脂蛋白(a)与稳定型心绞痛患者经皮冠状动脉介入治疗围术期心肌损伤研究
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摘要
目的探讨脂蛋白(a)[Lp(a)]与稳定型心绞痛患者经皮冠状动脉介入治疗(PCI)围手术期心肌损伤(PMI)的相关性及其预测价值。方法选取2016年1月至2018年6月采用择期PCI治疗的稳定型心绞痛患者194例,收集临床基线资料及冠状动脉病变情况。常规检测术前血生化、术前和术后心肌肌钙蛋白(cTn)T等指标。根据术后cTnT值,分为cTnT正常组(n=93)和cTnT升高组(n=101),对比两组间Lp(a)值。根据紫杉醇PCI和外科手术协同研究(SYNTAX)评分评价靶病变严重程度,分为低评分(0～22分)、中评分(23～32分)、高评分(≥33分),分析各组间Lp(a)差异。结果 cTnT正常组和升高组临床基线资料差异均无统计学意义(P>0.05)。cTnT升高组Lp(a)值显著高于cTnT正常组,差异有统计学意义[(342.08±36.30) mg/L对(188.63±15.64) mg/L,P<0.05)]。SYNTAX评分显示76例低评分,77例中评分,41例高评分,Lp(a)值分别为(180.41±30.54) mg/L、(282.46±28.00) mg/L、(408.33±56.06) mg/L,两两比较差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,Lp(a)为PCI围手术期cTnT升高的独立危险因素(OR=2.136,95%CI=1.014～4.499,P<0.05)。结论 Lp(a)与PCI后cTnT升高相关,术前Lp(a)高值是PCI术后PMI发生的独立危险因素。Lp(a)与冠状动脉病变严重程度呈正相关。
Objective To explore the correlation between lipoprotein(a) [Lp(a)] level and perioperative myocardial injury(PMI) in patients with stable angina after percutaneous coronary intervention(PCI), and to discuss the predictive value of Lp(a) for PMI. Methods A total of 194 patients with stable angina, who were admitted to the Affiliated Yixing Hospital of Jiangsu University of China to receive PCI during the period from January 2016 to June 2018, were included in this study. The clinical baseline data and the distribution pattern of coronary lesions were collected. The preoperative blood serum biochemicals,preoperative and postoperative cardiac troponin T(cTnT) were routinely tested. According to the postoperative cTnT value, the patients were classified into normal cTnT group(n=93) and elevated cTnT group(n=101),the cTnT values were compared between the two groups. Based on paclitaxel PCI and surgery, the cooperative study(SYNTAX) scores were used to assess the severity of target vascular lesions, which were classified into low-score group(0-22 points), middle-score group(23-32 points) and high-score group(≥33 points), and the differences in Lp(a) levels between each other among the three groups were analyzed. Results No statistically significant difference in clinical baseline data existed between normal cTnT group and elevated cTnT group(P >0.05). The Lp(a) level in elevated cTnT group was(342.08 ±36.30) mg/L, which was significantly higher th an(188.63 ±15.64) mg/L in normal cTnT group, the difference was statistically significant(P<0.05). SYNTAX score analysis showed that low-score group had 76 patients, the middle-score group had 77 patients and the high-score group had 41 patients, their Lp(a) levels were(180.41±30.54) mg/L,(282.46±28.00) mg/L and(408.33±56.06) mg/L respectively, the differences between each other among three groups was statistically significant(P<0.05). Multivariate logistic regression analysis revealed that Lp(a) level was the independent risk factor for the elevation of cTnT value during the perioperative period of PCI(OR=2.136, 95%CI=1.014-4.499, P<0.05). Conclusion Lp(a) levels are closely related to the elevation of cTnT values after PCI, and a high preoperative Lp(a) level is an independent risk factor for PMI after PCI. Lp(a)level has a positive relationship with the severity of coronary lesions.
Objective To explore the correlation between lipoprotein(a) [Lp(a)] level and perioperative myocardial injury(PMI) in patients with stable angina after percutaneous coronary intervention(PCI), and to discuss the predictive value of Lp(a) for PMI. Methods A total of 194 patients with stable angina, who were admitted to the Affiliated Yixing Hospital of Jiangsu University of China to receive PCI during the period from January 2016 to June 2018, were included in this study. The clinical baseline data and the distribution pattern of coronary lesions were collected. The preoperative blood serum biochemicals,preoperative and postoperative cardiac troponin T(cTnT) were routinely tested. According to the postoperative cTnT value, the patients were classified into normal cTnT group(n=93) and elevated cTnT group(n=101),the cTnT values were compared between the two groups. Based on paclitaxel PCI and surgery, the cooperative study(SYNTAX) scores were used to assess the severity of target vascular lesions, which were classified into low-score group(0-22 points), middle-score group(23-32 points) and high-score group(≥33 points), and the differences in Lp(a) levels between each other among the three groups were analyzed. Results No statistically significant difference in clinical baseline data existed between normal cTnT group and elevated cTnT group(P >0.05). The Lp(a) level in elevated cTnT group was(342.08 ±36.30) mg/L, which was significantly higher th an(188.63 ±15.64) mg/L in normal cTnT group, the difference was statistically significant(P<0.05). SYNTAX score analysis showed that low-score group had 76 patients, the middle-score group had 77 patients and the high-score group had 41 patients, their Lp(a) levels were(180.41±30.54) mg/L,(282.46±28.00) mg/L and(408.33±56.06) mg/L respectively, the differences between each other among three groups was statistically significant(P<0.05). Multivariate logistic regression analysis revealed that Lp(a) level was the independent risk factor for the elevation of cTnT value during the perioperative period of PCI(OR=2.136, 95%CI=1.014-4.499, P<0.05). Conclusion Lp(a) levels are closely related to the elevation of cTnT values after PCI, and a high preoperative Lp(a) level is an independent risk factor for PMI after PCI. Lp(a)level has a positive relationship with the severity of coronary lesions.
