2020 年第 4 期 第 15 卷

小而密低密度脂蛋白与急性心肌梗死患者经皮冠状动脉介入术后预后的关系

Relation between small dense low-density lipoprotein and prognosis of acute myocardial infarction patients after percutaneous coronary intervention

作者：马磊黄觊吴翔宇孙俊萍郝中玲李志忠

英文作者：Ma Lei Huang Ji Wu Xiangyu Sun Junping Hao Zhongling Li Zhizhong

单位：首都医科大学附属北京安贞医院心内科十五病房100029

英文单位：The Fifteenth Ward of Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性心肌梗死；小而密低密度脂蛋白；经皮冠状动脉介入；预后

英文关键词：Acutemyocardialinfarction;Smalldenselow-densitylipoprotein;Percutaneouscoronaryintervention;Prognosis

• 摘要：

• 【摘要】目的    探究小而密低密度脂蛋白(sdLDL)与急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术后预后的相关性。方法    选取2018年1—8月就诊于首都医科大学附属北京安贞医院的AMI患者353例，均行经皮冠状动脉介入（PCI）治疗。所有患者入院后收集相关资料并进行血脂生化指标检测，出院后进行1年以上随访观察。依据随访期间主要不良心血管事件（MACE）发生情况分为MACE组和无MACE组，比较2组患者的临床特点，分析与sdLDL有关的影响因素，并探究影响AMI预后的危险因素。结果    随访期间发生MACE者71例（20.1%），其中全因死亡4例，再发心绞痛58例，靶血管重建8例，恶性心律失常1例。相关性分析显示，sdLDL与三酰甘油（r＝0.509）、总胆固醇(r＝0.812)、体重指数(r＝0.132)等指标具有明显相关性（均P＜0.05）。经多因素Cox回归分析发现，sdLDL（风险比＝1.900，95%置信区间：1.067～3.383）、脂蛋白A(风险比＝2.825，95%置信区间：1.441～5.540)、血尿酸(风险比＝1.003，95%置信区间：1.000～1.005)是AMI患者PCI术后发生MACE的独立危险因素（均P＜0.05）。进行Kaplan-Meier生存分析发现，sdLDL≥0.78 mmol/L患者在1年随访期有更加不良的预后（Log-Rank=4.463，P＝0.035）。结论    sdLDL是AMI患者PCI术后发生MACE的独立危险因素，且较LDL有更强的预后预测价值。

• 【Abstract】Objective    To investigate the correlation between small dense low-density lipoprotein(sdLDL) and prognosis in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention（PCI）. Methods    A total of 353 patients with AMI who had PCI in Beijing Anzhen Hospital, Capital Medical University were enrolled from January to August 2018. Clinical indicators and blood lipid biochemical indexes were collected. All patients were followed up for at least 1 year to observe the occurrence of major adverse cardiovascular events(MACE). Influencing factors of sdLDL and risk factors affecting the prognosis of AMI were analyzed. Results    There were 71 cases(20.1%) of MACE occurring during follow-up, including 4 cases of all-cause death, 58 cases of recurrent angina, 8 cases of target revascularization and 1 case of malignant arrhythmia. Analysis showed that sdLDL was associated with triacylglycerol(r＝0.509), total cholesterol(r＝0.812) and body mass index(r＝0.132). Multivariate Cox regression analysis suggested that sdLDL(hazard ratio＝1.900, 95% confidence interval: 1.067-3.383), lipoprotein A(hazard ratio＝2.825, 95% confidence interval: 1.441-5.540) and uric acid(hazard ratio＝1.003, 95% confidence interval: 1.000-1.005) were independent risk factors of MACE（all P＜0.05）. Kaplan-Meier survival analysis found that patients with sdLDL≥0.78 mmol/L had poor prognosis at 1 year follow-up(Log-Rank=4.463, P＝0.035). Conclusion    SdLDL is a risk factor of MACE after PCI treating AMI.