血浆残余胆固醇水平与青年冠心病的远期不良心血管事件有关  

Elevated plasma remnant cholesterol associated with long-term adverse cardiovascular events in young patients with coronary artery disease

作　　者：张韶辉[1] 苏强[2] 耿亚明 潘慧 张扬 苏兴 张慧玲[1] 王建军[1] ZHANG Shaohui;SU Qiang;GENG Yaming;PAN Hui;ZHANG Yang;SU Xing;ZHANG Huiling;WANG Jianjun(Department of Cardiology,Affiliated Hospital of Jining Medical University&Shandong Provinicial Key Laboratory of Cardiac Disease Diagnosis and Treatment,Jining,Shandong 272029,China;Health Management Center,Affiliated Hospital of Jining Medical University,Jining,Shandong 272029,China)

机构地区：[1]济宁医学院附属医院心内科,山东省心脏疾病诊疗重点实验室,山东省济宁市272029 [2]济宁医学院附属医院健康管理中心,山东省济宁市272029

出　　处：《中国动脉硬化杂志》2023年第12期1058-1066,共9页Chinese Journal of Arteriosclerosis

基　　金：山东省医药卫生科技发展计划项目(2019WS367)。

摘　　要：[目的]明确残余胆固醇(RC)与青年冠心病患者远期心血管风险的关系。[方法]回顾性分析2013年5月—2015年11月住院行冠状动脉造影的冠心病患者3200例,按照年龄分为三组:青年组(<45岁)、中年组(45~70岁)和老年组(≥70岁);根据RC水平分为高组和低组。统计分析主要不良心血管事件(MACE)的发生率。用KM法评估无MACE事件的生存率,Cox回归评价临床终点的预测因子。采用限制性立方样条(RCS)模型展示RC与MACE风险之间的剂量-效应关系。[结果]完成随访3112例,随访率为97.25%。其中青年组(<45岁)160例,中年组(45~70岁)2390例,老年组(≥70岁)562例。随访时间中位数7.36年。其中864例(27.8%)经历了MACE事件。KM曲线显示,RC不是全年龄段冠心病患者远期发生MACE的预测因子(P>0.05),也不是中年组和老年组的预测因子(P>0.05);KM曲线和Cox回归发现,RC是青年冠心病患者远期发生MACE的独立预测因子,青年冠心病患者的RC每升高1 mmol/L其发生MACE的风险增加1.07倍(HR=2.07,95%CI:1.35~3.17,P<0.01);通过计算及验证,发现预测青年冠心病患者发生MACE的RC最佳截断值为0.94 mmol/L,RC>0.94 mmol/L的青年冠心病患者MACE风险增加1.98倍(HR=2.98,95%CI:1.41~6.32,P<0.01);反之,RC<0.94 mmol/L的青年冠心病患者MACE风险降低66%(HR=0.34,95%CI:0.16~0.71,P<0.01)。[结论]高血浆RC水平是青年冠心病患者远期(7.36年)发生MACE的独立预测因子,该人群RC水平的最佳截断值为0.94 mmol/L,在此水平以下可使青年冠心病患者的MACE风险降低66%。Aim To determine the relationship between remnant cholesterol(RC)and long-term cardiovascular risk in young patients with coronary artery disease(CAD).Methods 3200 patients with CAD hospitalized from May 2013 to November 2015 were analyzed retrospectively.They were divided into three groups according to age:young group(<45 years old),middle-aged group(45~70 years old)and elderly group(≥70 years old);They are divided into high group and low group according to RC levels.The incidence of major adverse cardiovascular event(MACE)was statistically analyzed.KM method was used to evaluate the survival rate without MACE event,and Cox regression was used to evaluate the predictors of clinical endpoint.The dose-response relationship between RC and MACE risk was demonstrated using a restricted cubic spline(RCS)model.Results A total of 3112 patients were followed up(97.25%),including 160 in young group,2390 in middle-aged group,and 562 in elderly group.The median follow-up time was 7.36 years.Among them,864 cases(27.8%)experienced MACE events.KM curve showed that RC was not a predictor of long-term MACE in patients with CAD of all ages(P>0.05),nor was it a predictor of MACE in middle-aged and elderly groups(P>0.05).KM curve and Cox regression showed that RC was an independent predictor of long-term MACE in premature CAD patients,and the risk of MACE increased by 1.07 times for every 1 mmol/L increase in RC(HR=2.07,95%CI:1.35~3.17,P<0.01).Through calculation and verification,it was found that the optimal cutoff value of RC for predicting the occurrence of MACE in premature CAD patients was 0.94 mmol/L,and the risk of MACE in premature CAD patients with RC>0.94 mmol/L increased by 1.98 times(HR=2.98,95%CI:1.41~6.32,P<0.01);Conversely,the risk of MACE was reduced by 66%in premature CAD patients with RC<0.94 mmol/L(HR=0.34,95%CI:0.16~0.71,P<0.01).Conclusion RC is an independent predictor of long-term MACE occurrence in premature CAD patients(7.36 years).The optimal cutoff value of RC in this population is 0.94 mmol/L.Controllin

关 键 词：青年冠心病 残余胆固醇 主要不良心血管事件 

分 类 号：R54[医药卫生—心血管疾病]