≤45岁急性冠脉综合征患者中超高危冠状动脉粥样硬化性心脏病人群降脂治疗后血脂达标率及影响因素研究  

Lipid Goal Attainment Rate and Influencing Factors in 45-year-old or Younger Acute Coronary Syndrome Patients with an Ultra-high Risk of Atherosclerotic Cardiovascular Disease after Lipid-lowering Treatment

作　　者：高扬 王贇霞 张优 高传玉 GAO Yang;WANG Yunxia;ZHANG You;GAO Chuanyu(People's Hospital of Zhengzhou University/Heart Center of Henan Provincial People's Hospital/Coronary Heart Disease Ward 1,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450000,China;Department of Radiology,Henan University People's Hospital/Henan Provincial People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学人民医院、河南省人民医院心脏中心、阜外华中心血管病医院冠心病一病区,河南省郑州市450000 [2]河南大学人民医院、河南省人民医院医学影像科,河南省郑州市450000

出　　处：《中国全科医学》2023年第27期3383-3387,3410,共6页Chinese General Practice

基　　金：国家重点研发计划(2018YFC0114500)。

摘　　要：背景急性冠脉综合征(ACS)是临床常见的危重症,近年来呈现出年轻化的趋势,有效的降脂治疗可以改善患者的预后,目前各指南对降脂目标要求越来越高,年轻ACS患者中超高危冠状动脉粥样硬化性心脏病(ASCVD)人群的降脂疗效有待进一步评价。目的评估≤45岁ACS患者中诊断为超高危ASCVD患者经降脂治疗后的血脂达标率并分析其影响因素。方法选取2019年1月—2021年10月于阜外华中心血管病医院住院治疗18~45岁ACS患者为研究对象。通过电子病历系统,收集患者的基线资料。所有患者空腹8 h后取静脉血,采用全自动生化仪进行血脂指标检验,包括总胆固醇(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),计算非HDL-C。所有患者在出院1个月后再次于本院门诊或住院部进行血脂检测,本研究采用出院1个月后首次血脂记录,末次随访日期2021-11-30。将445例符合超高危ASCVD诊断的患者根据血脂是否达标分为血脂达标组(n=84)和血脂未达标组(n=361)。采用Spearman秩相关分析进行相关性分析,采用单因素、多因素Logistic回归分析探究ASVCD患者血脂达标的影响因素。结果超高危ASVCD患者占ACS患者的87.4%(445/509),经降脂治疗后,共18.9%(84/445)超高危ASCVD患者血脂达标。共有29例患者采用他汀联合依洛尤单抗,其中24例患者血脂达标。血脂达标组与血脂未达标组患者糖尿病史、急性心肌梗死(AMI)、行三磷酸腺苷结合盒转运子B亚家族成员(ABCB1)基因检测、行溶质载体有机阴离子转运蛋白家族成员1B1(SLCO1B1)基因检测、TC、TG、基线LDL-C、非HDL-C、降脂方案比较,差异有统计学意义(P<0.05);血脂达标组患者采用中等强度他汀降脂方案比例低于血脂未达标组,采用他汀联合依洛尤单抗方案比例高于血脂未达标组(P<0.05)。Spearman秩相关分析结果显示,糖尿病史、AMI、行ABCB1基因检测、SLCO1Background Acute coronary syndrome(ACS)is a group of critical conditions commonly encountered clinically,showing a trend of younger age of onset in recent years.Effective lipid-lowering therapy can improve the prognosis of patients.Various guidelines are increasingly strict on lipid-lowering targets,and the lipid-lowering efficacy in young ACS patients with an ultra-high risk atherosclerotic cardiovascular disease(ASCVD)needs further evaluation.Objective To evaluate the rate of lipid goal attainment and influencing factors in young acute coronary syndrome ACS patients(≤45 years old)with an ultra-high risk of ASCVD after lipid-lowering treatment.Methods Patients with ACS aged 18-45 years who were hospitalized in Fuwai Central China Cardiovascular Hospital from January 2019 to October 2021 were enrolled.Patient baseline data were collected through the electronic medical record system.Venous samples were collected after eight hours of fasting,and serum lipid〔including total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)〕in which were analyzed using a fully automated biochemistry analyzer,and non-HDL-C was calculated.All patients underwent blood lipid detection again in the outpatient or inpatient department of our hospital 1 month after discharge.In this study,the first blood lipid record was adopted 1 month after discharge,and the last follow-up date was November 30,2021.Among the patients,445 cases were found with an ultra-high risk ASCVD,and 84 of them were detected with attained lipid goals(attainment group),and the other 361 with poor attainment of lipid goals(non-attainment group).Spearman rank correlation analysis was used to measure the correlation of lipid goal attainment with various other parameters.Univariate and multivariate Logistic regression were used to analyze the influencing factors of lipid goal attainment in ASCVD patients.Results Patients with an ultra-high risk of ASVCD accounted for 87.4%(445/509)of ACS patients

关 键 词：冠状动脉心脏病 冠状动脉疾病 冠状动脉粥样硬化 高脂血症 降血脂药 影响因素分析 

分 类 号：R541.4[医药卫生—心血管疾病]