冠心病患者血清脂蛋白相关磷脂酶A2水平与冠状动脉药物洗脱支架置入术后支架内再狭窄的关系

The correlation of serum lipoprotein-associated phospholipase A2 with intra-stent restenosis after drug-eluting stent implantation

目的探讨冠心病患者血清脂蛋白相关磷脂酶A2水平(Lp-PLA2)与冠状动脉药物洗脱支架(DES)置入术后支架内再狭窄(ISR)的关系。方法选取2017年10月至2018年9月期间初次于南京市第一医院就诊的227例经冠状动脉造影(CAG)确认心外膜冠状动脉存在严重狭窄并行经皮冠状动脉介入治疗(PCI)、置入DES的患者,随访1~1.5年后复查CAG,并根据CAG结果将患者分为ISR组(n=30)和非支架内再狭窄(nISR)组(n=197),同时分析患者复查CAG时的各项生化指标及多种血清炎症因子,包括Lp-PLA2、超敏C反应蛋白(hs-CRP)、白细胞介素2(IL-2)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)等,多因素logistic回归和多元线性回归分析DES置入术后发生ISR的影响因素。结果ISR组患者的血清Lp-PLA2水平及高血压比例明显高于nISR组,差异有统计学意义(均P<0.01),高密度脂蛋白胆固醇(HDL-C)水平明显低于nISR组(P<0.05),而两组间其他生化指标和炎症因子水平差异无统计学意义(均P>0.05)。ISR组患者的支架段最小管腔直径明显小于nISR组(t=14.975,P<0.01),而支架段血管直径狭窄程度明显大于nISR组,差异均有统计学意义(均P<0.01)。多因素logistic回归分析显示,血清Lp-PLA2水平与ISR发生风险显著相关(OR=1.011,95%CI:1.005~1.017)。多元线性回归分析显示,血清Lp-PLA2水平与ISR程度呈线性相关(β=0.790,P<0.01)。结论血清Lp-PLA2水平与冠心病患者ISR发生风险增加独立相关。

Objectives To investigate the correlation of serum lipoprotein-associated phospholipase A2(Lp-PLA2)with intra-stent restenosis(ISR)after drug-eluting stent(DES)implantation.Methods A total of 227 patients with coronary artery disease,who were diagnosed with severe epicardial coronary stenosis by coronary angiography(CAG)and treated by percutaneous coronary intervention(PCI)and DES implantation were enrolled in our study.After follow-up for 1-1.5 years,the CAG was performed and the patients were divided into ISR group and non-ISR(nISR)group according to the consequence of CAG.Biochemical data and multiple serum inflammatory factors such as Lp-PLA2,hypersensitive C-reactive protein(hs-CRP),interleukin 2(IL-2),interleukin 6(IL-6)and tumor necrosis factor-α(TNF-α)were analyzed before the CAG.Multivariate logistic regression and multiple linear regression were used to analyze the influencing factors of stent restenosis after DES implantation.Results The level of serum Lp-PLA2 and the proportion of hypertension in ISR group were significantly higher than those in nISR group,and the level of high density lipoprotein cholesterol(HDL-C)was significantly lower than that in nISR group(all P<0.05),but there was no significant difference in other biochemical indexes and inflammatory factors between the two groups(all P>0.05).The minimum lumen diameter of stent segment in ISR group was significantly lower than that in nISR group(t=14.975,P<0.01),and the stenosis degree of stent segment diameter was significantly higher than that in nISR group(P<0.01).Multivariate logistic regression analysis showed that Lp-PLA2 remained an independent predictor for ISR(1.011,95%CI:1.005-1.017).Only the serum levels of Lp-PLA2 had linear relationship with the degree of ISR by multivariate linear regression analysis(β=0.790,P<0.01).Conclusions Serum Lp-PLA2 level is independently associated with an increased risk of ISR in patients with coronary heart disease.