总胆固醇水平对OPCAB患者发生早期心功能不全的预测价值  

Predictive value of total cholesterol level in the early cardiac insufficiency in patients undergoing off-pump coronary artery bypass grafting

作　　者：张海涛[1] 韦薇 王磊[1] 李岩 冯增斌[1] ZHANG Haitao;WEI Wei;WANG Lei;LI Yan;FENG Zengbin(Department of Cardiac Surgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Hematology Laboratory,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院心脏外科,067000 [2]承德医学院附属医院血液检验室,067000

出　　处：《天津医药》2022年第7期753-756,共4页Tianjin Medical Journal

基　　金：河北省医学科学研究课题计划(20220006);承德市科技计划项目(202006A032)。

摘　　要：目的探讨总胆固醇(TC)水平与非体外循环冠状动脉旁路移植术(OPCAB)后患者发生早期心功能不全的关系。方法回顾性分析行OPCAB患者共201例,按照手术后早期心功能不全的诊断标准将患者分为发生术后早期心功能不全组(心功能不全组,22例)和未发生术后早期心功能不全组(对照组,179例)。收集患者实验室资料以及临床资料。比较2组术前的临床基线资料;将差异有统计学意义的相关研究因素纳入多因素二分类Logistic回归,分析OPCAB后患者发生早期心功能不全的影响因素;利用受试者工作特征(ROC)曲线分析TC的预测价值。结果心功能不全组与对照组在年龄、性别、体质量指数(BMI)、血糖、收缩压、术前左心室射血分数(LVEF)、移植血管数量、吸烟、心肌梗死病史及脑梗死病史比较差异无统计学意义(P>0.05),总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平差异有统计学意义(P<0.05)。二分类Logistic回归分析结果显示,TC水平升高是OPCAB患者发生术后早期心功能不全的危险因素(OR=11.842,95%CI:4.055~34.580,P<0.01)。TC预测术后早期心功能不全的ROC曲线下面积(AUC)为0.974(95%CI:0.954~0.994),敏感度为0.955,特异度为0.922。结论血清TC能有效预测OPCAB患者早期心功能不全的发生,TC水平越高,术后早期发生心功能不全的风险越大。Objective To investigate the correlation between total cholesterol(TC)levels and the development of the early cardiac insufficiency in patients after off-pump coronary artery bypass grafting(OPCAB).Methods A total of 201 patients who underwent OPCAB were retrospectively analyzed.Patients were divided into the cardiac insufficiency group(with the occurrence of early postoperative cardiac insufficiency,n=22)and the control group(without early postoperative cardiac insufficiency,n=179)according to the diagnostic criteria of early postoperative cardiac insufficiency.The laboratory and clinical data were collected.The preoperative clinical baseline data were compared between the 2 groups.The relevant study factors with statistically significant differences were included in a multifactorial dichotomous Logistic regression analysis to analyze the factors influencing the occurrence of the early postoperative cardiac insufficiency in patients after OPCAB.The predictive value of influencing factors was analyzed using the subject work characteristic(ROC)curve.Results There were no significant differences in age,gender,body mass index(BMI),glucose,systolic blood pressure,preoperative left ventricular ejection fraction(LVEF),number of transplanted vessels,smoking,history of myocardial infarction and history of cerebral infarction between the cardiac insufficiency group and the control group(P>0.05),and there were significant differences in baseline TC,triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)and highdensity lipoprotein cholesterol(HDL-C)levels between the two groups(P<0.05).The results of dichotomous Logistic regression analysis showed that the elevated TC level was a risk factor for the development of early postoperative cardiac insufficiency in OPCAB patients(OR=11.842,95%CI:4.055-34.580,P<0.01).The area under the ROC curve AUC was 0.974(95%CI:0.954-0.994).The sensitivity was 0.955 and specificity was 0.922.Conclusion Serum TC level can effectively predict the occurrence of early cardiac insufficiency i

关 键 词：冠状动脉旁路移植术 非体外循环 危险因素 总胆固醇 早期心功能不全 

分 类 号：R654.2[医药卫生—外科学] R541.4[医药卫生—临床医学]