NSTEMI患者血浆低密度脂蛋白胆固醇/高密度脂蛋白胆固醇与代谢综合征及心血管结局的相关性研究

Association of LDL-C to HDL-C ratio with metabolic syndrome and cardiovascular outcomes in patients with non-ST segment elevation myocardial infarction

摘要:

目的：探讨非ST段抬高型急性心肌梗死（non-ST segment elevation myocardial infarction，NSTEMI）患者血浆低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值（LDL-C to HDL-C ratio，LHR）与代谢综合征及心血管结局的相关性。方法：本研究为回顾性队列研究，纳入2019年1月至2019年7月于陆军军医大学第二附属医院心内科入院的NSTEMI患者408例，男性占67.4%，按LHR中位数将研究人群分为低LHR组（≤2.72，204例）和高LHR组（>2.72，204例），比较2组间的临床资料及实验室指标，分析LHR水平与代谢综合征（metabolic syndrome，MetS）的关联性，评估LHR与入院后12个月主要不良心血管事件（major cardiovascular events，MACE）的相关性。结果：在NSTEMI人群中，高LHR组较低LHR组具有更高的MetS和M ACE发生率（P<0.05）。多因素logistic回归分析表明，LHR与MetS显著相关（OR=1.424，95%CI=1.031~1.965，P=0.032），高LHR可能是MetS的独立危险因素。随访12个月，共出现69例MACE，其中高LHR组48例，低LHR组21例，多因素COX回归分析进一步表明，LHR水平与MACE风险增加显著相关（HR=1.309，95%CI=1.021~1.678，P=0.034），高LHR可能是MACE的独立预测因素（HR=2.271，95%CI=1.345~3.836，P=0.002）。结论：在NSTEMI患者中，LHR可能是MetS和MACE的独立危险因素，计算LHR有助于控制心血管风险。

Abstract:

Objective：To explore the association of LDL-C to HDL-C ratio（LHR） with metabolic syndrome（MetS） and cardiovascu－lar outcomes in patients with non-ST segment elevation myocardial infarction（NSTEMI）. Methods：A retrospective cohort study was conducted，involving 408 patients diagnosed with NSTEMI（male accounted for 67.4%） who were admitted to the cardiology department in our hospital from January 2019 to July 2019. According to the median LHR，the subjects were divided into the low LHR group（≤2.72，204 cases） and the high LHR group（>2.72，204 cases）. Clinical data and laboratory parameters were compared between the two groups；the correlation between LHR levels and MetS was analyzed；the association of LHR with major adverse cardiovascular events（MACE） was evaluated during 12 months follow-up after admission. Results：The high LHR group had a higher incidence of MetS and MACE than that of the low LHR group in patients with NSTEMI（P<0.05）. Multivariate logistic regression analysis showed that LHR was significantly correlated with MetS（OR=1.424，95%CI=1.031-1.965，P=0.032） and high LHR level might be an independent risk factor for MetS. After 12 months of follow-up，totally 69 cases developed MACE（16.9%） including 48 cases in the high LHR group and 21 cases in the low LHR group. Multivariate COX regression analysis further indicated that LHR level was significantly associated with increased MACE risk（HR=1.309，95%CI=1.021-1.678，P=0.034）. High LHR might be an independent predictor of MACE（HR=2.271，95%CI=1.345-3.836，P=0.002）. Conclusion：LHR may be an independent risk factor for MetS and MACE and calculating LHR contributes to controlling cardiovascular risk in patients with NSTEMI.