APOA1 and Genisini score are closely associated with rapid progression of coronary atherosclerosis
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摘要: 目的 探讨冠状动脉(冠脉)粥样硬化快速进展患者的血脂动态演变过程及影响因素。方法 收集2018年6月—2022年2月在安徽医科大学第一附属医院心内科住院，且在10(5~12)个月内进行过两次冠脉造影的患者201例，根据冠脉病变的进展，分为缓慢进展组(100例)和快速进展组(101例)。比较两组病史、用药、血管造影特征和血脂演变，采用logistic回归分析影响因素。结果 与缓慢进展组比较，快速进展组患者第1次造影时的Gensini评分更高，病变血管数更多，APOA1的差值存在统计学差异。多因素logistic回归分析结果显示，冠脉粥样硬化快速进展的独立影响因子有冠脉Gensini评分(OR=1.020，P=0.000)和APOA1的差值(OR=6.097，P=0.029)。结论 Genisini评分及APOA1降低幅度是冠脉粥样斑块病变快速进展的独立影响因素。
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关键词:
- 冠状动脉粥样硬化 /
- 快速进展 /
- APOA1 /
- Genisini评分
Abstract: Objective To investigate the dynamic evolution of blood lipids and its influencing factors in patients with rapid progression of coronary artery atherosclerosis.Methods A total of 201 patients admitted to the Department of Cardiology, the First Affiliated Hospital of Anhui Medical University from June 2018 to February 2022 who underwent coronary angiography twice within 10(5-12) months were collected. According to the progression of coronary lesions, they were divided into slow progression group(100 cases) and fast progression group(101 cases). The medical history, medication, angiographic features and lipid evolution of the two groups were compared, and the influencing factors were analyzed by regression.Results Compared with the slow progression group, Gensini score increased and stenosis vessels were more as well as the difference of APOA1 decreased in the fast progression group. Multivariate logistic regression analysis showed that the Gensini score(OR=1.020, P=0.000) and APOA1(OR=6.097, P=0.029) were the independent factors in the rapid progression of coronary atherosclerosis.Conclusion Genisini score and APOA1 reduction are independent factors in the rapid progression of coronary atherosclerotic plaque.-
Key words:
- coronary atherosclerosis /
- rapid progression /
- APOA1 /
- Genisini score
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表 1 患者的基线资料
Table 1. Characteristics of patients
例(%), X±S, M(P25, P75) 项目 缓慢进展组(100例) 快速进展组(101例) χ2/t/Z P 年龄/岁 59.23±11.08 60.79±11.02 -1.002 0.318 BMI/(kg/m2) 25.22±3.89 24.62±3.21 1.182 0.238 男/女/例 60/40 69/32 1.512 0.219 吸烟史 27(27.0) 34(33.7) 1.055 0.304 饮酒史 18(18.0) 25(24.8) 1.362 0.243 高血压史 57(57.0) 53(52.5) 0.415 0.519 糖尿病史 22(22.0) 25(24.8) 0.212 0.645 冠心病史 21(21.0) 12(11.9) 3.045 0.081 血糖/(mmol/L) 5.46(4.96，6.63) 5.64(5.09，7.07) -0.751 0.453 两次造影间期/月 12.00(9.00，19.00) 7.00(4.00，11.00) -6.933 0.000 两次造影间期用药 胰岛素 4(4.0) 4(4.0) - 1.000 口服降糖药 15(15.0) 15(14.9) 0.001 0.976 β受体阻滞剂 55(55.0) 48(47.5) 1.124 0.289 ACEI/ARB类 30(30.0) 33(32.7) 0.167 0.683 钙通道阻滞剂 16(16.0) 15(14.9) 0.051 0.822 抗血小板聚集药 78(78.0) 80(79.2) 0.044 0.835 他汀类 77(77.0) 80(79.2) 0.143 0.705 
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表 2 患者的血管造影特征
Table 2. Angiographic characteristics of the patients
M(P25, P75) 参数 缓慢进展组(100例) 快速进展组(101例) χ2/Z P 冠脉Gensini评分/分 22.0(11.3，46.0) 46.0(24.0，67.0) -4.458 0.000 病变血管数/支 3.0(1.0，3.8) 3.0(2.0，4.0) -3.148 0.002 长病变或弥漫性病变/例(%) 21(21.0) 33(32.7) 3.485 0.062
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表 3 两组血脂比较
Table 3. Comparison of blood lipids between the two groups
X±S, M(P25, P75) 指标 缓慢进展组(100例) 快速进展组(101例) 第1次 第2次 差值 第1次 第2次 差值 TC/(mmol/L) 4.04±1.04 3.45±0.731) -0.58±0.89 3.95±1.13 3.43±0.941) -0.52±1.01 TG/(mmol/L) 1.40(1.03，1.99) 1.34(0.95，1.86) -0.22(-0.47，0.21) 1.43(1.16，2.04) 1.46±0.73 -0.22±0.66 HDL-C/(mmol/L) 1.03±0.24 1.05±0.24 0.02±0.14 1.04±0.27 0.98(0.85，1.15) -0.01±0.21 n-HDL-C/(mmol/L) 2.99±0.97 2.41±0.701) -0.58±0.87 2.91±1.02 2.41±0.861) -0.51±0.93 LDL-C/(mmol/L) 2.34±0.91 1.82±0.571) -0.52±0.80 2.29±0.93 1.63(1.29，2.24)1) -0.43±0.84 VLDL-C/(mmol/L) 0.52(0.38，0.74) 0.50(0.35，0.69) -0.08(-0.17，0.08) 0.53(0.43，0.75) 0.54±0.27 -0.08±0.24 APOA1/(g/L) 1.15±0.20 1.21±0.211) 0.06±0.18 1.17±0.22 1.17±0.22 -0.01±0.202) APOB/(g/L) 0.77±0.21 0.65±0.181) -0.12±0.18 0.77±0.23 0.60(0.53，0.74)1) -0.11±0.21 LP(a)/(mg/L) 175.50(77.25±386.25) 171.50(70.50，428.50) -3.50(-49.75，41.25) 179.00(90.50，442.00) 173.00(79.50，431.50) 2.00(-53.00，44.00) TC/HDL-C 4.01±1.18 3.40±0.841) 3.89±1.00 3.43±0.951) n-HDL-C/HDL-C 3.00±1.14 2.40±0.821) 2.88±1.00 2.43±0.951) LDL-C/HDL-C 2.32±0.95 1.80±0.591) 2.24±0.81 1.68(1.32，2.12)1) APOB/APOA1 0.69±0.23 0.56±0.171) 0.67±0.21 0.58±0.201) 与同组第1次比较，1)P＜0.05；与缓慢进展组比较，2)P＜0.05。
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表 4 冠脉粥样硬化快速进展的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of influencing factors for rapid progression of coronary atherosclerosis
变量 b SE Wald χ2 P OR 95%CI 冠脉Gensini评分 0.020 0.005 14.192 0.000 1.020 1.010~1.031 APOA1的差值 1.808 0.828 4.771 0.029 6.097 1.204~30.873
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