LDL-C/HDL-C比值与老年冠心病患者冠状动脉病变严重程度及2年预后的关联研究  

Effect of LDL-C/HDL-C ratio on severity of coronary artery disease and 2-year long-term prognosis in elderly patients with coronary heart disease

作　　者：许晶晶 刘颖娴 李钦雪 宋莹 姜琳 郝一莼 高展 李建新 张茵 高立建 赵雪燕 宋雷 刘震宇 鲁向锋 袁晋青 Xu Jingjing;Liu Yingxian;Li Qinxue;Song Ying;Jiang Lin;Hao Yichun;Gao Zhan;Li Jianxin;Zhang Yin;Gao Lijian;Zhao Xueyan;Song Lei;Liu Zhenyu;Lu Xiangfeng;Yuan Jinqing(Department of Cardiology,Fuwai Hospital and Cardiovascular Institute,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100005,China)

机构地区：[1]中国医学科学院、北京协和医学院国家心血管病中心、阜外医院冠心病中心,北京100037 [2]中国医学科学院、北京协和医学院、北京协和医院心内科,北京100005

出　　处：《中华医学杂志》2024年第46期4221-4228,共8页National Medical Journal of China

基　　金：中央高水平医院临床科研业务费(2022GSP-QN-1);国家重点研发计划(2016YFC1301301)。

摘　　要：目的分析低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)与老年冠心病患者冠状动脉病变严重程度和2年预后的关联。方法前瞻性多中心队列研究,研究对象来源于中国冠心病患者血栓和出血评分系统(PROMISE)研究,入选2015年1月至2019年5月8个区域性三级医院18701例确诊冠心病患者。研究纳入≥65岁老年冠心病患者6770例,根据LDL-C/HDL-C的中位数(2.1)将患者分为低LDL-C/HDL-C组(LDL-C/HDL-C≤2.1,n=3346)和高LDL-C/HDL-C组(LDL-C/HDL-C2.1,n=3424)。收集基线资料,并进行2年随访,记录死亡、心肌梗死、血运重建、卒中等心脑血管不良事件的发生情况,比较不同LDL-C/HDL-C水平老年冠心病患者之间的差异,多因素Cox回归模型分析LDL-C/HDL-C与患者冠状动脉病变严重程度及2年预后的关联。结果低LDL-C/HDL-C组年龄大于高LDL-C/HDL-C组[(71.9±5.5)比(71.5±5.4)岁,P=0.003],两组男性占比差异无统计学意义(61.9%比63.4%,P=0.208)。高LDL-C/HDL-C组靶病变个数、冠状动脉病变支数、术前SNYTAX评分及三支病变比例均高于低LDL-C/HDL-C组[分别为(1.01±0.81)比(0.88±0.78)个、(2.28±0.81)比(2.14±0.83)支、(16.05±10.67)比(13.59±9.49)分、49.0%比41.0%,均P0.05]。2年随访结果显示,高LDL-C/HDL-C组与低LDL-C/HDL-C组主要不良心脑血管事件(MACCE)、全因死亡、心源性死亡、心肌梗死及血运重建发生率差异均无统计学意义(均P>0.05)。按不同性别比较,女性高LDL-C/HDL-C组全因死亡及心源性死亡发生率高于低LDL-C/HDL-C组(分别为6.9%比4.8%、5.3%比3.7%,均P0.05);男性两组间各不良事件发生率差异无统计学意义(均P<0.05)。多因素Cox回归模型分析结果显示,无论男性还是女性,LDL-C/HDL-C都不是老年冠心病患者2年MACCE的危险因素(男性:HR=1.21,95%CI:0.87~1.69;女性:HR=0.96,95%CI:0.65~1.43;合计:HR=1.09,95%CI:0.85~1.39,均P>0.05)。结论老年冠心病患者高LDL-C/HDL-C比值者冠状动脉病变的严重程度ObjectiveTo explore the effect of low density lipoprotein cholesterol(LDL-C)/high density lipoprotein cholesterol(HDL-C)ratio on the severity of coronary artery disease and 2-year adverse events in elderly patients with coronary heart disease.MethodsThis prospective,multicenter,observational cohort study was from the prospective observational multicenter cohort for ischemic and hemorrhage risk in coronary artery disease patients(PROMISE)study,in which 18701 patients with coronary heart disease(CHD)were included from January 2015 to May 2019.Among them,6770 elderly patients with CHD were enrolled in the current study.According to the median of LDL-C/HDL-C ratio(2.1),the patients were divided into two groups:low LDL-C/HDL-C group(LDL-C/HDL-C≤2.1,n=3346)and high LDL-C/HDL-C group(LDL-C/HDL-C2.1,n=3424).Baseline data and 2-year outcomes(including death,myocardial infarction,revascularization,stroke)were collected and analyzed in order to found the differences of elderly CHD patients with different LDL-C/HDL-C levels,and explore the correlation between LDL-C/HDL-C ratio with the severity of coronary artery disease and prognosis using Cox multivariate regression analysis.ResultsPatients in the low LDL-C/HDL-C group were older[(71.9±5.5)vs(71.5±5.4)years old,P=0.003],and there was no statistically significant difference in the proportion of males between the two groups(61.9%vs 63.4%,P=0.208).The indicators reflecting the severity of coronary artery lesions,including the number of target lesions,the number of coronary artery disease,preoperative SNYTAX score,and the proportion of triple-vessel disease(1.01±0.81 vs 0.88±0.78,2.28±0.81 vs 2.14±0.83,16.05±10.67 vs 13.59±9.49,49.0%vs 41.0%,respectively,all P>0.05)were higher in the high LDL-C/HDL-C group.The 2-year follow-up showed that there was no statistically significant difference in the incidence of major adverse cardiovascular and cerebrovascular events(MACCE),all-cause mortality,cardiac death,myocardial infarction,and revascularization between the high LDL-

关 键 词：冠心病 老年人 低密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值 前瞻性队列研究 

分 类 号：R541.4[医药卫生—心血管疾病]