脂蛋白(a)水平对冠心病患者药物洗脱支架植入术后支架内再狭窄及非靶病变的影响

Effect of Lp(a) on in-stent restenosis and non-target coronary lesions in CAD patients with drug-eluting stents

目的研究血清脂蛋白(a)[Lp(a)]水平与用药物洗脱支架行经皮冠状动脉介入治疗(PCI)术后支架内再狭窄及冠状动脉非靶病变的关系。方法收集2013年1月-2017年1月在中山市人民医院心血管内科确诊为冠心病并首次行PCI、术后1~4年内复查冠脉造影或再次植入支架的患者174例,其中31例发生了支架内再狭窄(再狭窄组),143例未发生支架内再狭窄(无再狭窄组)。比较两组间的血脂及冠脉病变情况;以Lp(a)水平500 mg/L为界将174例患者分为高Lp(a)组(33例)和低Lp(a)组(141例),比较两组间的冠脉病变情况及非靶病变情况,并采用多因素logistic回归分析支架内再狭窄和非靶病变的危险因素。结果在植入药物洗脱支架的患者中,再狭窄组的Lp(a)水平高于无再狭窄组[(437.57±391.60)mg/L vs.(279.46±288.06)mg/L],差异有统计学意义(P=0.040);高Lp(a)组的三支血管病变和左主干+三支血管病变比例均明显高于低Lp(a)组(P=0.022)。Logistic回归分析结果显示,Lp(a)高水平和植入支架数量多是行药物洗脱支架术患者支架内再狭窄的独立危险因素。高Lp(a)组的非靶血管病变例数占比、非靶病变例数占比、支架内再狭窄率、最小管腔直径和支架内晚期管腔丢失均明显高于低Lp(a)组,差异有统计学意义(P<0.05);logistic回归分析显示,Lp(a)高水平是非靶病变的独立危险因素(P=0.001)。结论Lp(a)水平升高是支架内再狭窄以及非靶病变的独立危险因素,与冠心病再发及进展显著相关。

Objective To explore the effect of lipoprotein(a)[Lp(a)]on in-stent restenosis and non-target coronary lesions in coronary artery disease(CAD)patients implanted with drug-eluting stents.Methods One hundred and seventy-four patients,diagnosed as CAD and underwent percutaneous coronary intervention(PCI)with the implantation of drug-eluting stents(DES),were enrolled in present study;all of them were performed another elective PCI or revascularization within 1-4 years after their previous procedures.Thirty-one of enrolled patients were discovered to have in-stent restenosis.The relationship between Lp(a)and in-stent restenosis and the development of non-target coronary lesions were analyzed in groups stratified by the presence of in-stent stenosis or Lp(a)levels,and the independent risk factors of both in-stent restenosis and non-target lesions were also analyzed by multivariate logistic regression analysis.Results In CAD patients with DES,Lp(a)level in patients with in-stent restenosis showed a significant increase than those with the Lp(a)level non-restenosis[(437.57±391.60)mg vs.(279.46±288.06)mg,P=0.04].In following analysis comparing lipid profiles and coronary angiography results between low and high Lp(a)groups,the percentage of triple-vessel disease and left main plus triple-vessel disease appeared to be statistically higher in high Lp(a)group than those in low Lp(a)group(P=0.022).Multivariate logistic regression analysis revealed that high level of Lp(a)and much number of stents implanted were the independent risk factors for in-stent restenosis of DES.In comparing the characteristics of coronary angiography and results of quantitative coronary angiography,number of cases with not-target vessel lesions,number of cases with non-target lesions,presence of in-stent restenosis,minimal lumen diameter and in-stent late lumen loss were all significantly higher in high Lp(a)group than those in low Lp(a)group(P<0.05),and high level of Lp(a)was again proved to be an independent risk factor for non-target lesions in patients with DES(P=0.001).Conclusion Elevated Lp(a)level is an independent risk factor for both instent restenosis and the development of non-target coronary lesions,and is closely related to the relapse and aggravation of coronary artery disease.