血浆致动脉粥样硬化指数与冠状动脉支架内新生脂质斑块相关性分析

Analysis of the correlation between atherogenic index of plasma and coronary in-stent neoatheroma

摘要:

目的]探讨冠状动脉支架植入术后血浆致动脉粥样硬化指数(AIP)与支架内新生脂质斑块(ISNAM)的相关性。 [方法]连续入选2019年1月—2021年12月于本院心内科住院治疗并行冠状动脉内光学相干断层成像检查的冠状动脉支架内再狭窄(ISR)患者164例。根据是否存在支架内新生脂质斑块分为ISNAM组(75例)和非ISNAM组(non-ISNAM组,89例)。比较两组患者AIP及其他临床特征,采用Logistic回归分析法评价支架内新生脂质斑块发生的风险,受试者工作特征(ROC)曲线分析AIP的预测效能。 [结果]ISNAM组因急性冠脉综合征入院比例、合并高血压比例较non-ISNAM组显著升高(P＜0.05),糖化血红蛋白水平为non-ISNAM组的1.1倍(P＜0.05),AIP为non-ISNAM组的2.4倍(P＜0.01)。Logistic回归分析显示,支架植入时间较长、合并高血压病、AIP升高为冠状动脉支架内新生脂质斑块的独立危险因素。AIP预测新生脂质斑块的ROC曲线下面积(AUC)为0.664(95%CI:0.561~0.767,P＝0.003)。 [结论]AIP升高是冠状动脉支架植入术后支架内新生脂质斑块的独立危险因素,除严格控制低密度脂蛋白胆固醇水平外,还应改善整体血脂谱的代谢异常以改善患者预后。

Abstract:

Aim To investigate the correlation between atherogenic index of plasma (AIP) and the occurrence of coronary in-stent neoatheroma (ISNAM) after coronary stent implantation. Methods A total of 164 consecutive patients with coronary in-stent restenosis (ISR) who were admitted to the Department of Cadiology, Beijing Anzhen hospital and underwent coronary intravascular optical coherence tomography from January 2019 to December 2021 were enrolled. Patients were divided into ISNAM group (75 cases) and non-ISNAM (89 cases) based on the presence of ISNAM. AIP and other clinical features were compared between the two groups. Logistic regression analysis was used to evaluate the risk of ISNAM occurrence. The receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of AIP.Results The proportions of patients admitted for acute coronary syndrome (ACS) and patients with hypertension in the ISNAM group were significantly higher than those in the non-ISNAM group (P＜0.05). The glycated hemoglobin level in the ISNAM group was 1.1 times that of the non-ISNAM group (P＜0.05), and the AIP was 2.4 times that of the non-ISNAM group (P＜0.01). Logistic regressions analysis showed that longer duration since coronary stent implantation, hypertension, and elevated AIP were independent risk factors for coronary ISNAM. The area under the curve (AUC) of AIP for predicting neoatheroma was 0.664 (95%CI:0.561～0.767, P＝0.003). Conclusion Elevated AIP was an independent risk factor for ISNAM after coronary stent implantation. Beyond strict control of low density lipoprotein cholesterol, clinicians should also improve the overall lipid profile to correct metabolic abnormalities and enhance patient prognosis.