摘要
目的探讨残余胆固醇(RC)与青年急性非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉病变严重程度和预后的相关性。方法回顾性纳入2018年1月至2023年1月于沧州市人民医院首次诊断为NSTEMI的患者754例,根据患者发病年龄分为青年组(<45岁)143例和中老年组(≥45岁)611例,所有患者均接受规范化冠心病治疗,收集患者一般临床资料,并根据空腹血脂计算出RC。比较这两组一般资料并进行多因素logistic回归分析青年NSTEMI的影响因素。对青年组根据冠状动脉造影结果计算SYNTAX评分并进行随访,随访终点为发生主要不良心血管事件(MACE),根据青年组预后情况再分为MACE组(37例)和非MACE组(106例)。比较两组临床资料,多因素Cox比例风险回归分析青年NSTEMI患者MACE影响因素,采用Spearman相关分析法分析低密度脂蛋白胆固醇(LDL-C)、RC与SYNTAX评分的相关性。采用受试者工作特征曲线(ROC)评估RC和LDL-C对青年NSTEMI患者发生MACE的预测价值,并根据最佳截断值将青年NSTEMI患者分为高RC组和低RC组,Kaplan-Meier生存曲线比较RC分组组间非MACE率的差异。结果与中老年组相比,青年组男性和吸烟占例显著增多、尿酸、总胆固醇(TC)、甘油三酯(TG)、LDL-C、RC水平显著增高、高密度脂蛋白胆固醇(HDL-C)显著降低(P<0.01)。多因素二元Logistic回归分析结果显示,男性、吸烟史、尿酸、HDL-C、LDL-C、RC均为青年NSTEMI的影响因素(P<0.05);Spearman相关性分析显示,LDL-C(r=0.254,P=0.002)、RC(r=0.302,P<0.001)与SYNTAX评分呈正相关关系。青年NSTEMI患者MACE组的LDL-C水平、RC水平、SYNTAX评分均显著高于非MACE组(P<0.01)。多因素Cox回归分析结果显示,RC、LDL-C、SYNTAX评分均为青年NSTEMI患者发生MACE的独立危险因素(P<0.05)。RC预测青年NSTEMI患者发生MACE的AUC为0.767,敏感度为67.6%,特异度为77.4%,最佳截断值为0.935 mmol/L。生存曲线分析显示,青年NSTEMI患者高RC组和低RC组比较非MACE率差异有统计学意义(Log-rankχ^(2)=17.464,P<0.001)。结论RC是青年NSTEMI的独立危险因素,同时RC与青年NSTEMI患者冠状动脉病变严重程度正相关,并且是青年NSTEMI患者发生MACE的独立危险因素,对预后评估有一定价值。
Objective To investigate the correlation of residual cholesterol(RC)with the coronary artery lesion and prognosis in the young patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 754 patients with NSTEMI who were first diagnosed in Cangzhou People’s Hospital from January 2018 to January 2023 were enrolled.According to the age of onset,the patients were divided into the youth group(<45 years old)143 cases and the middle-aged and elderly group(≥45 years old)611 cases.All the patients received the standardized coronary heart disease treatment.The general clinical data of the patients were collected and the RC were calculated according to the fasting blood lipids.The data of the two groups were compared;multivariate logistic regression was used to analyze the influencing factors of NSTEMI in the young people.SYNTAX score was counted in the young group through coronary angiography.The young group were followed up and the endpoint of follow-up was the occurrence of major adverse cardiovascular events(MACE).According to the prognosis of the young group,they were divided into MACE group(n=37)and non-MACE group(n=106).The data of the two groups were compared.Multivariate Cox proportional hazard regression was used to analyze the influencing factors of MACE in the young NSTEMI patients.Spearman correlation analysis was used to analyze the correlation between low density lipoprotein cholesterol(LDL-C)and RC and SYNTAX score.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of RC and LDL-C for MACE in the young NSTEMI patients.According to the optimal survival curve analysis showed that there was significant difference in non-MACE rate between the high RC group and low RC group in the young NSTEMI patients.cut-off value,young NSTEMI patients were divided into high RC group and low RC group.Kaplan-Meier survival curve was used to compare the difference of non-MACE rate between RC groups.Results Compared with the middle-aged and elderly group,the proportions of male and smoking were significantly increased,the levels of uric acid,total cholesterol(TC),triglyceride(TG),LDL-C and RC were significantly increased and high density lipoprotein cholesterol(HDL-C)was significantly decreased in the young group(P<0.01).Multivariate binary logistic regression analysis showed that male,smoking history,uric acid,HDL-C,LDL-C and RC were all the related factors of NSTEMI in the young people(P<0.05).Spearman correlation analysis showed that LDL-C(r=0.254,P=0.002)and RC(r=0.302,P<0.001)were positively correlated with SYNTAX score.The LDL-C,RC and SYNTAX scores of the young NSTEMI patients in the MACE group were higher than those in the non-MACE group,and the difference was statistically significant(P<0.01).Multivariate Cox regression analysis showed that RC,LDL-C and SYNTAX score were the independent risk factors for MACE in the young NSTEMI patients.The AUC of RC was 0.767 in predicting MACE in the young NSTEMI patients,the sensitivity was 67.6 and the specificity was 77.4%,and the best cut-off value of RC was 0.935 mmol/L.Survival curve analysis showed that there was significant difference in the non-MACE rate between high RC group and low RC group in the young NSTEMI patients(Log-rankχ^(2)=17.464,P<0.001).Conclusion RC is the independent risk factor for the young NSTEMI and positively correlated with the severity of coronary artery disease in the young NSTEMI patients,which has certain value for the prognosis evaluation.
作者
白春兰
孙亚召
孟杰杰
BAI Chun-lan;SUN Ya-zhao;MENG Jie-jie(Department of Cardiology,Cangzhou People’s Hospital,Cangzhou 061000,China)
出处
《中国心血管病研究》
CAS
2024年第4期303-309,共7页
Chinese Journal of Cardiovascular Research
基金
河北省医学科学研究课题计划(20211161)。
关键词
残余胆固醇
青年人
急性非ST段抬高型心肌梗死
冠状动脉病变程度
预后
Residual cholesterol
Young people
Acute non-ST-segment elevation myocardial infarction
The coronary artery lesion
Prognosis
