05 ）. Conclusions There presents significant influence on blood lipids and Apolipoproteins A1 and B after CABG, and initiate lipid（s） -lowering therapy as soon as possible.