| Background and aims:Coronary artery disease(CAD)is the leading cause of death all around the world,which leads to a heavy economic burden on both family and society,has been a difficult problem.At present,eoronary angiography(CAG)is the "golden standard" for the diagnosis of coronary artery disease,which is invasive,expensive and also need a practiced team to perform because of these disadvantages,it is not a good choice to use CAG for screening patients with CAD or evaluating the severity of coronary artery lesions.It is said that some markers in blood may be associated with CAD occurrence and development,and have the potency to work as predictors for that.Although some studies demonstrated the markers of lipid or inflammation can be predictor for CAD,few of them foeus on the severity of eoronary artery lesions,that is why we designed this study.We aim to investigate the relationship between serum lipid,inflammatory markers and CAD,the severity of coronary artery lesions,or the prognosis in order to find a noninvasive method to screen patient with CAD or evaluate the lesion progress,which may help to achieve more precise treatment as well as low the risk and cost.Methods:2603 patients underwent coronary angiography from January 2015 to December 2017 at our center were included.Patients were grouped into two categories according to the results of CAG:CAD group(1426 patients)and non-CAD group(1177 patients).We collected information of pre-CAG basic clinical characteristics,angiographic results and post-CAG medicine therapy.Multivariate logistic regression was used to identify independent risk factors for CAD.In order to reveal the association between markers and severity of coronary artery lesions,we used multivariate linear regression to identify the independent risk factors.There were 417 patients who had received PCI underwent CAG again after 12 months(±3 months),according to the results of CAG whether there was in-stent restenosis,we grouped those patients into:non-ISR group(327 patients)and ISR group(90 patients).Serum lipid and inflammatory markers were compared between first CAG and second CAG After that we used multivariate logistic regression to identify the risk factors for the prognosis.Results:Aging(OR=1.039,95%CI:1.025-1.053,P<0.001)?male(OR=2.191,95%CI:1.728-2.778,P<0.001)?hypertension(OR=2.060,95%CI:1.714-2.475,P<0.001).diabetes mellitus(OR=1.813,95%CI:1.435-2.290,P<0.001)?smoking(OR=1.698,95%CI:1.219-2.365,P0.002)?higher lipoprotein a(Lp(a))(OR=1.014,95%CI:1.010-1.018,P<0.001)?higher white blood cell(WBC)(OR=1.068,95%CI:1.023-1.116,P=0.003)?higher fasting blood-glucose(FBG)(OR=1.056,95%CI:1.011-1.102,P=0.014)were the independent risk factors of CAD,while HDL-C(OR=0.712,95%CI:0.515-0.986,P=0.041)?mean platelet volume(MPV)(OR=0.84,95%CI:0.790-0.893,P<0.001)?total bilirubin(TBil)(OR=0.961,95%CI:0.949-0.973,P<0.001)played the protective roles in CAD.Aging(P=0.083,P=0.002)?diabetes mellitus(p=0.078,P=0.007)?higher Lp(a)(p=0.100,P=0.001)?higher WBC(?=0.077,P=0.004)?higher NLR(?=0.136,P<0.001)were the independent risk factors of severity of coronary artery lesions,while higher HDL-C(?=-0.132,P<0.001)was a protective factor.Threshold of Gensini score used in other studies were performed in ROC curve for each factor.Among these ROC results(P<0.05),we find the maximum AUC for HDL-C,Lp(a),WBC,NLR when Gensini score was 15,45,42,55 in sequence.There were 417 patients underwent CAG again in 12 months(±3 months)after the first PCI,among non-ISR group,their total cholesterol(TG)(3.92±1.11 v 3.59±0.92,P<0.001)?low density lipoprotein cholesterol(LDL-C)(1.99±0.83 vs 1.69±0.63,P<0.001)?CRP(3.23±8.01 vs 1.63±2.50,P<0.001)and WBC(6.11±1.73 vs 5.76±1.46,P<0.001)levels showed a significant decline compared to the results 1 year ago.While ISR group only had a decline in TG(4.02±1.55 vs3.69±1.08,P=0.029).Higher CRP(OR=1.072,95%CI:1.005-1.144,P=0.036)and higher WBC(OR=1.167,95%CI:1.003-1.358,P=0.046)before the second CAG were the independent risk factors of 1 year prognosis(in-stent restenosis).And higher Gensini score(OR=1.010,95%CI:1.001-1.019,P=0.034)and higher creatinine(OR=1.023,95%CI:1.009-1.037,P=0.001)before the first CAG can be predictors for the risk of atherosclerosis progress.Conclusion:Our study demonstrated Lp(a),WBC were not only the independent risk factors of CAD but also of the severity.HDL-C played the protective role both in CAD and severity of coronary lesions.NLR is one of the independent risk factors for severity of coronary artery lesions.And we also found the relationship between CRP,WBC and in-stent restenosis.All of the results showed that both dyslipidemia and inflammation reaction play the important role in CAD or atherosclerosis.It is of importance for us to put inflammatory markers in a vital place just like where the lipid markers are.CAD patients may benefit more when they accept the medicine therapy of anti-inflammtion on basis of lipid-modulating therapy.For those who has higher Gensini score and serum creatinine level,it is better to have more follow-up. |
PDF Full Text Request