山东医药

目的 观察冠状动脉粥样硬化性心脏病（简称冠心病）患者药物治疗前后血清残余胆固醇（RC）水平对冠状动脉病变进展的影响，并探讨其预测价值。方法 选择首次经冠状动脉造影明确诊断为冠心病后仅接受药物治疗的患者166例，根据首次确诊及治疗6个月后的冠状动脉造影检查结果，采用Gensini评分标准判断冠状动脉病变进展情况。收集患者的一般资料及治疗前实验室检查指标，治疗6个月后检测血清中的血脂相关指标，并计算治疗前后血清RC。采用多因素Logistic回归分析冠心病药物治疗患者冠状动脉病变进展的独立危险因素。绘制治疗前及治疗后血清RC预测冠心病药物治疗患者冠状动脉病变进展的受试者工作特征（ROC）曲线，分析其预测效能。结果 166例患者药物治疗6个月后冠状动脉病变进展87例、未进展79例。冠状动脉病变进展与未进展患者的一般资料及实验室检查指标比较差异均无统计学意义（P均>0.05）。冠状动脉病变进展与未进展患者治疗前血清RC分别为0.58(0.35,0.84)、0.48(0.36,0.62)mmol/L，两者比较P<0.05；治疗后血清RC分别为0.85(0.63,1.24)、0.49(0.37,0.63)mmol/L，两者比较P<0.05。多因素Logistic回归分析结果显示，治疗前血清RC升高（OR=1.094,95%CI:0.957～1.251,P>0.05）不是影响冠心病药物治疗患者冠状动脉病变进展的独立危险因素，治疗后血清RC升高（OR=1.365,95%CI:1.209～1.541,P<0.05）是其独立危险因素。ROC曲线分析结果显示，治疗前血清RC预测冠心病药物治疗患者冠状动脉病变进展的曲线下面积（AUC）为0.626(95%CI:0.540～0.711)，截断值为0.74 mmol/L时，灵敏度为0.368，特异度为0.937；治疗后血清RC预测冠心病药物治疗患者冠状动脉病变进展的AUC为0.815(95%CI:0.747～0.882)，截断值为0.67 mmol/L时，灵敏度为0.724，特异度为0.848。结论 冠心病药物治疗后冠状动脉病变进展患者治疗前后的血清RC均较高，治疗后血清RC较高与其冠状动脉病变进展有关，可作为冠状动脉病变进展的预测指标之一。

Objective To investigate the effects of pre-and post-pharmacotherapy serum remnant cholesterol(RC) levels on coronary lesion progression in patients with coronary atherosclerotic heart disease(abbreviated as coronary heart disease) and to evaluate their predictive value. Methods We selected 166 patients with coronary heart disease initially confirmed by coronary angiography who were treated with medications only, and used Gensini score to assess the progression of coronary lesion according to the first and the follow-up coronary angiography after an interval of no less than 6months. We collected baseline data, pre-pharmacotherapy laboratory parameters, and post-pharmacotherapy lipid parameters, and calculated the per-and post-pharmacotherapy serum RC levels. Multivariate Logistic regression analysis was performed to identify independent risk factors for coronary lesion progression in patients with coronary heart disease undergoing pharmacotherapy. We drew an receiver operating characteristic(ROC) curve to evaluate the predictive efficacy of perand post-pharmacotherapy serum RC levels for coronary lesion progression in patients with coronary heart disease.Results Among 166 patients receiving pharmacotherapy for no less than 6 months, coronary lesion progression was observed in 87 cases, while 79 cases showed no progression. The baseline data and laboratory parameters between the coronary lesion progression group and non-progression group showed no statistically significant differences(all P>0. 05). The pre-pharmacotherapy serum RC levels in the coronary lesion progression group and non-progression group were 0. 58(0. 35, 0. 84) and 0. 48(0. 36, 0. 62) mmol/L, respectively, with statistically significant difference(P<0. 05); the postpharmacotherapy serum RC levels were 0. 85(0. 63, 1. 24) and 0. 49(0. 37, 0. 63), respectively, with statistically significant difference(P<0. 05). Multivariate Logistic regression analysis revealed that elevated pre-pharmacotherapy serum RC(OR=1. 094, 95% CI: 0. 957-1. 251, P=0. 188) was not an independent risk factor for coronary lesion progression in patients with coronary heart disease, while elevated post-pharmacotherapy serum RC(OR=1. 365,95% CI: 1. 209-1. 541, P<0. 05) was an independent risk factor. The AUC of pre-pharmacotherapy serum RC for diagnosing coronary lesion progression was 0. 626(95% CI: 0. 540-0. 711), and the cut-off value was 0. 74 mmol/L with a sensitivity of 0. 368 and a specificity of 0. 937. The AUC of post-pharmacotherapy serum RC for diagnosing coronary lesion progression was 0. 815(95% CI: 0. 747-0. 882), and the cut-off value was 0. 67 mmol/L with a sensitivity of 0. 724 and a specificity of 0. 848.Conclusions The pre-and post-pharmacotherapy serum RC levels are both high in the coronary lesion progression patients with coronary heart disease. Elevated post-pharmacotherapy serum RC is associated with coronary lesion progression and can be used as one of the predictive indicators for coronary lesion progression.