摘要
目的探究急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后血脂管理水平与预后的关系。方法选择2021年1月至2022年2月间于宁国市人民医院收治接受PCI的ACS患者122例作为研究对象,对比不同危险分层ACS患者治疗前后血脂水平,根据ACS患者PCI术后2年内主要不良心血管事件(MACE)的发生情况将研究对象分为MACE组(n=24)和非MACE组(n=98),分析低密度脂蛋白胆固醇(LDL-C)水平与ACS患者预后的相关性,绘制ROC曲线,分析HDL-C对ACS患者预后的预测效能。结果不同危险分层ACS患者LDL-C水平具有显著差异,其中高危组患者LDL-C水平高于低危组(P<0.05);治疗后三组总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及LDL-C水平均降低,其中高危组患者TC及LDL-C水平高于低危组(P<0.05)。调整混杂影响后,LDL-C水平1.8~3.4 mmol/L、3.4~4.1 mmol/L、>4.1 mmol/L组患者发生MACE的风险分别是参照组(LDL-C<1.8 mmol/L)的1.775倍、2.203倍和3.194倍,差异有统计学意义(P<0.05)。在不同危险分层分组中,LDL-C水平与预后的关联强度均呈非线性剂量-反应关系(非线性检测,P<0.001)。与中低危ACS患者相比,利用LDL-C水平预测高危ACS患者MACE发生的ROC曲线(AUC)为0.758、准确性0.744和约登指数0.487,预测价值更高。Kaplan-Meier生存曲线分析显示,与血脂管理达标组相比,血脂管理未达标患者发生MACE的概率更高(P<0.05)。结论PCI术后血脂管理未达标ACS患者发生MACE的概率更高。在不同危险分层ACS患者分组中,LDL-C水平与预后的关联强度均呈非线性剂量-反应关系。与中低危ACS患者相比,LDL-C水平对高危ACS患者MACE发生预测效能更佳。
Objective To study the relationship between blood lipid management and prognosis in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods ACS patients(n=122)underwent PCI were chosen from People’s Hospital of Ningguo City from Jan.2021 to Feb.2022,and blood lipid level were compared in ACS patients with different risk stratifications before and after treatment.According to occurrence of major adverse cardiovascular events(MACE)within 2 y after PCI,the patients were divided into MACE group(n=24)and non-MACE group(n=98).The correlation between level of low-density lipoproteincholesterol(LDL-C)and prognosis was analyzed in ACS patients,and predictive efficacy of LDL-C for prognosis was analyzed after drawing ROC curve.Results There was significant difference in LDL-C level in ACS patients with different risk stratifications,and LDL-C level was significantly higher in high-risk group than that in lowrisk group(P<0.05).After treatment,the levels of total cholesterol(TC),high-density lipoprotein-cholesterol(HDL-C)and LDL-C decreased significantly in high-risk group,middle-risk group and low-risk group,and were significantly higher in high-risk group than those in low-risk group(P<0.05).After adjusting confound factors,the risk of MACE was 1.775 times higher in low-LDL-C group(1.8~3.4 mmol/L),2.203 times higher in middle-LDL-C group(3.4~4.1 mmol/L)and 3.194 times higher in high-LDL-C group(>4.1 mmol/L)compared with control group(LDL-C<1.8 mmol/L,P<0.05).The association intensity showed a nonlinear dose-response relationship between LDL-C level and prognosis in different risk stratification groups(P<0.001).In predicting MACE occurrence with LDL-C level,the results of ROC curve analysis showed that AUC(0.758),accuracy(0.744)and Jorden index(0.487)were higher in high-risk group than those in middle-risk and low-risk groups.The results of Kaplan-Meier survival curve analysis showed that MACE incidence was higher in group achieved lipid management goals than that in group with suboptimal lipid management(P<0.05).Conclusion The probability of MACE is higher in ACS patients with substandard lipid management after PCI.The association intensity between LDL-C level and prognosis shows a nonlinear dose-response relationship in ACS patient with stratifications.The efficacy of LDL-C in predicting ACS is higher in patient with high ACS risk than that in patients with middle-low ACS risk.
作者
刘华
聂克红
吕钢
柴俊兵
马海峰
Liu Hua;Nie Kehong;Lyu Gang;Chai Junbing;Ma Haifeng(Department of Cardiovascular Medicine,People’s Hospital of Ningguo City,Ningguo 242300,China;不详)
出处
《中国循证心血管医学杂志》
2025年第5期600-604,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
血脂管理
急性冠脉综合征
预后
经皮冠状动脉介入治疗
Blood lipid management
Acute coronary syndrome
Prognosis
Percutaneous coronary intervention
