残粒脂蛋白胆固醇水平与冠状动脉狭窄程度的相关性及其预测效能
Correlation and predictive efficacy analysis of residual lipoprotein-cholesterol and the severity of coronary artery stenosis
陶诗怡 1汤献文 2于林童 1杨德爽 3张兰鑫 4张瑾 1黄力 3吴佳芸2
作者信息
- 1. 100029 北京,北京中医药大学
- 2. 518000 深圳,北京中医药大学深圳医院(龙岗)
- 3. 100029 北京,中日友好医院
- 4. 100053 北京,中国中医科学院广安门医院
- 折叠
摘要
目的 探讨残粒脂蛋白胆固醇(RLP-C)与冠状动脉(冠脉)狭窄程度的相关性及其预测效能.方法 选择中日友好医院中西医结合心内科于2019年9月至2021年11月疑诊冠状动脉粥样硬化性心脏病(冠心病)患者602例,根据冠脉造影结果 分为冠心病组(CHD组,490例)和非冠心病组(nCHD组,112例).采集两组患者的基本资料和相关检查指标,依据公式计算RLP-C.比较CHD组和nCHD两组的基线特征,探索CHD组中不同冠脉狭窄程度RLP-C水平差异.多因素Logistic回归分析探讨冠心病的影响因素,Pearson相关性分析探索RLP-C与冠脉狭窄程度的相关性.通过受试者工作特征(ROC)曲线下面积(AUC)和决策曲线分析(DCA)综合判断RLP-C对中重度冠脉狭窄的预测效能.结果 多因素Logistic回归分析提示男性是冠脉狭窄的保护因素,年龄、吸烟史、糖尿病史、高胆固醇、高同型半胱氨酸、高糖化血红蛋白、高肱踝动脉脉搏波速度、高RLP-C和高Gensini积分是危险因素.低度狭窄组和中度狭窄组各指标,差异无统计学意义;除外性别这一指标,余下指标在低、重度狭窄组和中、重度狭窄组间差异均有统计学意义;吸烟史差异仅在低、重度狭窄组间具有统计学意义.Pearson相关性分析显示,RLP-C与Gensini积分呈正相关(r=0.526,P＜0.05).单独RLP-C指标的AUC为0.525(0.407,0.643),联合预测AUC为0.705(0.610,0.800);当阈值概率＞40%时,RLP-C联合预测中、重度冠脉狭窄比对所有患者实施干预方案更有利.结论 RLP-C是冠心病的重要危险因素,与冠脉狭窄程度呈正相关,对预测中重度冠脉狭窄有一定优势,与其他影响因素联合判断时临床效能更优.
Abstract
Objective To investigate the association between residual lipoprotein-cholesterol(RLP-C)and the severity of coronary artery stenosis and its predictive efficacy.Methods A total of 602 eligible patients with suspected CHD were included from September 2019 to November 2021 in the Department of Integrative Cardiology at China-Japan Friendship Hospital.According to the results of coronary angiography,490 patients were divided into the CHD group,and 112 patients were divided into the CHD group.Basic clinical features and relevant indicators were collected,and RLP-C was calculated according to the formula.The baseline characteristics of the CHD and the nCHD group were compared,and the difference of RLP-C level in the CHD group with different severity of coronary artery stenosis was explored.Multivariate logistic regression analysis was used to explore the influence factors of CHD,and Pearson correlation analysis was used to analyze the association between RLP-C and the severity of coronary artery stenosis.The predictive efficacy of RLP-C on moderate to severe coronary artery stenosis was synthetically evaluated by the area under the curve(AUC)of the receiver operating characteristic(ROC)and decision curve analysis(DCA).Results Multivariate logistic regression analysis showed that men were a protective factor against coronary artery stenosis.However,age,smoking history,diabetes history,high total cholesterol(TC)level,high homocysteine(HCY)level,high hemoglobin A1c(HbA1c)level,high brachial-ankle pulse wave velocity(baPWV)level,high RLP-C level and high Gensini score level were risk factors.There were no significant differences between the low and moderate stenosis groups.Except for the sex index,the remaining indicators were statistically significant between the low and severe stenosis and moderate and severe stenosis groups,respectively.The difference in smoking history was statistically significant only between the low and severe stenosis groups.Pearson correlation analysis showed that RLP-C was positively correlated with Gensini score(r=0.526,P＜0.05).The AUC for RLP-C was 0.525(0.407,0.643),and the combined AUC was 0.705(0.610,0.800);when the threshold probability was＞40%,the combined prediction of moderate to severe coronary stenosis was more favorable to predict the moderate to severe coronary artery stenosis than to made treatments for all patients.Conclusion RLP-C is an important risk factor for CHD,which is positively correlated with the severity of coronary artery stenosis.RLP-C has an advantage in predicting moderate to severe coronary artery stenosis and has better clinical power when combined with other factors.
关键词
冠状动脉粥样硬化性心脏病/冠状动脉狭窄/残粒脂蛋白胆固醇Key words
Coronary atherosclerotic heart disease/Coronary artery stenosis/Residual lipoprotein-cholesterol引用本文复制引用
基金项目
国家自然科学基金青年科学基金(81803925)
国家重点研发计划(2017YFC1700102)
广东省中医药局科研项目(20232146)
出版年
2024
NETL
NSTL
万方数据