摘要
目的:探讨急性ST段抬高型心肌梗死(STEMI)患者低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)比值(LHR)与其院内主要不良心血管事件(MACE)的相关性及其在临床中的应用价值。方法:收集发病12h内就诊的481例STEMI住院患者的临床资料及MACE发生情况,根据LHR的中位数(2.9)将患者分为低LHR组(LHR≤2.9,n=223)和高LHR组(LHR>2.9,n=258)。分析LHR与STEMI患者院内MACE的相关性。结果:高LHR组患者院内MACE比例均高于低LHR组[恶性室性心律失常:29(11.2%) VS 9(4.0%),P=0.004;高度房室传导阻滞:22(8.5%) VS 6(2.7%),P=0.006;心源性休克+死亡:29(11.2%) VS 7(3.1%),P=0.001]。恶性室性心律失常、心源性休克+死亡患者LHR差异有统计学意义(P均<0.05)。Pearson相关分析显示,除高度房室传导阻滞(r=0.060,P>0.05)外,LHR与恶性室性心律失常(r=0.121)、心源性休克和死亡(r=0.115)均显著相关(P<0.05)。多因素Logistic回归分析显示,LHR、空腹血糖是STEMI患者发生院内MACE的独立危险因素(P均<0.05)。ROC曲线显示LHR预测STEMI患者院内MACE的曲线下面积为0.606(95%CI:0.544~0.668),cut-off值为2.854,敏感度为80.6%,特异度为52.1%;LHR>2.854时STEMI住院患者很可能会发生MACE。结论:STEMI患者LHR升高与恶性室性心律失常、心源性休克及死亡发生呈正相关。LHR是STEMI患者发生MACE的独立危险因素,对恶性室性心律失常、心源性休克及死亡发生有一定的预测价值。
Objective:To explore the correlation between the ratio of low-density lipoprotein cholesterol(LDL-C) to high-density lipoprotein cholesterol(HDL-C) and major adverse cardiovascular events(MACE) in patients with acute ST segment elevation myocardial infarction(STEMI) and its clinical application value.Methods:Clinical data and MACE incidence of 481 STEMI inpatients who visited within 12 hours of onset were collected.According to the median of LDL-C/HDL-C ratio(LHR=2.9),the patients were divided into a low LHR group(LHR ≤2.9,n=223) and a high LHR group(LHR>2.9,n=258).Analyze the correlation between LHR and in-hospital MACE in patients with STEMI.Results:The proportion of mace in the high LHR group was higher than that in the low LHR Group [malignant ventricular arrhythmia:29(11.2%) VS 9(4.0%),P=0.004;high degree atrioventricular block:22(8.5%) VS 6(2.7%),P=0.006;cardiogenic shock and death:29(11.2%) VS 7(3.1%),P=0.001].There were statistically significant differences in LHR between patients with malignant ventricular arrhythmia,cardiogenic shock and death(all P<0.05).Pearson correlation analysis showed that LHR was significantly correlated with malignant ventricular arrhythmia(r=0.121,P<0.05),cardiogenic shock and death(r=0.115,P<0.05),except for high degree atrioventricular block(r=0.060,P>0.05).Multivariate Logistic regression analysis showed that LHR and fasting blood glucose were independent risk factors for MACE in STEMI patients(P<0.05).The area under the ROC curve predicted by LHR for MACE in STEMI patients was 0.606(95%CI:0.544~0.668),the cut off value was 2.854,the sensitivity was 80.6%,and the specificity was 52.1%.When LHR>2.854,STEMI inpatients are likely to experience MACE.Conclusion:The increase of LHR in STEMI patients is positively correlated with malignant ventricular arrhythmia,cardiogenic shock and death.LHR is an independent risk factor for the occurrence of MACE in STEMI patients,and is useful to predict the value for malignant ventricular arrhythmia,cardiogenic shock and death.
作者
赵海峰
马炳辰
ZHAO Haifeng;MA Bingchen(Internal Medicine Department of Beijing Huasheng Rehabilitation Hospital,Beijing City 100075;不详)
出处
《医学理论与实践》
2024年第4期541-544,共4页
The Journal of Medical Theory and Practice