残余胆固醇联合传统血脂指标对高血压前期患者发生主要不良心脑血管事件的预测价值  

Predictive value of remnant cholesterol combined with traditional blood lipid parameters for major adverse cardiovascular and cerebrovascular events in patients with prehypertension

作　　者：陈焱 王兆丰 徐峰[4] 徐清 周庆志 吕志博 陈胜岳 赵昕[1,3] CHEN Yan;WANG Zhaofeng;XU Feng;XU Qing;ZHOU Qingzhi;L Zhibo;CHEN Shengyue;ZHAO Xin(Department of Cardiovascular Medicine of the Second Affiliated Hospital of Dalian Medical University,Dalian,Liaoning 116023,China;Graduate School of Jinzhou Medical University,Jinzhou,Liaoning 121001,China;Department of Cardiovascular Medicine of General Hospital of Northern Theater Command,Shenyang,Liaoning 110016,China;Department of Respiratory Medicine,the NO.967 Hospital of PLA Joint Logistics Support Force,Dalian,Liaoning 116021,China)

机构地区：[1]大连医科大学附属第二医院心血管内科,辽宁省大连市116023 [2]锦州医科大学研究生院,辽宁省锦州市121001 [3]北部战区总医院心血管内科,辽宁省沈阳市110016 [4]中国人民解放军联勤保障部队第九六七医院呼吸内科,辽宁省大连市116021

出　　处：《中国动脉硬化杂志》2022年第4期335-340,共6页Chinese Journal of Arteriosclerosis

基　　金：科技部国家重点研发计划项目(2020YFC2004701)。

摘　　要：目的评估残余胆固醇联合传统血脂指标能否提高对高血压前期患者发生主要不良心脑血管事件(MACCE)的预测效能。方法回顾性分析2004年—2014年于北部战区总医院心血管内科因冠心病或疑似冠心病住院而进行冠状动脉造影检查的421例高血压前期患者的临床资料,记录患者住院时进行冠状动脉造影检查前的各类数据,包括年龄、性别、身高、体质量、血脂、血糖等基本临床基线资料。患者出院后长期随访(随访方式包括但不限于电话、短信等),当其因MACCE再入院时则纳入病例组,共95例;选取同期队列中为高血压前期但未发生MACCE的患者200例作为对照组。分析比较两组临床基线资料的差异、对各类血脂指标进行多因素Logistic回归分析明确其OR值、采用受试者工作特征(ROC)曲线分析各类血脂指标及联合预测因子对高血压前期患者发生MACCE的预测价值、采用MEDCALC软件对传统血脂指标及联合预测因子的曲线下面积进行比较。结果病例组残余胆固醇、低密度脂蛋白胆固醇(LDLC)、甘油三酯(TG)、总胆固醇(TC)、非高密度脂蛋白胆固醇(non-HDLC)、残余胆固醇/HDLC、LDLC/HDLC明显高于对照组,病例组高盐饮食人数、糖尿病患病人数也高于对照组,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,在校正性别、年龄(模型1)因素后,残余胆固醇、non-HDLC、TG、TC、残余胆固醇/HDLC、LDLC/HDLC均为导致高血压前期患者发生MACCE的独立预测因子(P<0.01)。ROC曲线分析残余胆固醇联合其他血脂指标预测高血压前期患者发生MACCE的AUC为0.704,而单用残余胆固醇或其他血脂指标预测高血压前期患者发生MACCE的AUC均小于联合预测因子的AUC;应用DELONG方法对联合预测因子的AUC与单独血脂指标的AUC进行比较发现,除non-HDLC显示临界阳性外,其他AUC差异均有统计学意义(P<0.05)。结论在高血压前期患者中,Aim To evaluate whether remnant cholesterol combined with traditional blood lipid parameters can improve the predictive efficacy for major adverse cardiovascular and cerebrovascular events(MACCE)in prehypertensive patients.Methods The clinical data of 421 prehypertensive patients who underwent coronary angiography for coronary heart disease or suspected coronary heart disease in General Hospital of Northern Theater Command from 2004 to 2014 were retrospectively analyzed,and various types of data before coronary angiography were recorded during hospitalization,including basic clinical baseline data such as age,gender,height,weight,blood lipids,and blood glucose.A total of 95 patients were included in the case group when they were readmitted due to MACCE during long-term follow-up(follow-up methods included but not limited to telephone,SMS,etc.);200 patients with prehypertension but without MACCE in the concurrent cohort were selected as the control group.The differences in clinical baseline data between the two groups were analyzed and compared,multivariate Logistic regression analysis was performed for various lipid parameters to determine their OR,receiver operating characteristic(ROC)curves were used to analyze the predictive value of various lipid parameters and combined predictors for MACCE in prehypertensive patients,and MEDCALC software was used to compare the area under the curve of traditional lipid parameters and combined predictors.Results The levels of remnant cholesterol,low density lipoprotein cholesterol(LDLC),triglyceride(TG),total cholesterol(TC),non-high density lipoprotein cholesterol(non-HDLC),remnant cholesterol/HDLC,and LDLC/HDLC in the case group were significantly higher than those in the control group,and the number of patients with high-salt diet and diabetes in the case group were also higher than those in the control group,and the above differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that remnant cholesterol,non-HDLC,TG,

关 键 词：残余胆固醇 高血压前期 主要不良心脑血管事件 联合预测因子 

分 类 号：R5[医药卫生—内科学]