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目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后非罪犯病变进展的相关因素。方法 PCI术后再次行冠状动脉造影术ACS患者401例,其中非罪犯病变未进展363例为对照组,非罪犯病变进展为罪犯病变38例为观察组。收集2组临床资料,对一般资料及实验室检查结果进行比较,分析非罪犯病变进展的相关性。结果 2组年龄、性别、高血压病史、糖尿病史比例及血脂异常发生率比较差异均无统计学意义(P>0.05);观察组总蛋白[(69.96±4.00)g/L]、球蛋白[(27.04±2.76)g/L]、载脂蛋白B(apolipoprotein B,ApoB)[(1.03±0.26)g/L]、ApoB/载脂蛋白A1(apolipoprotein A1,ApoA1)(0.88±0.26)、血浆纤维蛋白原(fibrinogen,Fib)[(3.55±1.04)g/L]水平高于对照组[总蛋白(67.39±4.34)g/L、球蛋白(24.96±2.55)g/L、ApoB(0.85±0.30)g/L、ApoB/ApoA1(0.76±0.24)、Fib(3.20±0.73)g/L](P<0.05),总胆红素[(9.58±2.97)μmol/L]低于对照组[(18.43±8.46)μmol/L](P<0.05);多因素logistic分析,非罪犯病变进展与高水平总胆红素(OR=0.749,95%CI:0.047~11.991,P=0.003)、ApoB(OR=1.265,95%CI:1.070~13.038,P=0.032)、ApoB/ApoA1(OR=1.531,95%CI:0.943~10.351,P=0.000)、Fib(OR=1.664,95%CI:0.788~3.516,P=0.004)有关。结论高水平总胆红素、ApoB、ApoB/ApoA1、Fib为PCI术后非罪犯病变进展的可能影响因素,其中高水平总胆红素为保护因素,而高水平ApoB、ApoB/ApoA1、Fib为危险因素。
Objective To investigate the related factors of the progression of non-culprit lesions after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods One hundred and fifty-one ACS patients underwent coronary angiography after PCI were enrolled. Among them, 363 non-criminally advanced non-crib disease patients were the control group, and 38 non-criminally lesioned criminals lesions were observed. Two sets of clinical data were collected, the general information and laboratory test results were compared to analyze the non-criminally related to the progress of the lesion. Results There was no significant difference in the age, sex, history of hypertension, the history of diabetes mellitus and the incidence of dyslipidemia between the two groups (P> 0.05). The total protein [(69.96 ± 4.00) g / L] (27.04 ± 2.76) g / L], apolipoprotein B (1.03 ± 0.26) g / L, apolipoprotein A1 (ApoA1) The level of fibrinogen (Fib) [(3.55 ± 1.04) g / L] was higher than that of the control group [total protein 67.99 ± 4.34 g / L, globulin 24.96 ± 2.55 g / (P <0.05), total bilirubin [(9.58 ± 2.97) μmol / L] was lower than that of the control group [0.30 g / L, ApoB / ApoA1 0.76 ± 0.24 and Fib 3.20 ± 0.73 g / (18.43 ± 8.46) μmol / L] (P <0.05) .Multivariate logistic analysis showed that the progression of non-criminals was associated with high level of total bilirubin (OR = 0.749, 95% CI: 0.047-11.991, P = 0.003) (OR = 1.665, 95% CI: 1.070-13.038, P = 0.032), ApoB / ApoA1 (OR = 1.531,95% CI: 0.943-10.351, P = 0.000) ~ 3.516, P = 0.004). Conclusions High levels of total bilirubin, ApoB, ApoB / ApoA1 and Fib are possible influencing factors for the progression of non-culpable lesions after PCI. High levels of total bilirubin are the protective factors. High levels of ApoB, ApoB / ApoA1 and Fib are Risk factors.