老年稳定性冠心病患者高敏C反应蛋白与高密度脂蛋白比值对预后的影响  

The association between high-sensitivity C-reactive protein to high-density lipoprotein ratio and prognosis in elderly patients with stable coronary heart disease

作　　者：李恒青 范俊利 张亚静 李华伟 刘黎洁 LI Hengqing;FAN Junli;ZHANG Yajing;LI Huawei(Department of Cardiovascular Medicine,Xingtai Central Hospital,Xingtai 054001,China)

机构地区：[1]邢台市中心医院心内科,054001 [2]邢台市中心医院心内科监护室,054001 [3]不详

出　　处：《心肺血管病杂志》2024年第12期1254-1261,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：邢台市重点研发计划自筹项目(2023ZC091)。

摘　　要：目的:高敏C反应蛋白与高密度脂蛋白胆固醇比值(high-sensitivity C-reactive protein/high-density lipoprotein cholesterol ratio,hs-CRP/HDL-C)在心血管疾病中的预测价值日益受到重视。本文研究,旨在探讨该比值对接受PCI术的老年(≥60岁)稳定性冠心病患者远期预后的影响。方法:本回顾性队列研究纳入514例在邢台市中心医院接受PCI术的老年稳定性冠心病患者(平均年龄67.8岁),研究时间为2020年5月至2021年5月。根据hs-CRP/HDL-C的三分位数将患者分为三组。主要终点事件为主要不良心血管事件(major adverse cardiovascular events,MACE),包括全因死亡、再次血运重建和非致死性心肌梗死。采用Kaplan-Meier曲线评估事件发生率,Cox回归模型分析风险因素,限制性立方样条(restricted cubic spline,RCS)曲线探讨非线性关系,并进行亚组分析。随访期为3年。结果:随访期间记录132例(25.7%)MACE事件。多变量Cox回归分析表明,较高的hs-CRP/HDL-C比值与MACE风险增加显著相关(最高组vs.最低组:HR=1.76,95%CI:1.09~2.83),尤其是再次血运重建风险(HR=2.46,95%CI:1.18~5.14)。Kaplan-Meier分析表明,hs-CRP/HDL-C较低者MACE(Log-rank P=0.002)和再次血运重建(Log-rank P=0.015)发生率显著降低。RCS曲线分析表明,MACE风险随hs-CRP/HDL-C比值升高呈非线性增加(非线性P=0.025)。亚组分析发现,在年龄≤75岁(HR=1.77,95%CI:1.32~2.37)、BMI≤28 kg/m^(2)(HR=1.77,95%CI:1.32~2.39)和射血分数>40%(HR=1.86,95%CI:1.38~2.50)的患者中,hs-CRP/HDL-C与MACE的关联更为显著,且存在明显交互作用(交互P值均<0.05)。结论:hs-CRP/HDL-C可作为预测老年稳定性冠心病患者PCI术后远期MACE风险的独立指标,特别是在≤75岁、体质量正常及心功能保持良好的患者中具有较高预测价值。Objective:The predictive value of the high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio(hs-CRP/HDL-C)in cardiovascular diseases has gained increasing attention.This study aimed to investigate the impact of this ratio on the long-term prognosis of elderly patients with stable coronary artery disease(SCAD)who underwent PCI.Methods:This retrospective cohort study included 514 elderly(age≥60)SCAD patients(mean age 67.8 years)who underwent PCI at Xingtai Central Hospital between May 2020 and May 2021.Patients were divided into three groups based on the tertiles of the hs-CRP/HDL-C ratio.The primary endpoint was major adverse cardiovascular events(MACE),including allcause death,repeat revascularization,and non-fatal myocardial infarction.Kaplan-Meier curves were used to assess event rates,Cox regression models to analyze risk factors,restricted cubic spline(RCS)curves to explore non-linear relationships,and subgroup analyses were performed.The follow-up period was 3 years.Results:During follow-up,132(25.7%)MACE were recorded.Multivariate Cox regression analysis showed that a higher hs-CRP/HDL-C ratio was significantly associated with increased MACE risk(highest vs.lowest group:HR=1.76,95%CI:1.09-2.83),especially for repeat revascularization risk(HR=2.46,95%CI:1.18-5.14).Kaplan-Meier analysis indicated that patients with lower hs-CRP/HDL-C levels had significantly lower rates of MACE(Log-rank P=0.002)and repeat revascularization(Log-rank P=0.015).RCS curve analysis revealed a non-linear increase in MACE risk with increasing hs-CRP/HDL-C ratio(non-linear P=0.025).Subgroup analysis found that the association between hs-CRP/HDL-C ratio and MACE was more significant in patients aged≤75 years(HR=1.77,95%CI:1.32-2.37),BMI≤28 kg/m^(2)(HR=1.77,95%CI:1.32-2.39),and ejection fraction>40%(HR=1.86,95%CI:1.38-2.50),with significant interactions(all interaction P<0.05).Conclusion:The hs-CRP/HDL-C ratio is an independent predictor of long-term MACE risk in elderly SCAD patients after PCI,with part

关 键 词：稳定性冠心病 冠状动脉支架置入术 高敏C反应蛋白与高密度脂蛋白胆固醇比值 预后评估 心血管事件 

分 类 号：R54[医药卫生—心血管疾病]