龚晓璇,应良红,李江津,张清,田晓沂,马树人,张喜文,李振

• 1:南京医科大学第一附属医院心内科
• 2:淮安市第二人民医院心内科
• 3:南京医科大学附属淮安第一医院心内科

摘要(Abstract)：

目的评估血管内超声(intravascular ultrasound,IVUS)联合单核细胞/高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)比值(monocyte to HDL-C ratio,MHR)对非左主干临界病变患者行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)12个月的预后。方法连续入选2017年1月至2018年1月在南京医科大学附属淮安第一医院经冠状动脉造影明确诊断为非左主干临界病变且需要行PCI的冠状动脉粥样硬化性心脏病患者共184例,检测入院时单核细胞计数与HDL-C水平并计算MHR。行IVUS检查判断罪犯病变处斑块稳定性,根据结果将患者分为斑块稳定组(44例)与斑块不稳定组(140例)。所有患者均至少满足斑块不稳定或最小管腔面积<4 mm2中的一项,对上述患者行PCI。随访患者PCI术后12个月的主要不良心血管事件发生情况。结果斑块不稳定组的MHR值[(22.6±8.4)比(14.1±7.2),P<0.001]显著高于斑块稳定组,差异有统计学意义。ROC曲线结果显示,MHR切点值为16.05时对非左主干临界病变患者PCI术后12个月发生主要不良心血管事件的预测价值最大(AUC 0.78,95%CI 0.71～0.85,P<0.001),敏感度为74.2%,特异度为77.0%。斑块不稳定且MHR值>16.05是PCI术后12个月发生主要不良心血管事件的独立危险因素(调节HR 3.26,95%CI 2.48～4.14,P=0.020)。结论 IVUS联合MHR对非左主干临界病变行PCI的患者预后判断具有一定临床价值。

关键词(KeyWords)： 冠状动脉临界病变;血管内超声;单核细胞/高密度脂蛋白胆固醇;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 龚晓璇,应良红,李江津,张清,田晓沂,马树人,张喜文,李振

