冠心病合并颈动脉斑块的危险因素及降脂方案分析

Analysis of the risk factors and lipid-lowering schemes related to coronary heart disease complicated with carotid plaque

目的探讨冠心病合并颈动脉斑块的相关危险因素,并比较不同降脂治疗方案对颈动脉斑块的影响。方法收集2017年1月-2019年12月因冠心病在武汉市第一医院心内科住院并行冠脉造影及经皮冠状动脉介入治疗(PCI)的335例患者的临床资料进行回顾性分析。对比分析冠心病合并颈动脉斑块组(n=257)与冠心病无颈动脉斑块组(n=78)的生化指标,在冠心病合并颈动脉斑块组中筛查并分析影响血脂水平分布的因素。采用单因素及多因素二元logistic回归分析冠心病合并颈动脉斑块的危险因素。剔除冠心病合并颈动脉斑块组无法成组的9例患者,根据实际口服降脂药物方案分为4个亚组:阿托伐他汀20 mg组(n=90)、阿托伐他汀10 mg+依折麦布10 mg组(n=51)、瑞舒伐他汀10 mg组(n=71)、匹伐他汀2 mg组(n=36)。分析4组间PCI术前和术后1年颈动脉斑块数目及大小的变化情况。结果冠心病合并颈动脉斑块组较无斑块组体重指数(BMI)、血压(包括收缩压和舒张压)、血肌酐、血尿酸、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、糖化血红蛋白(HbA_(1c))、脂蛋白磷脂酶A2(Lp-PLA2)均明显升高(P<0.01)。在冠心病合并颈动脉斑块患者中,性别、年龄、BMI是影响血脂水平的因素(P<0.05)。综合上述指标行单因素及多因素二元logistic回归分析,结果显示,HbA_(1c)、Lp-PLA2、LDL-C、肌酐、白蛋白和尿酸是影响颈动脉斑块的危险因素(P<0.05)。与PCI术前相比,采用不同降脂治疗方案的4个亚组术后1年均出现明显的颈动脉斑块数目减少和(或)体积缩小,但组间差异无统计学意义。结论HbA_(1c)、Lp-PLA2、LDL-C、肌酐、白蛋白和尿酸等生化指标可用于冠心病合并颈动脉斑块高危人群的筛查及针对性防治。不同降脂治疗方案对颈动脉斑块无明显影响。

Objective To explore the risk factors related to coronary heart disease(CHD)complicated with carotid plaque,and compare the effects of different lipid-lowering treatment schemes on carotid plaque.Methods The data of 335 patients with CHD,hospitalized in the Department of Cardiology of Wuhan First Hospital and undergone coronary angiography and percutaneous coronary intervention(PCI)from January 2017 to December 2019,were collected and analyzed retrospectively.The biochemical indexes of CHD with carotid plaque group(n=257)and CHD without carotid plaque group(n=78)were compared,and the factors affecting the distribution of blood lipid levels were screened and analyzed in the CHD with carotid plaque group.Univariate and multivariate logistic regression were performed to analyze the risk factors of CHD complicated with carotid plaque.Then the patients in CHD complicated with carotid plaque group were divided into four subgroups according to the actual oral lipid-lowering drug regimen:atorvastatin 20 mg group(n=90),atorvastatin 10 mg+ezetimibe 10 mg group(n=51),rosuvastatin 10 mg group(n=71),and pivastatin 2 mg group(n=36).The number and size changes of carotid plaques were analyzed before and one year after PCI.Results The BMI,blood pressure(including systolic pressure and diastolic pressure),serum creatinine and uric acid levels,low density lipoprotein cholesterol(LDL-C)and total cholesterol(TC),glycosylated hemoglobin(HbA_(1c))and lipoprotein phospholipase A2(Lp-PLA2)increased obviously in CHD complicated with carotid plaque group compared with without carotid plaque group(P<0.01).In patients with CHD complicated with carotid plaque,gender,age and BMI were the factors affecting blood lipid levels(P<0.05).The results of univariate and multivariate logistic regression analysis showed that HbA_(1c),Lp-PLA2,LDL-C,creatinine,albumin and uric acid were the risk factors affecting carotid plaque(P<0.05).The number and/or size decreased of carotid plaques could be reduced by different lipid-lowering treatment schemes one year after PCI in the four subgroups,but there was no significant difference between the groups.Conclusions Biochemical indicators such as HbA_(1c),Lp-PLA2,LDL-C,creatinine,albumin and uric acid can be used for screening and targeted prevention and treatment of high-risk population.Different lipid-lowering treatment schemes have no significant effect on carotid plaque.