摘要
目的应用血管内超声评估冠心病合并非酒精性脂肪肝(NAFLD)患者经皮冠状动脉介入治疗(PCI)后1年支架内再狭窄(ISR)发生情况及新生斑块特征,探讨NAFLD对ISR的影响。方法2021年5—9月秦皇岛市第一医院初次行PCI的冠心病患者200例,根据是否合并NAFLD分为合并NAFLD组100例和未合并NAFLD组100例,比较2组基线生化指标、支架直径、支架长度等。PCI后均给予冠心病规范治疗,随访1年时行冠状动脉造影及血管内超声评估支架内新生斑块负荷量及斑块性质,比较合并NAFLD组与未合并NAFLD组ISR发生率、生化指标等。根据PCI后1年是否发生ISR将200例患者分为发生ISR组19例和未发生ISR组181例,比较2组高血压、糖尿病、NAFLD比率及支架直径、支架长度等;采用多因素logistic回归分析冠心病患者PCI后1年发生ISR的影响因素。结果合并NAFLD组基线三酰甘油[(3.52±0.22)mmol/L]、总胆固醇[(7.78±0.34)mmol/L]、低密度脂蛋白胆固醇[(3.75±0.18)mmol/L]、血尿酸[(548.33±71.46)μmol/L]、血同型半胱氨酸[(18.57±4.22)μmol/L]、C反应蛋白[(12.32±0.37)mg/L]水平及稳态模型胰岛素抵抗指数(4.53±0.91)均高于未合并NAFLD组[(2.09±0.24)mmol/L、(5.51±1.09)mmol/L、(2.32±0.39)mmol/L、(412.99±97.56)μmol/L、(14.99±5.37)μmol/L、(7.21±0.33)mg/L、2.97±0.69](P<0.05),高血压和糖尿病比率、高密度脂蛋白胆固醇水平、支架直径、支架长度与未合并NAFLD组比较差异均无统计学意义(P>0.05)。合并NAFLD组PCI后1年ISR比率(17.0%)、支架内新生斑块负荷量[(43.17±10.99)%]、C反应蛋白水平[(6.39±0.77)mg/L]、稳态模型胰岛素抵抗指数(2.33±0.76)均高于未合并NAFLD组[2.0%、(26.14±10.11)%、(4.21±0.33)mg/L、1.88±0.75](P<0.05),三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血尿酸、血同型半胱氨酸水平与未合并NAFLD组比较差异均无统计学意义(P>0.05)。合并NAFLD组支架内新生斑
Objective To evaluate the in-stent restenosis(ISR)one year after percutaneous coronary intervention(PCI)by intravascular ultrasonography(IVUS)and the new plaque characteristics in coronary heart disease(CHD)patients with non-alcoholic fatty liver disease(NAFLD),and to investigate the influence of NAFLD on ISR.Methods Totally200 patients were diagnosed with CHD by primary PCI in the First Hospital of Qinhuangdao from May to September,2021.According to the presence of NAFLD,200 patients were divided into NAFLD group(n=100)and non-NAFLD group(n=100),and the baseline biochemical indicators,stent diameter and stent length were compared between two groups.Both two groups were given standardized anti-CHD therapy after PCI.All patients were followed up for one year to assess the new stent plaque load and plaque property by coronary angiography and IVUS.The ISR rate and biochemical indicators were compared between two groups.According to the presence of ISR one year after PCI,200 patients were divided into ISR group(n=19)and non-ISR group(n=181),and the percentages of patients with hypertension,diabetes and NAFLD,stent diameter and stent length were compared between two groups.The influencing factors of ISR one year after PCI were analyzed by multivariate logistic regression.Results The baseline levels of triacylglycerol,total cholesterol,low-density lipoprotein cholesterol,blood uric acid,homocysteine,C-reactive protein,and homeostasis model assessment of insulin resistance were higher in NAFLD group[(3.52±0.22)mmol/L,(7.78±0.34)mmol/L,(3.75±0.18)mmol/L,(548.33±71.46)μmol/L,(18.57±4.22)μmol/L,(12.32±0.33)mg/L,4.53±0.91]than those in non-NAFLD group[(2.09±0.24)mmol/L,(5.51±1.09)mmol/L,(2.32±0.39)mmol/L,(412.99±97.56)μmol/L,(14.99±5.37)μmol/L,(7.21±0.33)mg/L,2.97±0.69](P<0.05),and there were no significant differences in the percentages of patients with hypertension and diabetes,high-density lipoprotein cholesterol,stent diameter and stent length between two groups(P>0.05).The ISR rate,new stent plaque lo
作者
陈明
王晶
谭强
CHEN Ming;WANG Jing;TAN Qiang(Department of Cardiovascular Medicine,the First Hospital of Qinhuangdao,Qinhuangdao,Hebei 066000,China;Department of Hematology,the First Hospital of Qinhuangdao,Qinhuangdao,Hebei 066000,China)
出处
《中华实用诊断与治疗杂志》
2023年第8期771-775,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河北省重点研发计划项目(20377756D)。
关键词
非酒精性脂肪肝
经皮冠状动脉介入治疗
支架内再狭窄
新生斑块
血管内超声
non-alcoholic fatty liver disease
percutaneous coronary intervention
in-stent restenosis
new plaque
intravascular ultrasonography
