2型糖尿病合并冠心病患者血清LDL-C/HDL-C比值、Lp(a)变化及其与PCI术后近期主要不良心血管事件的相关性  

Changes of serum LDL-C/HDL-C ratio and Lp(a)in patients with type 2 diabetes and coronary heart disease and their correlation with major adverse cardiovascular events in the near future after PCI

作　　者：尹佳锋 宋琳岚 董炜[1] 张妮[1] 韩婕 何谦[1] Yin Jiafeng;Song Linlan;Dong Wei;Zhang Ni;Han Jie;He Qian(Department of Laboratory Medicine,Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi,Xi'an 710004,China;不详)

机构地区：[1]西安交通大学第二附属医院检验科,西安710004 [2]西安交通大学第二附属医院心血管内科,西安710004

出　　处：《疑难病杂志》2025年第3期263-267,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2021-03-09)。

摘　　要：目的探讨2型糖尿病(T2DM)合并冠心病(CHD)患者血清低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)比值、脂蛋白(a)[Lp(a)]变化及其与经皮冠状动脉介入治疗(PCI)术后近期主要不良心血管事件(MACE)的相关性。方法选取2022年9月-2023年6月西安交通大学第二附属医院心血管内科收治的T2DM合并CHD患者120例为观察组,并根据PCI术后近期是否发生MACE将T2DM合并CHD患者分为预后不良亚组29例和预后良好亚组91例。另选取同期医院单纯CHD患者65例为对照组,采用酶法测定血清LDL-C、HDL-C水平,免疫比浊法测定血清Lp(a)水平;Pearson法分析血清LDL-C/HDL-C比值、Lp(a)水平与Gensini评分的相关性;多因素Logistic回归分析T2DM合并CHD患者PCI术后近期MACE的影响因素;受试者工作特征(ROC)曲线分析血清LDL-C/HDL-C比值、Lp(a)水平对T2DM合并CHD患者PCI术后近期MACE的预测价值。结果观察组血清LDL-C/HDL-C比值、Lp(a)水平高于对照组(t/P=6.594/<0.001、11.369/<0.001);Pearson分析结果显示,T2DM合并CHD患者血清LDL-C/HDL-C比值、Lp(a)水平均与Gensini评分呈正相关(r/P=0.751/<0.001,0.744/<0.001);PCI术后随访12个月,T2DM合并CHD患者MACE发生率为24.17%(29/120)。预后不良亚组Gensini评分、血清LDL-C/HDL-C比值、Lp(a)水平高于预后良好亚组(t/P=3.939/<0.001、4.413/<0.001、4.333/<0.001);多因素Logistic回归分析显示,Gensini评分高、LDL-C/HDL-C比值高、血清Lp(a)水平高为T2DM合并CHD患者PCI术后近期MACE的独立危险因素[OR(95%CI)=5.298(3.259~8.614)、4.817(2.914~7.963)、4.855(2.852~8.264)];血清LDL-C/HDL-C比值、Lp(a)水平及二者联合预测T2DM合并CHD患者PCI术后近期MACE的曲线下面积(AUC)分别为0.765、0.737、0.930,二者联合的AUC大于两指标单独预测(Z/P=20.093/<0.001、18.651/<0.001)。结论T2DM合并CHD患者LDL-C/HDL-C比值、血清Lp(a)水平异常高表达,且分别与Gensini评分呈正相关,二者联合可有效预测T2DM合并CHDObjective To investigate the changes of serum low density lipoprotein cholesterol(LDL-C)/high density lipoprotein cholesterol(HDL-C)ratio,lipoprotein(a)[Lp(a)]in patients with type 2 diabetes mellitus(T2DM)and coronary heart disease(CHD)and their correlation with major adverse cardiovascular events(MACE)in the near future after percutaneous coronary intervention(PCI).Methods A total of 120 T2DM patients with CHD admitted to the Second Affiliated Hospital of Xi'an Jiaotong University from September 2022 to June 2023 were selected as the observation group,and 65 patients with CHD alone were selected as the control group.According to whether MACE occurred recently after PCI,T2DM patients with CHD were divided into poor prognosis subgroup(29 cases)and good prognosis subgroup(91 cases).Serum LDL-C and HDL-C levels were determined by enzymatic method,and serum Lp(a)levels were determined by immunoturbidimetry.The correlation between serum LDL-C/HDL-C ratio,Lp(a)level and Gensini score was analyzed by Pearson method.Multivariate Logistic regression analysis was performed to analyze the influencing factors of MACE in T2DM patients with CHD after PCI.The predictive value of serum LDL-C/HDL-C ratio and Lp(a)level for short-term MACE in T2DM patients with CHD after PCI was analyzed by receiver operating characteristic(ROC)curve.Results The LDL-C/HDL-C ratio and Lp(a)level in the observation group were higher than those in the control group(t/P=6.594/<0.001,11.369/<0.001).The results of Pearson analysis showed that the serum LDL-C/HDL-C ratio and Lp(a)level in T2DM patients with CHD were positively correlated with Gensini score(r/P=0.751/<0.001,0.744/<0.001).At 12 months follow-up after PCI,the incidence of MACE in 120 T2DM patients with CHD was 24.17%(29/120).Gensini score,serum LDL-C/HDL-C ratio and Lp(a)level in poor prognosis subgroup were higher than those in good prognosis subgroup(t/P=3.939/<0.001,4.413/<0.001,4.333/<0.001).Multivariate Logistic regression analysis showed that high Gensini score,high LDL-C/HDL-C ratio

关 键 词：2型糖尿病 冠心病 LDL-C/HDL-C比值 脂蛋白(a) 主要不良心血管事件 相关性 

分 类 号：R587.1[医药卫生—内分泌] R541.4[医药卫生—内科学]