摘要
目的 探讨载脂蛋白B/载脂蛋白A（apoB/apoA）联合非高密度脂蛋白胆固醇（non-HDL-C）检测对急性冠状动脉综合征（ACS）患者主要心血管不良事件（MACE）的预测价值，旨在为其临床诊疗、预后评估提供参考。方法 选取ACS患者120例，检测患者未使用调脂药物状态下的血脂指标，包括胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、apoB、apoA，计算non-HDL-C。将non-HDL-C的截断点界定为130 mg/dL（3.38 mmol/L）、apoB/apoA的截断点界定为0.9，依据non-HDL-C、apoB/apoA的截断点将患者分入4个亚组，其中A组37例、B组 38例、C组32例、D组13例，随访6个月记录MACE情况。结果 有效受试者118例，其中apoB/apoA≤0.9组患者68例，apoB/apoA＞0.9组患者50例；non-HDL-C≤3.38 mmol/L组患者74例，non-HDL-C＞3.38 mmol/L组患者44例。apoB/apoA＞0.9组与apoB/apoA≤0.9组比较，non-HDL-C＞3.38 mmol/L组与non-HDL-C≤3.38 mmol/L组比较，合并糖尿病、合并高血压、HDL-C、apoB、apoB/apoA、non-HDL-C指标间比较差异具有统计学意义（χ^2/t=3.97~5.20, P＜0.05）。B、C、D组MACE发生率均高于A组（χ^2=5.10、11.83、25.74, P＜0.05或P＜0.01），D组MACE发生率均高于B、C组（χ^2=13.82、7.45, P＜0.01）。多因素Logistic回归分析显示，non-HDL-C及apoB/apoA对MACE有预测价值，且两者联合（均处于高水平）时对MACE具有更强的预测价值（95%CI 3.211~57.621, P＜0.01）。结论 apoB/apoA、non-HDL-C能够更全面地反映脂蛋白代谢的变化，对ACS患者MACE的发生具有一定的预测价值，且两者联合（均处于高水平）时对MACE的预测价值更强，apoB/apoA联合non-HDL-C检测对ACS患者的临床诊疗、预后评估等都具有一定的指导意义和参考价值。
Objective To explore the predictive value in acute coronary syndrome （ACS） patients＇ major adverse cardiac events （MACE） by joint detection of apolipoprotein B/apolipoprotein A （apoB/apoA） and non - high density lipoprotein cholesterol （ non - HDL - C ） , to provide reference to its clinical diagnosis, treatment and evaluation. Methods 120 cases with ACS were selected, and blood lipid indexes were detected under the condition of unused lipid - lowering drugs, including cholesterol（TC）, high density lipoprotein cholesterol （HDL- C）, low density lipoprotein cholesterol （ LDL - C）, apoB, apoA, and non - HDL - C was calculated by Frost formula. The cut - off point of non- HDL- C was defined as 130 mg/dL（3.38 mmol/L） , apoB/apoA＇s cut- off point was defined as 0.9, and the patients were divided into 4 subgroups by above cut - off points, and group A with 37 cases, group B with 38 cases, group C with 32 cases, group D with 13 cases, and they were followed up for 6 months to record MACE. Results There was 118 cases of effective subjects, including 68 cases in group of apoB/apoA ≤0.9, 50 cases in group of apoB/apoA 〉 0.9, 74 cases in group of non- HDL- C≤3.38 mmol/L, and 44 cases in group of non - HDL - C 〉3.38 mmol/L. Comparing between groups of apoB/apoA 〉 0. 9 and apoB/apoA ≤0.9, non - HDL - C 〉 3.38 mmol/L and non - HDL - C ≤ 3.38 retool/L, there were statistical differences on complicating with diabetes mellitus, complicating with hypertension, HDL - C, apoB, apoB/apoA and non - HDL - C （ χ^2/t = 3.97 ~ 5.20, P 〈 0.05 ）. MACE＇s incidence in group B, C and D were all higher than that in group A（χ^2 = 5.10, 11.83,25.74, P 〈0.05 or P 〈0.01 ）, and MACE＇s incidence in group D were both higher than that in group B and C （χ^2 = 13.82, 7.45, P 〈0.01 ）. Multifactor Logistic regression analysis showed that, non - HDL - C and apoB/apoA both had predictive value for MACE, and it had stronger predictive value for MACE by joint detection of apoB/apoA and non- HDL- C （both at high level, 95% CI 3. 211 ~ 57. 621, P 〈 0. 01 ）. Conclusion ApoB/apoA and non - HDL - C can more comprehensively reflect the change of lipoprotein metabolism, and has some predictive value on MACE in patients with ACS, and has stronger predictive value by joint detection（ both at high level）, so it has some guiding significance and reference value on ACS patients＇ clinical diagnosis, treatment and prognosis evaluation.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第9期816-820,共5页
Chinese Journal of Critical Care Medicine
