估测的LDL-C累积暴露量与ACS患者冠状动脉病变严重程度及2年预后的相关性研究  

Association between estimated cumulative LDL-C exposure and coronary artery diseaseseverity and 2-year prognosis in acute coronary syndrome patients

作　　者：郝一莼 陈靖 闫少迪 宋莹[1] 姜琳[1] 陈艳[1] 崔成 高展[1] 赵雪燕[1] 张茵[1] 高立建[1] 陈珏[1] 袁晋青[1] 宋雷[1] 许晶晶[1] Hao Yichun;Chen Jing;Yan Shaod;Song Ying;Jiang Lin;Chen Yan;Cui Cheng;Gao Zhan;Zhao Xueyan;Zhang Yin;Gao Lijian;Chen Jue;Yuan Jinqing;Song Lei;Xu Jingjing(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,Shenzhen Hospital,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen 518057,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]中国医学科学院阜外医院深圳医院心内科,深圳518057

出　　处：《中华心血管病杂志》2025年第3期274-280,共7页Chinese Journal of Cardiology

基　　金：院士青年英才培育基金(YS-2022-002);中央高水平医院临床科研业务费(2022GSP-QN-1);国家科技支撑计划(2016YFC1301301)。

摘　　要：目的 探讨估测的低密度脂蛋白胆固醇(LDL-C)累积暴露量与急性冠脉综合征(ACS)患者冠状动脉病变严重程度和远期主要不良心脑血管事件(MACCE)的相关性。方法 研究对象来自PROMISE研究。该研究是一项前瞻性队列研究, 由中国医学科学院阜外医院牵头, 8家区域性三级医院作为分中心共同参与, 于2015年1月至2019年5月期间招募了18 701例确诊冠心病的患者。本研究纳入其中8 429例ACS患者。根据单次测量的基线LDL-C值计算估测的LDL-C累积暴露量, 并采用四分位法将患者分为4组。收集患者的基线资料、冠状动脉造影资料并随访2年, 主要终点为MACCE, 定义为包含全因死亡、心原性死亡、心肌梗死、卒中及血运重建的复合终点。估测的LDL-C累积暴露量与冠状动脉病变严重程度的相关性采用Spearman相关性分析。比较4组间MACCE的差异, 并采用多因素Cox回归, 分析估测的LDL-C累积暴露量二分位、三分位和四分位分组与MACCE的关系。结果 纳入的8 429例ACS患者年龄(60.9±11.4)岁, 女性1 951例(23.1%)。Spearman相关性分析显示估测的LDL-C累积暴露量与术前SYNTAX积分、三支病变、左主干病变、靶病变个数呈正相关(相关性系数r分别为0.14、0.10、0.04、0.03, P均<0.05)。2年随访结果显示, 估测的LDL-C累积暴露量不同水平分组的ACS患者MACCE、全因死亡、心原性死亡、心肌梗死、卒中的发生率差异有统计学意义(P均<0.05).多因素Cox回归分析结果显示,以最低值组作为参考, 二分位、三分位和四分位分组的最高值组MACCE发生风险分别增加21%(95%CI:1.08~1.37, P=0.002)、24%(95%CI:1.07~1.43, P=0.004)、21%(95%CI:1.02~1.43, P=0.025)。结论 ACS患者中估测的LDL-C累积暴露量与冠状动脉病变的严重程度存在正相关关系。估测的LDL-C累积暴露量高是ACS患者2年MACCE的危险因素。Objective To investigate the association between estimated cumulative low-density lipoprotein cholesterol(LDL-C)exposure and the severity of coronary artery disease and long-term adverse cardiovascular and cerebrovascular events(MACCE)in patients with acute coronary syndrome(ACS).Methods The subjects were from the PROMISE study.This study was a prospective cohort study led by Fuwai Hospital,Chinese Academy of Medical Sciences,with participation from eight regional tertiary hospitals as sub-centers,and enrolled 18701 patients with confirmed coronary heart disease between January 2015 and May 2019.Among them,8429 patients with ACS were included in this study.The estimated cumulative LDL-C exposure was calculated by multiplying LDL-C by age.Participants were then divided into four groups based on quartiles.Baseline data and coronary angiography data were collected,and participants were followed for 2 years.The primary endpoint was MACCE,which was composed of all-cause death,cardiac death,myocardial infarction,revascularization,and stroke.Spearman correlation analysis was used to estimate the correlation between cumulative LDL-C exposure and the severity of coronary artery disease.The differences in MACCE among the four groups were compared,and multivariate Cox regression was used to divide the estimated cumulative exposure LDL-C into two groups,three groups,and four groups to analyze its relationship with MACCE.Results The 8429 ACS patients included in the study had an age of(60.9±11.4)years,with 1951(23.1%)females.Spearman correlation analysis revealed that estimated cumulative LDL-C exposure was positively associated with the preoperative SYNTAX score,three-vessel lesions disease,left main disease,and the number of target lesions(correlation coefficients r=0.14,0.10,0.04 and 0.03,respectively,with all P<0.05).The 2-year follow-up results indicated that the incidence rates of MACCE,all-cause death,cardiac death,myocardial infarction,and stroke in AcS patients grouped by different levels of estimated cumulative LDL

关 键 词：急性冠状动脉综合征 低密度脂蛋白胆固醇 生物标志物 风险因素 

分 类 号：R54[医药卫生—心血管疾病]