Xu Hai-yan, Qiao Shu-bin, Li Jian-jun, Yang Yue-jin, Zhang Jia-fen, Xu Bo, Xie Gao-qiang, Dong Qiu-ting
Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2009 Aug 25;89(32):2249-52.
To assess the different effects of inflammation and lipid levels before and after PCI on in-stent restenosis and lesion progression.
Patients were studied who successfully underwent PCI with stent implantation and were received coronary angiography again after three months to one year. In-stent restenosis was observed in 94 patients and lesion progression in 65 patients. No restenosis and lesion progression occurred in 307 cases. Total cholesterol (TC), total triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), C reactive protein (CRP) and high sensitive CRP (hsCRP) were determined before PCI and at time of re-angiography.
The levels of CRP and hsCRP before PCI in restenosis group were higher than those with no restenosis (CRP: median = 3.61 mg/L and 2.86 mg/L respectively, hsCRP: median = 1.56 mg/L and 0.89 mg/L respectively, P < 0.05). There was also difference between two groups in CRP levels at post-PCI follow-ups (median = 1.92 mg/L and 1.14 mg/L respectively, P < 0.05). The rate of restenosis in patients with hsCRP > 2 mg/L before PCI was higher than that in patients with hsCRP < or = 2 mg/L (Chi(2) = 4.32, P < 0.05). Logistic regression showed that the risk of restenosis markedly increased in patients with hsCRP > 2 mg/L (OR = 1.89, 95% CI 1.031-3.465). During the follow-up angiography the levels of TC, LDL-C and non-HDL-C were higher in lesion progression group than those in control group [TC (4.62 +/- 1.14) mmol/L and (4.26 +/- 1.01) mmol/L, LDL-C (2.51 +/- 0.93) mmol/L and (2.25 +/- 0.75) mmol/L, non-HDL-C (3.52 +/- 1.12) mmol/L and (3.20 +/- 0.98) mmol/L, respectively, P < 0.05).
Inflammation state before and after PCI are the risk factors for in-stent restenosis, while the levels of TC, LDL-C and non-HDL-C are the important risk factors for other coronary lesion progression. Secondary prevention should be long-term emphasized and strengthened after PCI.
评估经皮冠状动脉介入治疗（PCI）前后炎症和血脂水平对支架内再狭窄及病变进展的不同影响。
研究成功接受支架植入PCI且在3个月至1年后再次接受冠状动脉造影的患者。观察到94例患者发生支架内再狭窄，65例患者出现病变进展。307例未发生再狭窄和病变进展。在PCI前及再次血管造影时测定总胆固醇（TC）、总甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、C反应蛋白（CRP）和高敏CRP（hsCRP）。
再狭窄组PCI前的CRP和hsCRP水平高于无再狭窄组（CRP：中位数分别为3.61mg/L和2.86mg/L，hsCRP：中位数分别为1.56mg/L和0.89mg/L，P<0.05）。PCI后随访时两组的CRP水平也存在差异（中位数分别为1.92mg/L和1.14mg/L，P<0.05）。PCI前hsCRP>2mg/L患者的再狭窄率高于hsCRP≤2mg/L的患者（χ2=4.32，P<0.05）。Logistic回归显示，hsCRP>2mg/L患者的再狭窄风险显著增加（OR=1.89，95%CI 1.031 - 3.465）。在随访血管造影期间，病变进展组的TC、LDL-C和非HDL-C水平高于对照组[TC（4.62±1.14）mmol/L和（4.26±1.01）mmol/L，LDL-C（2.51±0.93）mmol/L和（2.25±0.75）mmol/L，非HDL-C（3.52±1.12）mmol/L和（3.20±0.98）mmol/L，P<0.05]。
PCI前后的炎症状态是支架内再狭窄的危险因素，而TC、LDL-C和非HDL-C水平是其他冠状动脉病变进展的重要危险因素。PCI后应长期强调并加强二级预防。
