摘要
目的 分析C反应蛋白(CRP)、非高密度脂蛋白胆固醇(非HDL-C)对老年冠心病风险的影响及其交互作用关系.方法 回顾性选取 2019 年 9 月至 2023 年 8 月于沧州市人民医院行冠状动脉造影检查的 1 185 例老年患者作为研究对象,根据冠状动脉造影结果分为冠心病组(606例)和非冠心病组(579 例),比较两组临床资料.采用logistic回归分析CRP、非HDL-C与冠心病风险间的关系.采用受试者工作特征(ROC)曲线评估CRP、非HDL-C对冠心病风险的影响,并依据最佳截断值将连续型变量转为二分类变量,分析高CRP 和高非HDL-C同时存在对老年冠心病风险的影响,计算交互作用指标包括相对超额危险度(RERI)、交互作用归因比(AP)和交互作用指数(SI).结果 本组患者平均年龄(67.4±5.0)岁,其中男性 608 例(51.3%).冠心病组与非冠心病组的吸烟比例、糖尿病比例、高血压比例、体质指数(BMI)、同型半胱氨酸、血尿酸、总胆固醇、HDL-C、低密度脂蛋白胆固醇、CRP和非HDL-C比较,差异均有统计学意义(均为P<0.001).调整混杂因素后,多因素logistic回归分析显示,CRP(OR=1.190,95%CI:1.118～1.266,P<0.001)、非 HDL-C(OR=2.493,95%CI:2.173～2.861,P<0.001)是老年冠心病的独立危险因素.CRP、非HDL-C对冠心病诊断价值的ROC曲线下面积为 0.684(95%CI:0.654～0.714,P<0.001)、0.736(95%CI:0.708～0.763,P<0.001).依据ROC曲线最佳截断值,以CRP>2.12 mg/L定义为高CRP,CRP≤2.12 mg/L定义为低CRP;以非HDL-C>2.82 mmol/L定义为高非HDL-C,非HDL-C≤2.82 mmol/L定义为低非HDL-C.以低CRP且低非HDL-C为参照组进行比较,调整混杂因素后,多因素logistic回归分析显示,高CRP和高非HDL-C同时存在的老年人冠心病风险是参照组人群的 31.271 倍,交互作用指标RERI(95%CI)为 12.041(0.317～23.766)、AP(95%CI)为 0.385(0.163～0.607)和 SI(95%CI)为 1.660(1.140～2.418).结论 CRP和非HDL-C可作为评估老年人冠心病风险的标志物,这两项指标与老年人冠心病风险存在相加交互作用.
Abstract
Objective To analyze the individual and interactive effects of C-reactive protein(CRP)and non-high-density lipoprotein cholesterol(non-HDL-C)on the risk of coronary heart disease(CHD)in the elderly.Methods This was a retrospective study.A total of 1 185 elderly patients who underwent coronary angiography at the Cangzhou People's Hospital from September 2019 to August 2023 were selected as the subjects for this study.Based on the results of the coronary angiography,they were categorized into two groups:the CHD group(606 cases)and the non-CHD group(579 cases).Clinical data between the two groups were compared.Logistic regression analysis was conducted to assess the relationship between CRP,non-HDL-C,and CHD risk.Receiver operation characteristic(ROC)curves were used to evaluate the predictive value of CRP and non-HDL-C for CHD risk.The combined effect of elevated CRP and high non-HDL-C on CHD risk and interaction indices,including the relative excess risk due to interaction(RERI),the attributable proportion due to interaction(AP),and the synergy index(SI),were analyzed.Results The average age of the patients was 67.4±5.0 years,with 608 male cases(51.3%).There were statistically significant differences between the CHD group and the non-CHD group in smoking rates,diabetes prevalence,hypertension prevalence,body mass index(BMI)and serum levels of homocysteine,uric acid,total cholesterol,HDL-C,low-density lipoprotein cholesterol,CRP,and non-HDL-C(all P<0.001).After adjusting for confounding factors,multifactorial logistic regression analysis revealed that CRP(OR=1.190,95%CI:1.118-1.266,P<0.001)and non-HDL-C(OR=2.493,95%CI:2.173-2.861,P<0.001)were independent risk factors for CHD in the elderly.The ROC area under the curve(AUC)for the diagnostic value of CRP and non-HDL-C for CHD was 0.684(95%CI:0.654-0.714,P<0.001)and 0.736(95%CI:0.708-0.763,P<0.001),respectively.Using the optimal cutoff values from the ROC curves,CRP>2.12 mg/L was defined as high CRP,CRP≤2.12 mg/L as low CRP;similarly,non-HDL-C>2.82 mmol/L was defined as high non-HDL-C,non-HDL-C≤2.82 mmol/L as low non-HDL-C.Comparing with the reference group of low CRP and low non-HDL-C,after adjusting for confounding factors,multifactorial logistic regression analysis revealed that the risk of CHD with high CRP and high non-HDL-C concurrently was 31.271 times higher than that of the reference group.The interaction indices were calculated as follows:RERI(95%CI)was 12.041(0.317-23.766),AP(95%CI)was 0.385(0.163-0.607),and SI(95%CI)was 1.660(1.140-2.418).Conclusions CRP and non-HDL-C can be used as markers to assess the risk of CHD in elderly patients,and these two indicators have additive interactions with the risk of CHD.
维普
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