参考文献(References)：

• [1]Nam CW,Yoon HJ,Cho YK,et al.Outcomes of percutaneous coronary intervention in intermediate coronary artery disease:fractional flow reserve-guided versus intravascular ultrasound-guided.JACC Cardiovasc Interv,2010,3(8):812-817.
• [2]Glaser R,Selzer F,Faxon DP,et al.Clinical progression of incidental,asymptomatic lesions discovered during culprit vessel coronary intervention.Circulation,2005,111(2):143-149.
• [3]Ben-Dor I,Torguson R,Deksissa T,et al.Intravascular ultrasound lumen area parameters for assessment of physiological ischemia by fractional flow reserve in intermediate coronary artery stenosis.Cardiovasc Revasc Med,2012,13(3):177-182.
• [4]左辉华,刘强,张志玲,等.血管内超声或血流储备分数指导冠状动脉临界病变介入治疗的临床效果.南宁医科大学学报,2014,34(5):704-708.
• [5]Cetin MS,Ozcan Cetin EH,Kalender E,et al.Monocyte to HDLcholesterol ratio predicts coronary artery disease severity and future major cardiovascular adverse events in acute coronary syndrome.Heart Lung Circ,2016,25(11):1077-1086.
• [6]Mintz GS,Nissen SE,Anderson WD,et al.American College of Cardiology clinical expert consensus document on standards for acquisition,measurement and reporting of intravascular ultrasound studies(IVUS).A report of the American College of Cardiology task force on clinical expert consensus documents.J Am Coll Cardiol,2001,37(5):1478-1492.
• [7]Kataoka Y,Puri R,Nicholls SJ.Inflammation,plaque progression and vulnerability:evidence from intravascular ultrasound imaging.Cardiovasc Diagn Ther,2015,5(4):280-289.
• [8]曹蘅,曾武涛,常荣,等.中国经皮冠状动脉介入治疗指南(2016).中华心血管病杂志,2016,44(5):382-400.
• [9]Nerlekar N,Cheshire CJ,Verma KP,et al.Intravascular ultrasound guidance improves clinical outcomes during implantation of both first-and second-generation drug-eluting stents:a meta-analysis.EuroIntervention,2017,12(13):1632-1642.
• [10]Ouldzein H,Elbaz M,Roncalli J,et al.Plaque rupture and morphological characteristics of the culprit lesion in acute coronary syndromes without significant angiographic lesion:analysis by intravascular ultrasound.Ann Cardiol Angeiol(Paris),2012,61(1):20-26.
• [11]李伯艳,赵庆霞,史苏娜,等.血管内超声和血流储备分数测定在冠状动脉临界病变治疗中的作用.重庆医学,2016,45(33):4672-4674.
• [12]李松,吴志华,林茴,等.血管内超声结合血流储备分数对不稳定型心绞痛患者冠状动脉临界病变介入治疗的指导价值.岭南心血管病杂志,2017,23(l):52-55.
• [13]Kang SJ,Lee JY,Ahn JM,et al.Intravascular ultrasound-derived predictors for fractional flow reserve in intermediate left main disease.JACC Cardiovasc Interv,2011,4(11):1168-1174.
• [14]Ben-Dor I,Torguson R,Deksissa T,et al.Intravascular ultrasound lumen area parameters for assessment of physiological ischemia by fractional flow reserve in intermediate coronary artery stenosis.Cardiovasc Revasc Med,2012,13(3):177-182.
• [15]Naganuma T,Latib A,Costopoulos C,et al.The role of intravascular ultrasound and quantitative angiography in the functional assessment of intermediate coronary lesions:correlation with fractional flow reserve.Cardiovasc Revasc Med,2014,15(1):3-7.
• [16]Ghattas A,Griffiths HR,Devitt A,et al.Monocytes in coronary artery disease and atherosclerosis:where are we now?J Am Coll Cardiol,2013,62(17):1541-1551.
• [17]Libby P.Inflammation in atherosclerosis.Nature,2002,420(6917):868-874.
• [18]Van der Laan AM,Hirsch A,Robbers LF,et al.A proin?ammatory monocyte response is associated with myocardial injury and impaired functional outcome in patients with ST-segment elevation myocardial infarction:monocytes and myocardial infarction.Am Heart J,2012,163(1):57-65.
• [19]Hafiane A,Genest J.High density lipoproteins:measurement techniques and potential biomarkers of cardiovascular risk.BBAClin,2015,3:175-188.
• [20]Karatas MB,Canga Y,Ozcan KS,et al.Monocyte to high-density lipoprotein ratio as a new prognostic marker in patients with STEMIundergoing primary percutaneous coronary intervention.Am JEmerg Med,2016,34(2):240-244.
• [21]?i?ek G,Kundi H,Bozbay M,et al.The relationship between admission monocyte HDL-C ratio with short-term and long-term mortality among STEMI patients treated with successful primary PCI.Coron Artery Dis,2016,27(3):176-184.
• [22]Zhang Y,Li S,Guo YL,et al.Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes:evidence from a large cohort of Chinese patients undergoing coronary angiography.Ann Med,2016,48(5):305-312.
• [23]Ucar FM.A potential marker of bare metal stent restenosis:monocyte count-to-HDL cholesterol ratio.BMC Cardiovasc Disord,2016,16(1):186.
• [24]Canpolat U,?etin EH,Cetin S,et al.Association of monocyte-toHDL cholesterol ratio with slow coronary flow is linked to systemic inflammation.Clin Appl Thromb Hemost,2016,22(5):476-482.
• [25]Dogan A,Oylumlu M.Increased monocyte-to-HDL cholesterol ratio is related to cardiac syndrome X.Acta Cardiol,2017,72(5):516-521.