CAJ | 학술논문

目的探讨C反应蛋白(CRP)和血清总胆固醇、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇对经皮冠状动脉介入(PCI)治疗术后支架内再狭窄及冠状动脉粥样斑块进展的影响.方法收集515例PCI术后患者的病历资料进行回顾性分析,这些患者术后9～12个月行冠状动脉造影复查,在PCI术前及复查冠状动脉造影时检查CRP及血脂指标.冠状动脉造影复查时根据病变程度将患者分为支架内再狭窄(ISR)组(97例)、冠状动脉粥样斑块进展组(病变进展组,66例)及没有支架内再狭窄也没有粥样斑块病变进展组(对照组,317例). 观察CRP、总胆固醇、LDL-C、非高密度脂蛋白胆固醇等指标的变化及其与ISR发生的相关性.结果 PCI术前ISR组CRP水平高于对照组[1.58(0.65,3.85) mg/L比0.90(0.11,2.29) mg/L](均P＜0.05).相关性分析显示无论PCI术前还是随访时,CRP与ISR发生有很大的相关性[PCI术前比值比(OR)=1.010,95％置信区间(CI):1.007 ～1.192,P＜0.05;随访时OR=1.158,95％CI:1.057 ～1.269,P＜0.05].当CRP以2 mg/L为临界值,CRP＞2 mg/L组Logistic回归分析说明ISR的发生率随着CRP增高而增加[OR=1.83,95％CI:1.034 ～ 3.462,P＜0.05].随访时病变进展组总胆固醇、LDL-C、非高密度脂蛋白胆固醇高于对照组[(4.58±1.16) mmol/L比(4.28±1.03) mmol/L,(2.53±0.94) mmol/L比(2.21±0.76) mmol/L,(3.54±1.14) mmol/L比(3.20±0.96) mmol/L] (P＜0.05).Logistic回归分析说明斑块进展与总胆固醇、LDL-C和非高密度脂蛋白胆固醇相关(均P＜0.05).结论 PCI术前的CRP水平与ISR明显正相关,而血脂指标(总胆固醇、LDL-C和非高密度脂蛋白胆固醇)水平与斑块进展明显正相关.
목적 탐토C반응단백(CRP)화혈청총담고순、저밀도지단백담고순(LDL-C)、비고밀도지단백담고순대경피관상동맥개입(PCI)치료술후지가내재협착급관상동맥죽양반괴진전적영향.방법 수집515례PCI술후환자적병력자료진행회고성분석,저사환자술후9～12개월행관상동맥조영복사,재PCI술전급복사관상동맥조영시검사CRP급혈지지표.관상동맥조영복사시근거병변정도장환자분위지가내재협착(ISR)조(97례)、관상동맥죽양반괴진전조(병변진전조,66례)급몰유지가내재협착야몰유죽양반괴병변진전조(대조조,317례). 관찰CRP、총담고순、LDL-C、비고밀도지단백담고순등지표적변화급기여ISR발생적상관성.결과 PCI술전ISR조CRP수평고우대조조[1.58(0.65,3.85) mg/L비0.90(0.11,2.29) mg/L](균P＜0.05).상관성분석현시무론PCI술전환시수방시,CRP여ISR발생유흔대적상관성[PCI술전비치비(OR)=1.010,95％치신구간(CI):1.007 ～1.192,P＜0.05;수방시OR=1.158,95％CI:1.057 ～1.269,P＜0.05].당CRP이2 mg/L위림계치,CRP＞2 mg/L조Logistic회귀분석설명ISR적발생솔수착CRP증고이증가[OR=1.83,95％CI:1.034 ～ 3.462,P＜0.05].수방시병변진전조총담고순、LDL-C、비고밀도지단백담고순고우대조조[(4.58±1.16) mmol/L비(4.28±1.03) mmol/L,(2.53±0.94) mmol/L비(2.21±0.76) mmol/L,(3.54±1.14) mmol/L비(3.20±0.96) mmol/L] (P＜0.05).Logistic회귀분석설명반괴진전여총담고순、LDL-C화비고밀도지단백담고순상관(균P＜0.05).결론 PCI술전적CRP수평여ISR명현정상관,이혈지지표(총담고순、LDL-C화비고밀도지단백담고순)수평여반괴진전명현정상관.
Objective To investigate the impacts of inflammation and lipid profile on both in-stent restenosis(ISR) and lesion progression in patients receiving PCI and scheduled follow-up.Methods A retrospective analysis of 515 patients was performed in patients who underwent percutaneous coronary intervention(PCI) and received coronary angiography again at an average of 9 months.The data of lipid profile and C-reactive protein (CRP) at both pre-PCI and follow-up were analyzed for all patients; 317 patients with neither ISR nor lesion progression were as a control group.Results CRP levels of pre-PCI in the ISR group were higher than those in the control group (P ＜ 0.05).The multivariate analysis indicated that the CRP levels at both pre-PCI and follow-up were significantly correlated with ISR [OR =1.010,95％ CI:1.007-1.1920,P ＜0.05 for pre-PCI,OR =1.158,95％ CI:1.057-1.269),P ＜ 0.05 for follow-up,P ＜ 0.05,respectively].When the cut-off of CRP was 2 mg/L,logistic regression analysis suggested an increased risk of ISR in patients with CRP greater than 2 mg/L (OR =1.830,95 ％ CI:1.034-3.462,P ＜ 0.05) at pre-PCI CRP.The levels of total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) during follow-up in the progression group were higher than those in the control group (P ＜ 0.05,respectively).Logistic regression showed that the risk for lesion progression was associated with the concentrations of TC,LDL-C and non-HDL-C (P ＜0.05).Conclusions The levels of pre-PCI CRP are strongly associated with ISR,whereas serum levels of TC,LDL-C and non-HDL-C are significantly correlated with coronary lesion progression.