目的 探讨经皮冠状动脉介入治疗(PCI)术前及术后炎症和血脂水平的控制对PCI术后支架内再狭窄和其他冠状动脉粥样硬化病变的影响.方法 入选在我院成功行支架植入术并于3个月后至一年内回院复查冠状动脉造影的患者,发生单纯支架内再狭窄94例(再狭窄组),发生单纯其他冠状动脉病变加重者65例(病变加蕈组),无变化者307例(无变化组).患者于PCI术前或复查冠状动脉造影时均测定了血清总胆同醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、高敏C反应蛋白(hsCRP),非HDL-C水平为TC与HDL-C之差.结果再狭窄组与无变化组PCI术前CRP和hsCRP水平均有显著性差异(两组术前CRP中位数分别是3.61、2.86mg/L,hsCRP水平中位数分别是1.56、0.89 mg/L,P<0.05),术后复查时CRP水平两组差异有显著性(中位数分别是1.92、1.14 mg/L),将术前hsCRP水平分为>2 mg/L和≤2 mg/L两个等级,再狭窄的发生率有明显差异(X2=4.32,P<0.05),Logistic回归显示hsCRP水平高的患者发生再狭窄的风险明显增加(OR=1.89,95%CI=1.031~3.465).而病变加重组与无变化组之间比较,术后TC[分别是(4.62±1.14)mmol/L和(4.26±1.01)mmol/L]、LDL-C[分别是(2.51±0.93)mmol/L和(2.25±0.75)mmol/L]及非HDL-C水平[分别是(3.52±1.12)mmol/L和(3.20±0.98)mmol/L]差异有统计学意义(P<0.05).结论 PCI术前和术后持续的炎症状态是发生支架内再狭窄的危险因素,而TC、LDL-C及非HDL-C水平是未行PCI的其他冠状动脉粥样硬化病变加重的重要危险因素,应长期加强PCI术后二级预防.
Objective To assess the different effects of inflammation and lipid levels before and after PCI on in-stent restenosis and lesion progression. Methods Patients were studied who successfully underwent PCI with stent implantation and were received coronary angiography again after three months to one year. In-stent restenosis was observed in 94 patients and lesion progression in 65 patients. No restenosis and lesion progression occurred in 307 cases. Total cholesterol (TC), total triglyceride (TG), high density lipoprotein-cholesterol ( HDL-C ), low density lipoprotein-cholesterol ( LDL-C ), C reactive protein ( CRP ) and high sensitive CRP(hsCRP) were determined before PCI and at time of re-angiography. Results The levels of CRP and hsCRP before PCI in restenosis group were higher than those with no restenosis( CRP: median = 3. 61 mg/L and 2.86 mg/L respectively, hsCRP: median = 1.56 mg/L and 0.89 mg/L respectively, P < 0.05 ). There was also difference between two groups in CRP levels at post-PCI fullow-ups ( median = 1.92 mg/L and 1.14 mg/L respectively, P < 0.05 ). The rate of restenosis in patients with heCRP >2 mg/L before PCI was higher than that in patients with hsCRP ≤2 mg/L (X2 =4.32, P<0.05) Logistic regression showed that the risk of restenesis markedly increased in patients with hsCRP > 2 mg/L (OR = 1.89,95%CI 1.031 -3.465). Ourig the follow-up angiography the levels ofTC, LDL-C and non-HDL-C were higher in lesion progression group than those in control group[TC (4. 62 ± 1.14)mmoL/L and (4.26± 1.01 ) mmol/L, LDL-C (2.51±0. 93 ) mmol/L and(2.25±0.75)mmol/L,non-HDL-C(3.52±1.12) mmol/L and (3.20 ±0. 98 ) mmoL/L, respectively, P < 0. 05 ). Conclusion Inflammation state before and after PCI are the risk factors for in-stent restenosis, while the levels of TC, LDL-C and non-HDL-C are the important risk factors for other coronary lesion progression. Secondary prevention should be long-term emphasized and strengthened after PCI.