王志坚,周玉杰,赵迎新,刘宇扬,史冬梅

• 1:首都医科大学附属北京安贞医院十二病房

摘要(Abstract)：

目的评价肥胖对接受药物洗脱支架(DES)置入的冠心病患者再次血运重建的影响,包括由再狭窄引起的靶病变血运重建(TLR)和动脉粥样硬化进展引起的非靶病变血运重建(非TLR)。方法我们回顾性分析了安贞医院自2004年1月至2006年12月接受DES的共4972例患者,根据体重指数(BMI)分为三组:正常组(BMI<24.9kg/m2,1284例);超重组(BMI25～29.9kg/m2,2475例)以及肥胖组(BMI>30kg/m2,1213例)。中位随访时间为26个月。结果随访结果显示,肥胖患者与正常和超重患者的TLR差异无统计学意义(6.8%比5.4%比6.3%,P=0.186)。而肥胖组患者的非TLR较正常和超重组患者明显增加(8.6%比5.9%比5.7%,P=0.001)。多因素分析显示,肥胖与糖尿病、高脂血症一起,均是非TLR的独立预测因素(HR=1.45,95%CI=1.03～1.98,P=0.024),而他汀治疗是非TLR的保护因素(HR=0.66,95%CI=0.52～0.84,P<0.001)。进一步分析发现,肥胖在未服用他汀的患者人群中是非TLR的独立预测因素(HR1.54,95%CI1.03～2.30;P=0.038),但在同时服用他汀的人群中,肥胖并不独立地增加非TLR的风险(HR1.28,95%CI0.81～2.04,P=0.265)。结论在接受DES的冠心病人群中,肥胖不增加TLR的风险,但可独立增加非TLR的风险。他汀治疗可能会部分缓解肥胖对非TLR的不良影响。本研究结果仍有待进一步研究的证实。

关键词(KeyWords)： 肥胖症;药物洗脱支架;心肌血管重建术;动脉粥样硬化

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王志坚,周玉杰,赵迎新,刘宇扬,史冬梅

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