血清sdLDL-C对冠心病PCI手术患者病情与预后评估的临床价值

Clinical value of serum sdLDL-C in evaluating the condition and prognosis of patients with coronary heart disease undergoing PCI

目的:探讨血清小而密低密度脂蛋白胆固醇(sdLDL-C)对冠心病(CHD)经皮冠状动脉介入治疗(PCI)手术患者病情与预后评估的临床价值。方法:选取2016年6月至2018年6月在襄阳市中心医院和襄阳市第一人民医院治疗的147例冠心病患者,均行PCI手术治疗。根据术前患者sdLDL-C检测水平分为低水平组(sdLDL-C<0.5 mmol/L),35例;中水平组(0.5 mmol/L≤sdLDL-C≤1 mmol/L),49例;高水平组(sdLDL-C>1 mmol/L),63例。检测冠心病相关指标三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、B型脑钠肽前体(NT-proBNP)、超敏肌钙蛋白T(hs-cTnT),完成术后6个月的随访并记录主要心血管事件(MACE),分析sdLDL-C与患者病情及MACE之间的关系。结果:患者术前hs-cTnT水平与sdLDL-C水平呈正相关(P<0.05),而HDL-C水平与sdLDL-C水平呈负相关(P<0.05);sdLDL-C水平随Gensini评分的增加而呈现上升趋势(P<0.05),sdLDL-C与Gensini评分成正相关(P<0.05)。术后随访6个月,sdLDL-C水平不同的患者血运重建发生率、MACE发生率均有统计学差异(P<0.05);Logistics回归分析显示,sdLDL-C≥1 mmol/L是冠心病PCI手术患者发生MACE的危险因素。结论:血清sdLDL-C与冠心病PCI手术患者病情呈正相关,术前高水平sdLDL-C是冠心病术后出现MACE的独立危险因素。

Objective:To investigate the clinical value of serum small dense low-density lipoprotein-cholesterol(sdLDL-C) in evaluating the condition and prognosis of patients with coronary heart disease undergoing percutaneous coronary intervention(PCI).Methods:A total of 147 patients with coronary heart disease hospitalized in two centers in Xiangyang City of Hubei Province from June 2016 to June2018 were selected.All patients were treated by PCI.According to the preoperative level of sdLDL-C,the patients were divided into low-level group(sdLDL-C<0.5 mmol/L,n=35),middle-level group(0.5 mmol/L≤sdLDL-C≤1 mmol/L,n=49),and high-level group(sdLDL-C>1 mmol/L,n=63).Serum levels of triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),brain natriuretic peptide precursor B(NT-proBNP),and hypersensitive troponin T(hs-cTnT) were detected.All cases were followed up for 6 months after operation,and major cardiovascular events(MACE) were recorded.The relationship between sdLDL-C levels and the patient′s condition or MACE was analyzed.Results:The levels of hs-cTnT were positively correlated with the levels of sdLDL-C before operation(P<0.05),while the levels of HDL-C was negatively correlated with the levels of sdLDL-C(P<0.05).The levels of sdLDL-C increased with the increase of Gensini score(P<0.001),while the levels of sdLDL-C were positively correlated with Gensini score(P<0.05).After 6 months of follow-up,there were significant difference in the incidence of revascularization and MACE in patients of different sdLDL-C levels(P<0.05).Logistic regression analysis showed that sdLDL-C(>1 mmol/L) was a risk factor for MACE in patients with coronary heart disease undergoing PCI.Conclusion:Serum sdLDL-C is positively correlated with the condition of patients with coronary heart disease undergoing PCI.Preoperative high level of serum sdLDL-C is an independent risk factor for MACE after coronary heart disease surgery.