sd-LDL-C/LDL-C比值对AMI患者介入治疗后支架内再狭窄的预测价值

Predictive value of sd-LDL-C/LDL-C ratio for in-stent restenosis in patients with AMI after interventional therapy

目的探讨小而密低密度脂蛋白胆固醇(sd-LDL-C)/低密度脂蛋白胆固醇(LDL-C)比值对急性心肌梗死(AMI)患者介入治疗后支架内再狭窄的预测价值。方法选取2020年8月—2021年8月内蒙古自治区人民医院行经皮冠状动脉介入治疗(PCI)的AMI患者145例。收集所有患者的临床资料,并检测入院时的血清总胆固醇(TC)、三酰甘油(TG)、LDL-C、高密度脂蛋白胆固醇(HDL-C)、sd-LDL-C和C反应蛋白(CRP)水平,计算sd-LDL-C/LDL-C比值。PCI术后随访1年,根据冠状动脉血管造影检查结果评估AMI患者支架内再狭窄的发生情况。采用点二列相关性分析评估sd-LDL-C/LDL-C比值与AMI患者发生支架内再狭窄的相关性。采用Logistic回归分析评估AMI患者发生支架内再狭窄的危险因素。采用受试者工作特征(ROC)曲线评估sd-LDL-C/LDL-C比值判断AMI患者发生支架内再狭窄的效能。结果PCI术后随访1年,失访4例,其余141例患者中有20例(14.18%)发生支架内再狭窄(狭窄组),121例未发生支架内再狭窄(非狭窄组)。狭窄组LDL-C、sd-LDL-C、LDL-C/sd-LDL-C比值高于非狭窄组(P<0.05),HDL-C、CRP 2个组之间差异均无统计学意义(P>0.05)。点二列相关性分析结果显示,AMI患者支架内再狭窄的发生与sd-LDL-C、LDL-C、sd-LDL-C/LDL-C比值呈正相关(r值分别为0.441、0.351、0.347,P<0.001)。Logistic回归分析结果显示,sd-LDL-C、LDL-C和sd-LDL-C/LDL-C比值升高是AMI患者发生支架内再狭窄的危险因素(P<0.05)。ROC曲线分析结果显示,血清sd-LDL-C、LDL-C和sd-LDL-C/LDL-C比值判断AMI患者发生支架内再狭窄的曲线下面积(AUC)分别为0.709、0.706、0.750。结论sd-LDL-C和LDL-C水平与AMI患者PCI术后支架内再狭窄的发生有关。sd-LDL-C/LDL-C比值或可作为判断支架内再狭窄的指标。

Objective To investigate the predictive value of small and dense low-density lipoprotein cholesterol(sd-LDL-C)/low-density lipoprotein cholesterol(LDL-C)ratio for in-stent restenosis in patients with acute myocardial infarction(AMI)after interventional therapy.Methods A total of 145 patients with AMI who underwent percutaneous coronary intervention(PCI)in Inner Mongolia Autonomous Region People's Hospital from August 2020 to August 2021 were enrolled.The clinical data of all the patients were collected,and the levels of serum total cholesterol(TC),triglyceride(TG),LDL-C,high-density lipoprotein cholesterol(HDL-C),sd-LDL-C and C-reactive protein(CRP)were determined at admission,and the ratio of sd-LDL-C/LDL-C was calculated.The patients were followed up for 1 year after PCI,and the occurrence of in-stent restenosis in AMI patients was evaluated according to the results of coronary angiography.The correlation between sd-LDL-C/LDL-C ratio and in-stent restenosis in AMI patients was evaluated by point two-column correlation analysis.Logistic regression analysis was used to evaluate the risk factors of in-stent restenosis in AMI patients.Receiver operating characteristic(ROC)curve was used to evaluate the efficacy of sd-LDL-C/LDL-C ratio in judging in-stent restenosis in AMI patients.Results During the 1-year follow-up after PCI,4 patients were lost to follow-up.Among the remaining 141 patients,20 patients(14.18%)had in-stent restenosis(stenosis group),and the other 121 patients without stenosis were enrolled into non-stenosis group.The LDL-C,sd-LDL-C and LDL-C/sd-LDL-C ratio in stenosis group were higher than those in non-stenosis group(P<0.05).There was no statistical significance in HDL-C and CRP between the 2 groups(P>0.05).The occurrence of in-stent restenosis in AMI patients was positively correlated with sd-LDL-C,LDL-C and sd-LDL-C/LDL-C ratio(r=0.441,0.351 and 0.347,P<0.001).The increased sd-LDL-C,LDL-C and sd-LDL-C/LDL-C ratio were risk factors for in-stent restenosis in AMI patients(P<0.05).The area under curve(AUC)of serum sd-LDL-C,LDL-C and sd-LDL-C/LDL-C ratio in judging in-stent restenosis in AMI patients were 0.709,0.706 and 0.750,respectively.Conclusions The levels of sd-LDL-C and LDL-C are related to the occurrence of in-stent restenosis after PCI in AMI patients.The ratio of sd-LDL-C/LDL-C may be used as an index to judge in-stent restenosis.