血浆高密度脂蛋白胆固醇水平对冠脉介入治疗术后1年不良事件的预测价值

Usefulness of Serum High-Density Lipoprotein Cholesterol Level as a Predictor of One-year Adverse Events after Percutaneous Coronary Interventions

目的:探讨冠脉介入治疗(PCI)术后1年不良心血管事件与高密度脂蛋白胆固醇(HDL-C)水平变化的关系。方法:本研究收集2009年1月至2010年1月我科收治的435例冠心病且接受PCI治疗患者的一般资料、PCI术后1年随访临床终点,按HDL-C水平分为三组:HDL-C>1.55 mmol/L,HDL-C 1.04-1.55 mmol/L,HDL-C<1.04/L,比较组间1年临床结果差异,并用多元回归方法分析PCI术后1年死亡的影响因素。结果:HDL-C水平的更低患者相对年轻(69.3±9.5 vs 65.5±9.2 vs 62.8±9.2,p=0.007),同时合并吸烟(14.5%vs 13.0%vs 24.6%,p=0.002)、糖尿病(23.4%vs 27.8%vs 36.6%,p=0.019)、LVEF<30%(2.4%vs 5.3%vs4.9%,p=0.020),接受急诊PCI比例更高(4.8%vs 6.5%vs 7.0%,p=0.034);且PCI术后1年死亡(2.4%vs 2.4%vs 6.3%,p=0.008)、再血管化(20.2%vs 21.9%vs 25.4%,p=0.022)、再次心源性入院(30.6%vs 32.0%vs 37.3%,p=0.013)、术后6m内心绞痛复发(20.2%vs 20.1%vs 22.5%,p=0.038)的比例均更高。结论:HDL-C<1.04 mmol/L是导致冠心病患者接受PC术后1年死亡的独立危险因素。

Objective： To analyze the relationship between One-Year Adverse Events After Percutaneous Coronary Interventions and Serum High-Density Lipoprotein Cholesterol Level. Methods： In a sample of 435 patients who underwent PCI, we evaluated 1-year mortality, acute myocardial infarction and repeat revascula- rization as a function of baseline HDL levels classified into approximate quartiles of HDL-C 〉1.55 mmol/1,HDL-C 1.04-1.55 retool/1 and HDL-C 〈1.04 mmol/1. Results： Decreasing levels of HDL cholesterol were associated with younger age （69.3＋ 9.5 vs 65.5：1：9.2 vs 62.8＋ 9.2, p=0.007）, smoking （14.5% vs 13.0% vs 24.6%, p--0.002）, diabetes mellitus （23.4% vs 27.8% vs 36.6%, p=0.019）, LVEF〈30% （2.4% vs 5.3% vs 4.9%, p=0.020） and emergent PCI （4.8% vs 6.5% vs 7.0%, p=0,034）. Furthermore, One-year mortality （2,4% vs 2.4% vs 6.3%,p=0.008）, coronary revascularization （20.2% vs 21.9% vs 25.4%,p=0.022）, readmission （30.6% vs 32.0% vs 37.3%,p=0.013） and repeated angina （20.2% vs 20.1% vs 22.5%,p=0.038）were significantly higher in the patients with decreased HDL-C level. Conclusion： In patients with coronary artery disease undergoing PCI, a baseline HDL-C 〈1.04 mmol/1 is an important prognostic indicator.