低密度脂蛋白胆固醇/残余胆固醇的一致性/ 非一致性对2型糖尿病患者随访发生 心脑 血管事件的预测价值分析  

Analysis of the predictive value of low-density lipoprotein cholesterol/remnant cholesterol consistency/disconsistency for cardiac and cerebrovascular events in type 2 diabetic patients

作　　者：马雪莲 常国花 赵洪星 Ma Xuelian;Chang Guohua;Zhao Hongxing(Department of Laboratory Medicine,Dongying District People’s Hospital,Dongying 257000,China;Department of Cardiology,Dongying District People’s Hospital,Dongying 257000,China)

机构地区：[1]东营市东营区人民医院检验科,257000 [2]东营市东营区人民医院心内科,257000

出　　处：《中国心血管杂志》2023年第2期119-124,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探索血清低密度脂蛋白胆固醇/残余胆固醇(LDL-C/RC)的一致性/非一致性对2型糖尿病(T2DM)患者随访发生心脑血管事件(MACCE)的预测价值。方法连续选取2018年1月至2020年1月在东营市东营区人民医院住院的T2DM患者426例。根据ESC 2019血脂管理指南等,LDL-C和RC的界值分为2.6 mmol/L和0.62 mmol/L。按照LDL-C/RC的一致性/非一致性分为四组,包括低LDL-C/低RC组(104例)、低LDL-C/高RC组(82例)、高LDL-C/低RC组(132例)和高LDL-C/高RC组(108例),采集四组患者基线临床资料和超声心动图检查结果,并对患者进行随访,主要观察MACCE,包括急性冠状动脉综合征、急性心力衰竭、心血管死亡、短暂性脑缺血发作或卒中,随访截止到2021年12月。生存分析评估四组的MACCE发生率,多因素Cox回归分析发生MACCE的相关因素。结果四组的年龄、男性比例、饮酒史、高血压等基线资料差异均有统计学意义(均为P<0.05)。平均随访(26.1±12.7)个月,107例(25.1%)发生MACCE。K-M生存分析和log-rank检验结果显示,与低LDL-C/低RC组比较,高LDL-C/高RC组的MACCE发生风险最高(HR=2.814,95%CI:1.673~5.289),其次为低LDL-C/高RC组(HR=2.471,95%CI:1.412~4.185)和高LDL-C/低RC组(HR=1.538,95%CI:1.119~2.374)。此外,高LDL-C/高RC组、低LDL-C/高RC组和高LDL-C/低RC组的急性冠状动脉综合征发生风险(分别为HR=2.254,HR=1.925,HR=1.516)、急性心力衰竭发生风险(分别为HR=1.875,HR=2.004,HR=1.073)、短暂性脑缺血发作发生风险(分别为HR=2.385,HR=1.914,HR=1.183)和脑卒中发生风险(分别为HR=2.553,HR=1.694,HR=1.052)均显著高于低LDL-C/低RC组(均为P<0.05)。多因素Cox回归分析结果显示,年龄、高血压、陈旧心肌梗死、卒中史、糖化血红蛋白、C反应蛋白、血肌酐、LDL-C和RC均与发生MACCE独立正相关(均为P<0.05),而血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂/血管紧张素受体-脑啡肽酶抑制剂、钠-葡萄糖共转运蛋�Objective To explore the predictive value of serum low-density lipoprotein cholesterol/remnant cholesterol(LDL-C/RC)consistency on cardiovascular and cerebrovascular events in patients with type 2 diabetes(T2DM)during follow-up.Methods A total of 426 T2DM patients hospitalized in our hospital from January 2018 to January 2020 were selected consecutively.According to the ESC 2019 lipid management guidelines,the cut-off values of LDL-C and RC are 2.6 mmol/L and 0.62 mmol/L,respectively.Based on the consistency of LDL-C and RC levels,patients were classified into four groups:low LDL-C and low RC(n=104),low LDL-C and high RC(n=82),high LDL-C and low RC(n=132),and high LDL-C and high RC(n=108).The baseline data,laboratory indexes and ultrasonic cardiac indexes of the four groups of patients were collected.Cardiovascular and cerebrovascular events,including acute coronary syndrome,acute heart failure,cardiovascular death,transient ischemic attack or stroke,were compared among the groups.Results There were significant differences in baseline data,including age,male ratio,drinking history,hypertension,etc among the four groups(P<0.05).The average follow-up time was(26.1±12.7)months.There were 107 cases(25.1%)of cardiovascular and cerebrovascular events.KM survival analysis and log rank test showed that compared with low LDL-C and low RC group,high LDL-C and high RC group had the highest risk of cardiovascular and cerebrovascular events(HR=2.814,95%CI=1.673-5.289),followed by low LDL-C and high RC group(HR=2.471,95%CI=1.412-4.185)and high LDL-C and low RC group(HR=1.538,95%CI=1.119-2.374).In addition,the risk of acute coronary syndrome(HR=2.254,HR=1.925,HR=1.516),acute heart failure(HR=1.875,HR=2.004,HR=1.073),risk of transient ischemic attack(HR=2.385,HR=1.914,HR=1.183)and stroke(HR=2.553,HR=1.694,HR=1.052)were significantly higher than those of low LDL-C and low RC group(all P<0.05).In multivariate Cox regression analysis,age,hypertension,prior myocardial infarction,stroke history,glycosylated hemoglobin,C-reactive pro

关 键 词：低密度脂蛋白胆固醇/残余胆固醇 糖尿病 心脑血管事件 相关性 

分 类 号：R587.1[医药卫生—内分泌]