脂蛋白(a)与老年冠心病病人PCI术后心肌损伤关系的研究

Effect of lipoprotein(a)on perioperative myocardial injury in elderly patients with coronary heart disease after PCI

目的探讨脂蛋白(a)[lipoprotein(a),Lp(a)]与老年冠心病病人行经皮冠状动脉介入治疗(PCI)发生围手术期心肌损伤(PMI)的关系。方法选取2020年1月至2021年3月在宜兴市人民医院接受择期PCI的老年冠心病病人200例,收集病人年龄、既往病史等临床基线资料,常规检查术前Lp(a)、血脂、肾功能、HbA1c等生化指标及术前、术后肌钙蛋白T(cTnT)。根据术后cTnT是否升高分为观察组(cTnT升高,n=106)和对照组(cTnT正常,n=94),并比较2组间各项指标的差异。根据冠状动脉病变心脏外科与介入治疗狭窄冠状动脉研究(SYNTAX)评分评价靶病变严重程度,分为低评分(0~22分)、中评分(23~32分)、高评分(≥33分)3组,分析各组间Lp(a)水平的差异。结果观察组和对照组性别、高血压史、糖尿病史、吸烟史、既往PCI手术史、他汀类药物服药史、HDL-C、LDL-C、血清肌酐、UA、HbA1c、SYNTAX评分、冠脉多支病变、冠脉分叉病变、冠脉长病变等差异均无统计学意义(P>0.05);观察组年龄、Lp(a)水平、植入支架数、植入支架总长度均高于对照组,差异有统计学意义(P<0.05)。根据SYNTAX评分分组,其中低评分组73例,中评分组81例,高评分组46例,3组Lp(a)值分别为(168.29±28.97)mg/L、(294.72±28.25)mg/L、(465.29±48.62)mg/L,两两比较差异均有统计学意义(P<0.05)。运用Logistic回归分析老年冠心病病人PMI的危险因素,结果显示年龄(OR=1.106,95%CI:1.044~1.171)、Lp(a)(OR=2.291,95%CI:1.150~4.562)、植入支架总长度(OR=1.015,95%CI:1.004~1.027)是PMI发生的独立影响因素。结论术前高水平Lp(a)是老年冠心病病人PCI术后PMI发生的危险因素;Lp(a)与冠脉病变严重程度呈正相关。

Objective To explore the relationship between lipoprotein(a)[Lp(a)]and perioperative myocardial injury(PMI)in the elderly patients with coronary heart disease(CHD).Methods A total of 200 elderly patients with CHD who received PCI in Yixing People’s Hospital from January 2020 to March 2021 were enrolled in this study.According to the level of troponin T(cTnT),the patients were divided into the observation group with elevated cTnT level(n=106)and the control group with normal cTnT level(n=94),and the differences in all the clinical data between the two groups were analyzed.According to SYNTAX score,the patients were divided into low score group(0-22),middle score group(23-32)and high score group(≥33).The level of Lp(a)was detected and compared among all groups.Results The levels of age and Lp(a),the numbers of the stents and the total length of the stents were significant higher in the observation group than those in the control group(P<0.05).According to SYNTAX score,the level of Lp(a)in the low score group,the middle score group and the high score group was 168.29±28.97 mg/L,294.72±28.25 mg/L and 465.29±48.62 mg/L,respectively,with significant differences among the three groups(P<0.05).The Logistic regression analysis showed that age(OR=1.106,95%CI:1.044-1.171),Lp(a)(OR=2.291,95%CI:1.150-4.562),total length of the stents(OR=1.015,95%CI:1.004-1.027)were the independent influencing factors of PMI.Conclusions The preoperative high level of Lp(a)is a risk factor of PMI after PCI in the elderly patients with CHD.Lp(a)has a positive relationship with the severity of coronary lesions.