脂蛋白a对冠状动脉植入支架术后非罪犯病变进展的影响

Study on the relationship between Lp(a)and progression of non-culprit coronary lessions after stent implantation in culprit lessions

目的观察脂蛋白a[lipoprotein a,Lp(a)]对冠状动脉植入支架术后患者非罪犯病变进展的影响。方法序贯入选行冠状动脉植入支架术后6个月行冠状动脉造影检查的患者296例。根据非罪犯病变的进展情况将所有患者分为进展组(n=46,15.5%)和非进展组(n=250,84.5%)。首先采用单因素分析筛选2组患者中存在显著差异的因素,再采用Logistic回归分析上述因素是否为冠状动脉植入支架术后非罪犯病变进展的独立危险因素。结果单因素分析显示2组患者糖尿病患病率、心脏射血分数、多支病变、Lp(a)、低密度脂蛋白胆固醇降低幅度差异有统计学意义(P<0.05)。进展组的Lp(a)显著高于非进展组(P<0.05),进展组的低密度脂蛋白胆固醇降低幅度与心脏射血分数均低于非进展组(P<0.01)。进展组的糖尿病患者及多支病变患者的比例显著高于非进展组(P<0.05)。以有无非罪犯病变进展为因变量进行多因素Logistic回归分析。结果显示Lp(a)≥300 mg/L、有糖尿病、多支病变、左心室射血分数<50%、6个月低密度脂蛋白胆固醇降低幅度<0.616 mmol/L是非罪犯病变进展的危险因素。结论Lp(a)升高是冠状动脉植入支架术后患者非罪犯病变进展的危险因素。

Objective To observe the relationship between lipoprotein a[Lp(a)]and the progression of non-culprit coronary lessions after successful stent implantation in culprit lessions.Methods In total,296 patients who underwent coronary angiograms angain with a time interval from 6 to 12 months after successful stent implantation at culprit lessions were enrolled in our center.The patients were divided into progression group(n=46,15.5%)and non-progression group(n=250,84.5%).First,single factor analysis was used to select factors with significant differences between two groups of patients,and then Logistic regression was used to analyze whether the above factors were independent risk factors for non-criminal disease progression after coronary stent implantation.Results Single factor analysis showed the prevalence of diabetes,cardiac ejection fraction,multi-vessel disease,Lp(a),and low-density lipoprotein cholesterol between two group were statistically significant(P<0.05).In univariate analysis,patients of progression group showed higher levels of Lp(a),higher incidence of multivessel diseases,higher incidence of diabetes,Less reduce of LDL,lower ejection fraction(EF).On multivariate logistic regression analysis,independent predictors of the progression of nonculprit coronary lesions included Lp(a)increase(≥300 mg/L),multivessel diseases,diabetes,less reduce of LDL(<0.616 mmol/L),lower EF(<50%).Conclusion Lp(a)increase(≥300 mg/L)is an independent risk factor for the progression of non-culprit coronary lessions after successful stent implantation in culprit lessions.