Non-HDL-C水平和ApoB/ApoA1比值与初发心肌梗死的相关性研究  

Correlation among non-high-density lipoprotein-cholesterol,apolipoprotein B/apolipoprotein A1 ratio and incipient acute myocardial infarction

作　　者：涂诗琴 高凌云[1] Tu Shiqin;Gao Lingyun(Department of Cardiovascular Medicine,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;不详)

机构地区：[1]重庆医科大学附属第一医院心血管内科,重庆400016

出　　处：《中国循证心血管医学杂志》2024年第4期436-440,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：重庆市科卫联合医学科研项目(2020FYYX074)。

摘　　要：目的探究不同非高密度脂蛋白胆固醇(non-HDL-C)水平初次急性心肌梗死患者的临床特征及载脂蛋白B(Apo B)和载脂蛋白A1(Apo A1)比值以及non-HDL-C与冠状动脉(冠脉)病变程度的相关性。方法选取2021年12月至2023年4月于重庆医科大学附属第一医院心内科入院治疗的首次诊断为急性心肌梗死且行冠脉造影的患者410例。计算Apo B/Apo A1比值及non-HDL-C,根据non-HDL-C三分位数分为低non-HDL-C组(≤2.89 mmol/L)、中non-HDL-C组(2.9~4.16 mmol/L)、高non-HDL-C组(≥4.17 mmol/L),比较三组患者一般临床资料及冠脉病变特点的差异性。另采用Spearman秩相关和二元Logistics回归分析non-HDL-C水平、Apo B/Apo A1对冠脉病变严重程度的影响。结果与低non-HDL-C组相比,中non-HDL-C组和高non-HDL-C组患者年龄更小(P<0.05);高non-HDL-C组较另外两组具有更高水平的体质指数(BMI)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、ApoB、ApoA1、ApoB/ApoA1、白蛋白、γ-谷酰转移酶、尿酸(P<0.05)。三组间左前降支病变、回旋支病变、多支血管病变、Gensini评分相比,差异有统计学意义(P<0.05)。偏相关分析显示Apo B/Apo A1和non-HDL-C均与多支血管病变、Gensini评分呈正相关(P<0.05);多因素二元Logistics回归分析显示ApoB/ApoA1比值(OR=3.149,95%CI:1.209~8.201,P=0.019)、non-HDL-C≥4.17 mmol/L(OR=4.199,95%CI:1.524~11.565,P=0.006)是多支血管病变的独立危险因素。结论在初次急性心肌梗死青年患者有冠脉病变或(冠状动脉粥样硬化性心脏病)危险因素中,更应关注ApoB/ApoA1及non-HDL-C,同时严格控制non-HDL-C是心肌梗死患者潜在的降脂目标。Objective To investigate the clinical characteristics of patients with incipient acute myocardial infarction(AMI)and different levels of non-high-density lipoprotein cholesterol(non-HDL-C),and discuss the correlation among,apolipoprotein B/apolipoprotein A1 ratio(ApoB/ApoA1),non-HDL-C and severity of coronary artery lesions.Methods The patients with incipient AMI undergone coronary angiography(CAG)examination(n=410)were chosen from Department of Cardiovascular Medicine in the First Affiliated Hospital of Chongqing Medical University from Dec.2021 to Apr.2023.Apo B/Apo A1 and non-HDL-C were calculated,and the patients were divided,according to non-HDL-C tertiles,into low non-HDL-C group(≤2.89 mmol/L),mediate non-HDL-C group(2.9~4.16 mmol/L)and high non-HDL-C group(≥4.17 mmol/L).The differences in clinical materials and coronary lesion features were compared among 3 groups.The influence of non-HDL-C level,and Apo B/Apo A1 on severity of coronary artery lesions were analyzed by using Spearman rank correlation and binary Logistic regression analysis.Results The patients were younger in mediate non-HDL-C group and high non-HDL-C group than those in low non-HDL-C group(P<0.05).The levels of body mass index(BMI),triglyceride(TG),HDL-C,ApoB,ApoA1,ApoB/ApoA1,albumin(ALB),gamma-glutamyltransferase(GGT)and uric acid(UA)were higher in high non-HDL-C group than those in other 2 groups(P<0.05).The differences in lesions of left anterior descending branch(LAD),left circumflex branch and multiple vessels,and Gensini scores had statistical significance among 3 groups(P<0.05).The Results of biased correlation analysis showed that Apo B/Apo A1,non-HDL-C,multiple vessel lesions and Gensini scores had positive correlation(P<0.05).The Results of multi-factor binary Logistic regression analysis showed that ApoB/ApoA1(OR=3.149,95%CI:1.209~8.201,P=0.019)and Non-HDL-C≥4.17 mmol/L(OR=4.199,95%CI:1.524~11.565,P=0.006)were independent risk factors for multiple vessel lesions.Conclusion The clinical indexes of ApoB/ApoA1 and non-HDL-C s

关 键 词：急性心肌梗死 非高密度脂蛋白胆固醇 多支血管病变 

分 类 号：R542.22[医药卫生—心血管疾病]