李世刚,郑博,陈明

• 1:北京大学第一医院心内科

摘要(Abstract)：

目的本研究旨在通过光学相干断层成像(optical coherence tomography,OCT)观察,探究药物洗脱支架经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后发生的新生动脉粥样硬化(neoatherosclerosis,NA)相关危险因素的评估以及他汀类药物降脂治疗的作用。方法回顾性分析从2013年6月至2016年6月在北京大学第一医院进行冠状动脉支架置入术后复查OCT的40例患者。根据患者低密度脂蛋白胆固醇(LDL-C)控制水平是否达标分为达标组(19例,LDL-C<1.8 mmol/L)和非达标组(21例,LDL-C≥1.8 mmol/L)。比较两组患者病史、生化指标及服药情况,通过OCT进行NA定性及定量分析。结果非达标组LDL-C水平[(2.42±0.79)mmol/L比(1.30±0.35)mmol/L,P<0.001]及胆固醇水平[(4.38±1.01)mmol/L比(3.07±0.87)mmol/L,P<0.001]均高于达标组,差异均有统计学意义;非达标组他汀类药物口服剂量[(15.26±2.30)mg/d比(22.38±2.10)mg/d,P=0.032]低于达标组,差异有统计学意义。两组患者OCT图像特征定量分析比较,非达标组管腔面积[(6.14±0.16)mm~2比(5.68±0.14)mm~2,P=0.038]及新生内膜再狭窄率[(25.12±1.10)%比(19.70±1.10)%,P=0.001]高于达标组,差异均有统计学意义。两组患者冠状动脉造影结果定量分析比较,非达标组参照血管直径[(2.62±0.18)mm比(3.08±0.15)mm,P=0.049]及最小管腔内径(MLD)[(1.88±0.15)mm比(2.55±0.15)mm,P=0.002]低于达标组,差异均有统计学意义;非达标组血管直径狭窄率(diameter stenosis,DS)[(27.22±3.95)%比(17.42±2.52)%,P=0.040]高于达标组,差异有统计学意义。两组患者OCT图像定性分析比较,非达标组NA(78.9%比38.1%,P=0.009),异质性新生内膜(78.9%比38.1%,P=0.009),脂质斑块(73.7%比38.1%,P=0.024),钙化斑块(26.3%比4.8%,P=0.049)发生率高于达标组,差异均有统计学意义。多因素回归分析显示,低密度脂蛋白水平(P=0.009),他汀类药物剂量(P=0.040)、男性(P=0.042)及血清肌酸酐水平(P=0.012)为NA影响因素,且低密度脂蛋白水平及他汀药物剂量,为其独立影响因素。低密度脂蛋白水平与支架内新生动脉硬化呈正相关性,口服他汀类药物剂量与之呈负相关性(均P<0.05)。结论 PCI术后支架内再狭窄(in-stent restenosis,ISR)和NA密切相关,LDL-C达标可以显著减少NA发生风险,相对强化的他汀类药物治疗策略可以预防NA发生。

关键词(KeyWords)： 光学相干断层成像;经皮冠状动脉介入治疗;新生动脉粥样硬化

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李世刚,郑博,陈明

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