Mori Kenta, Ishida Tatsuro, Tsuda Shigeyasu, Oshita Toshihiko, Shinohara Masakazu, Hara Tetsuya, Irino Yasuhiro, Toh Ryuji, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine.
J Atheroscler Thromb. 2017 Feb 1;24(2):123-132. doi: 10.5551/jat.32615. Epub 2016 Aug 4.
Clinical trials suggest that residual risks remain for coronary artery disease (CAD) during low-density lipoprotein cholesterol (LDL-C) lowering therapy. We aimed to investigate the role of exogenous lipids in the prognosis of CAD after percutaneous coronary intervention (PCI).
A total of 145 patients with CAD, who underwent elective PCI, and 82 non-CAD (control) patients were enrolled in this study. CAD patients underwent follow-up coronary angiography 6-9 months after PCI, and were classified into three groups: 1) patients who showed in-stent restenosis (ISR) in the original stented segment, 2) patients with other non-target coronary atherosclerotic lesions (de novo), and 3) patients with neither ISR nor a de novo lesion. Biochemical analyses were performed on fasting serum samples at the time of follow-up coronary angiography.
Despite the controlled serum LDL-C levels, CAD patients with statin showed elevated cholesterol absorption marker campesterol/total cholesterol (TC), synthesis marker lathosterol/TC, campesterol/lathosterol ratio, and apolipoprotein B48 (apoB48) concentration compared with non-CAD patients. The high campesterol/TC, campesterol/lathosterol ratio, and apoB48 concentration were associated with de novo lesion progression after PCI. In stepwise multivariate logistic regression analysis, campesterol/TC and apoB48 concentrations were independent risk factors for de novo lesion progression in statin-treated CAD patients after PCI.
The increase of cholesterol absorption marker and apoB48 concentration may lead to the progression of de novo lesions, and these markers may represent a residual risk during statin treatment after PCI.
临床试验表明，在低密度脂蛋白胆固醇（LDL-C）降低治疗期间，冠状动脉疾病（CAD）仍存在残余风险。我们旨在研究外源性脂质在经皮冠状动脉介入治疗（PCI）后CAD预后中的作用。
本研究共纳入145例接受择期PCI的CAD患者和82例非CAD（对照）患者。CAD患者在PCI后6-9个月接受随访冠状动脉造影，并分为三组：1）在原支架置入段出现支架内再狭窄（ISR）的患者；2）有其他非靶冠状动脉粥样硬化病变（新生病变）的患者；3）既无ISR也无新生病变的患者。在随访冠状动脉造影时，对空腹血清样本进行生化分析。
尽管血清LDL-C水平得到控制，但与非CAD患者相比，接受他汀类药物治疗的CAD患者的胆固醇吸收标志物菜油甾醇/总胆固醇（TC）、合成标志物羊毛甾醇/TC、菜油甾醇/羊毛甾醇比值和载脂蛋白B48（apoB48）浓度升高。高菜油甾醇/TC、菜油甾醇/羊毛甾醇比值和apoB48浓度与PCI后新生病变进展相关。在逐步多因素逻辑回归分析中，菜油甾醇/TC和apoB48浓度是他汀类药物治疗的CAD患者PCI后新生病变进展的独立危险因素。
胆固醇吸收标志物和apoB48浓度的升高可能导致新生病变的进展，这些标志物可能代表PCI后他汀类药物治疗期间的残余风险。