引文
[1]刘红旭.经皮冠状动脉介入治疗(PCI)围手术期心肌损伤中医诊疗专家共识解读[J].世界中医药, 2016, 11:377-380.
[2] Taylor J. Third universal definition of myocardial infarction[J].Eur Heart J, 2012, 33:2506-2507.
[3]陈燕春,殷云杰,徐亮,等.脂蛋白相关磷脂酶A2预测稳定型心绞痛患者经皮冠状动脉介入治疗围手术期心肌损伤研究[J].介入放射学杂志, 2017, 26:1073-1077.
[4]顾春霞.脂蛋白a与冠状动脉粥样硬化的严重程度的相关性研究[D].杭州:浙江大学, 2016:1-48.
[5]李卉卉,马礼坤.经皮冠状动脉介入术相关的心肌损伤及其研究进展[J].心血管病学进展, 2017, 38:151-155.
[6] Lo N, Michael TT, Moin D, et al. Periprocedural myocardial injury in chronic total occlusion percutaneous interventions:a systematic cardiac biomarker evaluation study[J]. JACC Cardiovasc Interv, 2014, 7:47-54.
[7]苏强,李浪.经皮冠状动脉介入治疗围手术期心肌损伤的防治进展[J].中国循环杂志, 2015, 30:1231-1234.
[8]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志, 2016, 44:382-400.
[9]张捷,乔蕊.脂蛋白(a)的研究进展[J].检验医学, 2012,27:1-3.
[10] Erqou S, Kaptoge S, Perry PL, et al. Lipoprotein(a)concentration and the risk of coronary heart disease, stroke, and nonvascular mortality[J]. JAMA, 2009, 302:412-423.
[11] Babu GG, Walker JM, Yellon DM, et al. Peri-procedural myocardial injury during percutaneous coronary intervention:an important target for cardioprotection[J]. Eur Heart J, 2011, 32:23-31.
[12]钟继明,李浪,陆永光,等.经桡动脉冠心病介入诊疗中桡动脉痉挛的发生及其预测因素[J].介入放射学杂志, 2011,20:265-268.
[13]刘曼娇,岳波,唐大海,等.血清蛋白质脂蛋白(a)和C反应蛋白对颈动脉易损斑块的诊断价值[J].海军医学杂志,2017, 38:27-29.
[14]武文峰,陈盼盼,王伟,等.血清脂蛋白(a)与冠心病患者SYNTAX评分的相关性研究[J].心肺血管病杂志, 2017, 36:256-258.
[15] Konishi H, Miyauchi K, Shitara J, et al. Impact of lipoprotein(a)on long-term outcomes in patients with diabetes mellitus who underwent percutaneous coronary intervention[J]. Am J Cardiol,2016, 118:1781-1785.
[2] Taylor J. Third universal definition of myocardial infarction[J].Eur Heart J, 2012, 33:2506-2507.
[3]陈燕春,殷云杰,徐亮,等.脂蛋白相关磷脂酶A2预测稳定型心绞痛患者经皮冠状动脉介入治疗围手术期心肌损伤研究[J].介入放射学杂志, 2017, 26:1073-1077.
[4]顾春霞.脂蛋白a与冠状动脉粥样硬化的严重程度的相关性研究[D].杭州:浙江大学, 2016:1-48.
[5]李卉卉,马礼坤.经皮冠状动脉介入术相关的心肌损伤及其研究进展[J].心血管病学进展, 2017, 38:151-155.
[6] Lo N, Michael TT, Moin D, et al. Periprocedural myocardial injury in chronic total occlusion percutaneous interventions:a systematic cardiac biomarker evaluation study[J]. JACC Cardiovasc Interv, 2014, 7:47-54.
[7]苏强,李浪.经皮冠状动脉介入治疗围手术期心肌损伤的防治进展[J].中国循环杂志, 2015, 30:1231-1234.
[8]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志, 2016, 44:382-400.
[9]张捷,乔蕊.脂蛋白(a)的研究进展[J].检验医学, 2012,27:1-3.
[10] Erqou S, Kaptoge S, Perry PL, et al. Lipoprotein(a)concentration and the risk of coronary heart disease, stroke, and nonvascular mortality[J]. JAMA, 2009, 302:412-423.
[11] Babu GG, Walker JM, Yellon DM, et al. Peri-procedural myocardial injury during percutaneous coronary intervention:an important target for cardioprotection[J]. Eur Heart J, 2011, 32:23-31.
[12]钟继明,李浪,陆永光,等.经桡动脉冠心病介入诊疗中桡动脉痉挛的发生及其预测因素[J].介入放射学杂志, 2011,20:265-268.
[13]刘曼娇,岳波,唐大海,等.血清蛋白质脂蛋白(a)和C反应蛋白对颈动脉易损斑块的诊断价值[J].海军医学杂志,2017, 38:27-29.
[14]武文峰,陈盼盼,王伟,等.血清脂蛋白(a)与冠心病患者SYNTAX评分的相关性研究[J].心肺血管病杂志, 2017, 36:256-258.
[15] Konishi H, Miyauchi K, Shitara J, et al. Impact of lipoprotein(a)on long-term outcomes in patients with diabetes mellitus who underwent percutaneous coronary intervention[J]. Am J Cardiol,2016, 118:1781-1785.