小而密低密度脂蛋白胆固醇与冠心病患者经皮冠状动脉介入治疗术后围术期心肌损伤的相关性

Correlation between small dense low-density lipoprotein cholesterol and peri-operative myocardial injury in patients with coronary heart disease after PCI

目的 探讨小而密低密度脂蛋白胆固醇(sdLDL-C)与冠心病患者经皮冠状动脉介入治疗(PCI)围术期心肌损伤(PMI)的相关性及其预测价值。方法 选取2021年1月至2022年6月在江苏大学附属宜兴医院行择期PCI治疗的冠心病患者141例,包括心绞痛98例和急性心肌梗死43例;以及同期非冠心病66例。收集临床基线资料及术中冠状动脉病变情况,常规检测术前血脂以及术前术后心肌肌钙蛋白I(cTnI)等指标。接受PCI治疗的患者根据术后cTnI是否升高分为观察组(cTnI升高,n=86)和对照组(cTnI正常,n=55),对比2组间各项指标的差异。同时比较非冠心病,心绞痛,急性心肌梗死3组间sdLDL-C水平的差异。采用SPSS 16.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ^(2)检验。3组之间两两比较采用方差分析及趋势检验。采用二分类logistic回归分析评价sdLDL-C与术后cTnI升高的关系。结果 观察组sdLDL-C、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、植入支架数、支架总长度均高于对照组,差异均有统计学意义[(0.74±0.26)和(0.56±0.27)mmol/L,(4.51±1.17)和(3.90±1.04)mmol/L,(2.77±0.80)和(2.25±0.73)mmol/L,(1.74±0.91)和(1.33±0.62),(52.52±27.93)和(36.92±19.41)mm;均P<0.05]。logistic回归分析显示,sdLDL-C(OR=14.798,95%CI 1.112~196.904),LDL-C(OR=3.074,95%CI 1.138~8.302)是冠心病患者PCI术后PMI的独立危险因素(P<0.05)。sdLDL-C在受试者工作特征(ROC)曲线下面积是0.727(95%CI 0.637~0.817,P<0.05),最佳截断值为0.518 mmol/L,诊断PMI灵敏度为86.0%,特异度为56.4%,约登指数为0.424。非冠心病、心绞痛、急性心肌梗死3组的sdLDL-C分别是(0.541±0.144),(0.621±0.257),(0.776±0.289)mmol/L,两两比较差异均有统计学意义(P<0.05),呈显著上升趋势(P<0.05)。结论 术前高水平sdLDL-C是冠心病患者PCI术后围术期心肌损伤的危险因素,sdLDL-C与疾病严重程度呈正相关。

Objective To investigate the correlation between small dense low-density lipoprotein cholesterol(sdLDL-C)and peri-operative myocardial injury(PMI)in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI)and the predictive value of sdLDL-C for PMI.Methods A total of 141 CHD patients,98 with angina and 43 with acute myocardial infarction,were retrospectively selected as the research subjects,who received elective PCI from January 2021 to June 2022,and 66 non-CHD individuals were selected during the same time.The clinical baseline data were collected,the distribution pattern of coronary lesions were recorded intraoperatively,and indexes such as the preoperative blood lipids and postoperative cardiac tropomom I(cTnI)were routinely tested.According to the postoperative cTnI value,the PCI patients were divided into the observation group with elevated cTnI level(n=86)and the control group with normal cTnI level(n=55).The two groups were compared for all the collected parameters,and the non-CHD group,the angina group and the acute myocardial infarction group were compared for sdLDL-C levels.SPSS 16.0 was used for statistical analysis.Data comparison between groups was performed using t-test orχ^(2) test,depending on data type.Analysis of variance and trend testing were used for pairwise comparison among the three groups.The relationship between sdLDL-C and postoperative cTnI elevation was evaluated using binary logistic regression analysis.Results sdLDL-C,total cholesterol,low-density lipoprotein cholesterol(LDL-C),numbers of implanted stents,and total length of the stents in the observation group were significantly higher than those in the control group[(0.74±0.26)vs(0.56±0.27)mmol/L,(4.51±1.17)vs(3.90±1.04)mmol/L,(2.77±0.80)vs(2.25±0.73)mmol/L,(1.74±0.91)vs(1.33±0.62),(52.52±27.93)vs(36.92±19.41)mm,all P<0.05].The logistic regression analysis showed that sdLDL-C(OR=14.798,95%CI 1.112-196.904)and LDL-C(OR=3.074,95%CI 1.138-8.302)were the independent risk factors of PMI(P<0.05).The area under ROC curve for sdLDL-C was 0.727(95%CI 0.637-0.817;P<0.05)with the best cut-off point of 0.518 mmol/L,and a sensitivity of 86.0%and a specificity of 56.4%for the diagnosis of PMI,and the Youden index was 0.424.sdLDL-C was(0.541±0.144)mmol/L in the non-CHD group,(0.621±0.257)mmol/L in the angina group,and(0.776±0.289)mmol/L in the acute myocardial infarction group,with significant differences between groups(P<0.05)and a significant upward trend(P<0.05).Conclusion The preoperative high level of sdLDL-C is a risk factor of PMI after PCI in the CHD patients,and sdLDL-C has a positive correlation with the severity of the disease.