目的 探讨低密度脂蛋白胆固醇(LDL-C)及载脂蛋白B(ApoB)与经皮冠状动脉介入治疗(PCI)后冠状动脉病变的相关性.方法 根据复查冠状动脉造影(CAG)结果,将1 410例复查CAG、最初诊断为急性冠脉综合征并行(PCI)的患者分为无新发病变组750例、支架内再狭窄(ISR)组210例和支架外新发病变组450例.于PCI前及复查CAG前分别检测3组患者的血脂等指标并进行比较分析.结果 3组患者复查CAG前的LDL-C及ApoB比较,差异均有统计学意义(P＜0.05).支架外病变组PCI前的总胆固醇(TC)高于ISR组及无新发病变组,LDL-C及ApoB高于无新发病变组(P＜0.05).复查CAG前,支架外病变组TC高于无新发病变组,LDL-C及ApoB高于无新发病变组及ISR组;ISR组ApoB高于无新发病变组,差异均有统计学意义(P＜0.05).多元Logistic回归分析结果显示,复查CAG前ApoB升高是冠状动脉支架植入术后ISR的危险因素(OR=1.27,95％CI 1.08 ～ 1.50,P=0.01,);复查CAG前ApoB、LDL-C升高是PCI后支架外病变的危险因素(分别为OR=1.54,95％ CI1.28～1.86,P＜0.01;OR=1.89,95％ CI l.03～3.47,P=0.04).结论 降低LDL-C可以减少PCI后支架外病变的发生,降低ApoB可以减少PCI后ISR及支架外病变的发生.%Objective To explore the correlation of low density lipoprotein cholesterol(LDL-C) and apolipoprotein B (ApoB) with postoperative coronary artery lesions after percutaneous coronary intervention(PCI).Methods According to the results of reexamination by coronary angiography(CAG),1 410 patients which accepted reexamination by CAG,were diagnosed of acute coronary syndrome and accepted PCI were divided into no new lesions group(750 cases),in-stent restenosis(ISR) group(210 cases) and out-stent lesions group (450 cases).Blood lipid and other indexes were tested before PCI and reexamination by CAG in patients of the three group and the results were compared and analyzed.Results LDL-C and ApoB before reexamination by CAG were significantly different between the three groups(P ＜ 0.05).Total cholesterol(TC) before PCI in out-stent lesions group was higher than those in ISR group and no new lesions group,LDL-C and ApoB were higher than those in no new lesions group (P ＜0.05).Before reexamination by CAG,TC in out-stent lesions group was higher than that in no new lesions group and LDL-C and ApoB were higher than those in no new lesions group and ISR group,meanwhile,ApoB in ISR group was higher than that in no new lesions group (P ＜ 0.05).Multiple Logistic regression analysis showed that increased ApoB before reexamination by CAG was a risk factor for ISR after PCI (OR =1.27,95％ CI 1.08-1.50,P =0.01)and increased ApoB and LDL-C before reexamination by CAG were risk factors for out-stent lesions after PCI (OR =1.54,95％ CI 1.28-1.86,P ＜ 0.01.OR =1.89,95％ CI 1.03-3.47,P =0.04).Conclusion Lowering LDL-C can reduce the occurrence of out-stent lesions after PCI.Lowering ApoB can reduce the occurrence of ISR and out-stent lesions after PCI.
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