脂蛋白a水平与冠状动脉支架内再狭窄关系的临床随访研究

Relationship between lipoprotein a level and coronary in-stent restenosis:a clinical follow-up study

目的探讨脂蛋白a水平对经皮冠状动脉介入治疗(PCI)患者支架内再狭窄(ISR)的影响。方法纳入2019年1月至2020年12月于中国科学技术大学附属第一医院心血管内科首次行PCI的患者2342例,收集患者基线资料及测定脂蛋白a水平。根据脂蛋白a中位数将患者分为低脂蛋白a组和高脂蛋白a组两组。1年后对所有患者进行随访,随访结局指标为出现ISR。采用Kaplan-Meier方法估计生存函数,采用log-rank检验对生存曲线的差异进行分析,Cox比例风险回归模型用于探索脂蛋白a与PCI术后ISR之间的独立关联。结果患者平均随访时间18.11±3.63月,低脂蛋白a组ISR患者共65例(5.5%),高脂蛋白a组ISR患者共87例(7.4%),两组差异无统计学意义(P=0.063)。随访24个月后无ISR生存率依次为:第一四分位组75%、第二四分位组79%、第三四分位组69%、最高四分位组69%。在校正了年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、血管钙化、高密度脂蛋白胆固醇、总胆固醇水平后,相对于低脂蛋白a组,高脂蛋白a组患者2年内发生ISR风险的HR为1.39(95%CI:1.01~1.93,P=0.046)。结论高脂蛋白a水平是PCI术后患者发生ISR的独立危险因素。

Objective To discuss the influence of lipoprotein a level on coronary in-stent restenosis(ISR)in patients undergone percutaneous coronary intervention(PCI).Methods The patients received first-time PCI(n=2342)were chosen from Department of Cardiovascular Medicine in the First Affiliated Hospital of University of Science and Technology of China from Jan.2019 to Dec.2020.The baseline materials were collected and level of lipoprotein a was detected.The patients were divided,according to median of lipoprotein a,into low-lipoprotein a group and high-lipoprotein a group.All patients were followed up after 1 y with ISR as outcome index.The survival function was estimated by using Kaplan-Meier method,and difference in survival curve was analyzed by using log-rank test.The independent correlation between Lipoprotein a and ISR after PCI was analyzed by using Cox proportional hazard regression model.Results The average follow-up time was(18.11±3.63)months.There were 65 ISR patients(5.5%)in low-lipoprotein a group and 87(7.4%)in high-lipoprotein a group(P=0.063).After 24-month followed-up,non-ISR survival rate was 75%in the first quartile group,79%in the second quartile group,69%in the third quartile group and 69%in the fourth quartile group.After corrected age,gender,smoking history,drinking history,hypertension history,diabetes history,angiosteosis and levels of high-density lipoproteincholesterol(HDL-C)and total cholesterol(TC),HR of ISR risk within 2 y was 1.39(95%CI:1.01~1.93,P=0.046)in high-lipoprotein a group compared with low-lipoprotein a group.Conclusion A higher level of lipoprotein a is an independent risk factor of ISR in patients after PCI.