血浆高密度脂蛋白胆固醇水平对冠脉介入治疗术后1年不良事件的预测价值

目的：探讨冠脉介入治疗（PCI）术后1年不良心血管事件与高密度脂蛋白胆固醇（rtDL-C）水平变化的关系。方法：本研究收集2009年1月至2010年1月我科收治的435例冠心病且接受PCI治疗患者的一般资料、PCI术后1年随访临床终点，按HDL-C水平分为三组：HDL-C〉1．55mmol／L，HDL-C1．04—1．55mmol／L，I-IDL-C〈1．04／L，比较组间1年临床结果差异，并用多元回归方法分析PCI术后1年死亡的影响因素。结果：HDL-C水平的更低患者相对年轻（69_3±9．5VS65．5±9．2VS62．8±9．2，p=0．007），同时合并吸烟（14．5％VS13．O％VS24．6％扩0．002）、糖尿痛（23．4％VS27．8％V836．6％,P=0．019）、LVEF〈30％（2．4％VS5．3％VS4．9％’p=0．020），接受急诊PCI比例更高（4．8％VS6．5％VS7．0％d）=0．034）；且PCI术后1年死亡（2．4％VS2．4％VS6．3％，p=0．008）、再血管化（20．2％VS21．9％VS25．4％，p=0．022）、再次心源性入院（30．6％VS32．0％VS37．3％，p=0．013）、术后6m内心绞痛复发（20．2％VS20．1％VS22．5％，p=0．038）的比例均更高。结论：HDL-C〈1．04mmol／L是导致冠心病患者接受PC术后1年死亡的独立危险因素。

Usefulness of Serum High-Density Lipoprotein Cholesterol Level as a Predictor of One-year Adverse Events after Percutaneous Coronary Interventions

Objective： To analyze the relationship between One-Year Adverse Events After Percutaneous Coronary Interventions and Serum High-Density Lipoprotein Cholesterol Level. Methods： In a sample of 435 patients who underwent PCI, we evaluated 1-year mortality, acute myocardial infarction and repeat revascula- rization as a function of baseline HDL levels classified into approximate quartiles of HDL-C 〉1.55 mmol/1,HDL-C 1.04-1.55 retool/1 and HDL-C 〈1.04 mmol/1. Results： Decreasing levels of HDL cholesterol were associated with younger age （69.3＋ 9.5 vs 65.5：1：9.2 vs 62.8＋ 9.2, p=0.007）, smoking （14.5% vs 13.0% vs 24.6%, p--0.002）, diabetes mellitus （23.4% vs 27.8% vs 36.6%, p=0.019）, LVEF〈30% （2.4% vs 5.3% vs 4.9%, p=0.020） and emergent PCI （4.8% vs 6.5% vs 7.0%, p=0,034）. Furthermore, One-year mortality （2,4% vs 2.4% vs 6.3%,p=0.008）, coronary revascularization （20.2% vs 21.9% vs 25.4%,p=0.022）, readmission （30.6% vs 32.0% vs 37.3%,p=0.013） and repeated angina （20.2% vs 20.1% vs 22.5%,p=0.038）were significantly higher in the patients with decreased HDL-C level. Conclusion： In patients with coronary artery disease undergoing PCI, a baseline HDL-C 〈1.04 mmol/1 is an important prognostic indicator.