急性冠状动脉综合征患者经皮冠状动脉介入治疗术后血浆游离脂肪酸水平对于主要不良心血管事件的影响

The effect of plasma free fatty acid levels on major adverse cardiovascular events in patients with acute coronary syndrome undergoing percutaneous coronary intervention

目的:本研究旨在探究急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后的血浆游离脂肪酸(FFA)水平与不良心血管事件的关系。方法:回顾性分析2016年1月至2018年12月在黄石市第四医院和黄石市爱康医院因ACS住院且住院期间接受PCI治疗的患者,按照入院血浆FFA水平三分位数将患者分成三组,比较三组患者主要不良心血管事件(MACE)发生风险。结果:1290例患者被纳入最终的数据分析,入选患者平均年龄为(60.1±10.2)岁,平均BMI(25.9±3.2)kg/m^(2),在PCI术后的平均(17.3±2.8)个月内共发生70例(5.4%)MACE事件。多因素Cox比例风险回归分析结果显示在调整相关危险因素后FFA每增加一个单位,患者MACE事件的发生风险增加了约3倍(HR=4.26,95%CI:2.03~8.96,P<0.001)。将FFA三分位数分组纳入多因素分析发现,相比较于FFA的第1三分位数组患者,第3三分位数组患者MACE事件的风险显著增加约2倍(中FFA组vs.低FFA组:HR=1.73,95%CI:0.82~3.62,P=0.100;高FFA组vs.低FFA组:HR=3.07,95%CI:1.56~6.07,P=0.001;P for trend=0.003)。亚组分析中在超重即BMI≥24 kg/m^(2)患者中显示出FFA与不良心血管事件的风险显著密切相关,但是在BMI<24 kg/m^(2)的患者中并没有出现相似的结果(P=0.079;交互作用检验P值=0.703)。结论:PCI治疗术后的ACS患者血浆FFA水平升高与MACE发生风险增加密切相关,这提示我们监测ACS患者经PCI治疗术后的FFA水平可能使患者获益,为临床医师处方更强效的降脂治疗提供依据。

Objective:To explore the relationship between plasma free fatty acid(FFA)levels and adverse cardiovascular events in patients with acute coronary syndrome(ACS)undergoing percutaneous translu-minal coronary intervention(PCI).Methods:We enrolled 1290 ACS patients underwent PCI from January 2016 to December 2018.Patients were divided into three groups according to the tertiles of plasma FFA level.The three groups of patients were compared by the risk of major adverse cardiovascular event(MACE).Re-sults:The average age of the enrolled patients was(60.1±10.26)years,and the average BMI was(25.9±3.24)kg/m^(2).A total of 70(5.4%)MACEs occurred within 18 months after PCI.The multivariate Cox propor-tional hazard regression analysis showed that,the risk of MACEs increased by about 3 times for every unit in-crease in FFA after adjusting for relevant risk factors(HR=4.26,95%CI:2.03-8.96,P<0.001).When pa-tients was stratified by tertiles of FFA,the risk of MACE events in the third tertile group was significantly in-creased by approximately 2 times compared with patients in the first tertile group(T2 vs.T1:HR=1.73,95%CI:0.82-3.62,P=0.100;T3 vs.T1:HR=3.07,95%CI:1.56-6.07,P=0.001;P for trend=0.003).In sub-group analysis,similar result were obtained in overweight patients with BMI≥24 kg/m^(2).However no similar re-sult were found in patients with BMI<24 kg/m^(2)(P=0.079).Conclusions:Increased plasma FFA level in ACS patients undergoing PCI was associated with the higher risk of MACEs.