老年冠心病伴冠状动脉钙化患者糖脂代谢、血清GSDMD、IL-18水平及其风险预警模型的研究  

Levels of glycolipid metabolism,gasdermin D,interleukin-18 and risk warning model in elderly patients with coronary heart disease complicated by coronary artery calcification

作　　者：海平 章启勇 梅能 张红 Hai Ping;Zhang Qiyong;Mei Neng;Zhang Hong(Emergency Department,People's Hospital of Wuwei City,Wuwei 238300,China;不详)

机构地区：[1]无为市人民医院急诊科,无为238300 [2]无为市人民医院老年科,无为238300 [3]无为市人民医心内科,无为238300

出　　处：《中国循证心血管医学杂志》2024年第9期1119-1123,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的研究老年冠状动脉粥样硬化性心脏病(冠心病)伴冠状动脉钙化患者糖脂代谢、血清消皮素D(GSDMD)、白介素-18(IL-18)水平变化及其风险预警模型。方法选择2022年12月至2023年10月于无为市人民医院确诊的冠心病患者350例作为观察对象。通过冠状动脉CT血管造影(CCTA)评估冠状动脉钙化积分(CACs),将患者分为CAC组(CACs≥10分,280例)及非CAC组(CACs<10分,70例)。比较两组患者基线资料。采用Logistic回归分析模型,分析冠心病CAC的独立危险因素。并据此构建列线图以及ROC曲线。结果两组在年龄、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、胰岛素抵抗(IR)、GSDMD、IL-18比较,有统计学差异(P<0.05)。经单因素筛选得出,年龄、FBG、TG、LDL-C、IR、GSDMD、IL-18可能为老年冠心病患者冠状动脉钙化的影响因素。通过Logistic回归分析得知,年龄≥65岁、高血糖、高TG、高LDL-C、高IR、高GSDMD、高IL-18为老年冠心病患者发生冠状动脉钙化的危险因素(P<0.05)。据此构建列线图模型得出,Bias-corrected预测曲线与Ideal线基本吻合,说明该模型预测患者出现冠状动脉钙化与实际风险一致性良好。该模型的决策曲线显示,其在阈值概率范围0.04~1.00之间表现出净收益率大于0的特点,超过了两条无效线。通过ROC分析显示,联合预测指标的AUC为0.888,大于单项指标的AUC,说明其对老年冠心病患者伴冠状动脉钙化有良好的区分度。结论年龄≥65岁、高血糖、高TG、高LDL-C、高IR、高GSDMD、高IL-18均为老年冠心病患者发生冠状动脉钙化的危险因素。Objective To study the level changes of glycolipid metabolism,gasdermin D(GSDMD)and interleukin-18(IL-18)and risk warning model in elderly patients with coronary heart disease(CHD)complicated by coronary artery calcification(CAC).Methods CHD patients(n=350)were chosen from People’s Hospital of Wuwei City from Dec.2022 to Oct.2023.After assessed CAC scores(CACs)by coronary CT angiography(CCTA),all patients were divided into CAC group(CACs≥10,n=280)and non-CAC group(CACs<10,n=70).The baseline materials were compared in 2 groups.The independent risk factors of CAC were analyzed by using Logistic regression analysis model,and nomogram and ROC curve were established.Results There were statistical differences in age,fasting blood glucose(FBG),glycated hemoglobin(HbAlc),triglyceride(TG),low-density lipoprotein-cholesterol(LDL-C),insulin resistance index(IR),GSDMD and IL-18 between 2 groups(P<0.05).The results of single-factor screening showed that age,FBG,TG,LDL-C,IR,GSDMD and IL-18 were possible influence factors of CAC in elderly CHD patients.The results of Logistic regression analysis showed that age≥65 and higher blood sugar,TG,LDL-C,IR,GSDMD and IL-18 were risk factors for CAC occurrence in elderly CHD patients(P<0.05).The results of nomogram model analysis showed that Bias-corrected predictive curve was basically aligns withIdeal line,which indicated that the model had a higher consistency between CAC and actual risk in risk predictions.The results of decision curve analysis showed that the model demonstrated a net benefit greater than 0 within the threshold probability range from 0.04 to 1.00,surpassed2 ineffective lines.The results of ROC curve analysis showed that,in combined index prediction,AUC was 0.888,which was larger than AUC of single index prediction with a higher discrimination for CAC in elderly CHD patients.Conclusion The risk factors for CAC occurrence include age≥65 and higher blood sugar,TG,LDL-C,IR,GSDMD and IL-18 in in elderly CHD patients.

关 键 词：老年冠心病 冠状动脉钙化 糖脂代谢 血清GSDMD 白介素-18 

分 类 号：R541.4[医药卫生—心血管疾病]