邓捷,韩雅玲,王效增,荆全民,王守力,马颖艳

• 1:解放军沈阳军区总医院心内科

摘要(Abstract)：

目的评价高密度脂蛋白胆固醇(HDL-C)水平对非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者冠状动脉介入治疗(PCI)结果的影响。方法2006年1月到2007年1月409例因NSTE-ACS行PCI的患者中,220例HDL-C≥40 mg/dL(HDL-C正常组),189例HDL-C<40 mg/dL(HDL-C降低组)。收集临床和冠状动脉造影资料并对其进行随访。结果HDL-C正常组C型病变数(18.6%比28.6%,P=0.02)、无复流发生率(1.4%比5.3%,P=0.02)显著低于HDL-C降低组。平均2年随访发现,HDL-C正常组病死率(2.3%比7.9%,P=0.01)、靶病变重建率(3.6%比9.0%,P=0.02)、靶血管重建率(5.0%比10.6%,P=0.03)显著低于HDL-C降低组。Cox多因素回归分析显示,HDL-C减低是NSTE-ACS患者死亡的独立危险因素之一(RR2.18,95%CI1.21~4.93,P=0.02)。生存分析表明,随访期间HDL-C正常组累积生存率高于HDL-C降低组(97.7%比89.9%,P=0.01)。结论HDL-C水平降低与冠心病心脏事件密切相关,对PCI术后疗效产生不良影响。

关键词(KeyWords)： 脂蛋白类,HDL胆固醇;冠状动脉疾病;血管成形术,经腔,经皮冠状动脉

Abstract:

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基金项目(Foundation):

作者(Author): 邓捷,韩雅玲,王效增,荆全民,王守力,马颖艳

参考文献(References)：

• [1]Lavie CJ,Milani RV.Shedding Light on High-Density Lipopro-tein Cholesterol:The Post-ILLUMINATE Era.J Am Coll Cardi-ol,2008,51;56-58.
• [2]陈征,华琦.冠状动脉病变与血脂代谢异常的相关性.中国介入心脏病学杂志,2005,02:100-102.
• [3]Ford ES,Giles WH,Dietz WH,et al.Prevalence of the meta-bolic syndrome among US adults:findings from the third NationalHealth and Nutrition Examination Survey.JAMA,2002,287:356-359.
• [4]Grundy SM,Cleeman JI,Daniels SR,et al.Diagnosis and man-agement of the metabolic syndrome:an American Heart Associa-tion/National Heart,Lung,and Blood Institute Scientific State-ment.Circulation,2005,112:2735-2752.
• [5]Roel MT,Fang-Shu Ou,Karen P,et al.Patterns and prognosticimplications of lowhigh-density lipoprotein levels in patients withnon-ST-segment elevation acute coronary syndromes.Eur HeartJ,2008,0:ehnvi-9.
• [6]Chapman MJ,Assmann G,Fruchart JC,et al.Raising high-density lipoprotein cholesterol with reduction of cardiovascularrisk:the role of nicotinic acid a position paper developed by theEuropean Consensus Panel on HDL-C.Curr Med Res Opin,2004,20:1253-1268.
• [7]Gordon DJ,Rifkind BM.High-density lipoprotein the clinicalimplications of recent studies.N Engl J Med,1989,321:1311-1316.
• [8]蒋利,沈卫峰,魏盟.冠状动脉内支架置入术后病变进展因素的探讨.中国介入心脏病学杂志,2004,12:106.
• [9]Castelli WP,Garrison RJ,Wilson PW,et al.Incidence of coro-nary heart disease and lipoprotein cholesterol levels:the Framing-ham Study.JAMA,1986,256:2835-2838.
• [10]Olsson AG,Schwartz GG,Szarek M,et al.High-density lipo-protein,but not low-density lipoprotein cholesterol levels influ-ence short-term prognosis after acute coronary syndrome:resultsfrom the MIRACL trial.Eur Heart J,2005,26:890-896.
• [11]Roswitha MW,Brewer HB,Zhenyi Xue,et al.Impact of lowhigh-density lipoproteins on in-hospital events and one-year clini-cal outcomes in patients with non-ST-elevation myocardial infarc-tion acute coronary syndrome treated with drug-eluting stent im-plantation.Am J Cardiol,2006,98:711-717.
• [12]Taylor AJ,Sullenberger LE,Lee HJ,et al.Arterial Biology forthe Investigation of the Treatment Effects of Reducing Cholesterol(ARBITER)2:a double-blind,placebo-controlled study of ex-tended-release niacin on atherosclerosis progression in secondaryprevention patients treated with statins.Circulation,2004,110:3512-3517.
• [13]Nissen SE,Tsunoda T,Tuzcu EM,et al.Effect of recombinantApoA-I Milano on coronary atherosclerosis in patients with acutecoronary syndromes:a randomized controlled trial.JAMA,2003,290:2292-2300.
• [14]Brousseau ME,Schaefer EJ,Wolfe ML,et al.Effects of an in-hibitor of cholesteryl ester transfer protein on HDL cholesterol.NEngl J Med,2004,350:1505-1515.
• [15]SoRelle R.ATPⅢcalls for more intensive low-density lipopro-tein lowering in target groups.Circulation,2002,106:e9068.