入院时高密度脂蛋白胆固醇水平对急性ST段抬高心肌梗死患者结局的影响

Impact of high-density lipoprotein levels at hospital admission on the outcome of patients with acute ST-segment elevation myocardial infarction

目的分析急性ST段抬高心肌梗死（ASTEMI）患者人院时高密度脂蛋白胆固醇（HDL-C）水平对随访一年主要心血管不良事件（MACCE）的影响。方法选取2009年5月至2010年5月辽宁省20家医院1067例症状发作24h内入院并进行血脂检测的ASTEMI患者。观察基线情况、住院时症状、诊断、治疗及检查结果。随访1、6个月和1年的药物使用及MACCE（心源性死亡、非致死性心肌梗死、脑卒中及再次血运重建）。采用Cox比例风险模型分析影响MACCE的独立危险因素。结果根据患者入院时HDL—C水平均值，分为〈1．27mmol／L组587例（低组）和≥1．27mmol／L组489例（高组）。随访1、6个月及1年时低组非致死性心肌梗死发生率显著高于高组（分别为1．4％ vs．O．0％，P=0．01；2．8％VS．0．4％，P=0．003；4．8％ vs．0．9％，P〈0．001），随访6个月及1年时低组MACCE发生率显著高于高组（分别为18．3％ vs．13．7％，P=0．04；23．7％ vs．18．1％，P=0．03）。年龄（HR=1．02，95％CI：1．006—1．035，P=0．005）、糖尿病（HR=1．05，95％CI：1．053～2．171，P=0．03）、HDL—C水平（HR=O．56，95％CI：0．340～0．921，P=0．02）是ASTEMI患者1年后发生MACCE的独立危险因素。结论入院时HDL-C水平高的ASTEMI患者随访1年和6个月时的MACCE（主要是非致死性心肌梗死）及1个月时的非致死性心肌梗死发生率显著低于HDL—C水平低的患者，并随时间延长其差异越明显。年龄、糖尿病及HDL-C水平是MACCE的独立危险因素。

Objective To analyze the impact of high-density lipoprotein cholesterol （HDL-C） levels at hospital admission on the incidence of major adverse cardiovascular events （MACCE） in patients with acute ST segment elevation myocardial infarction （ASTEMI）. Methods 1067 patients with ASTEMI who were admitted to the 20 hospitals in Liaoning region and with lipid profile tested within the 24 hours of admission from May 2009 until May 2010, were enrolled. Data on basic demographic, clinical, status on admission and method of treatment were collected. Rate on various medical use and MACCE （cardiovascular death, non-fatal myocardial infarction, revascularization and stoke） were compared between the two groups through follow-up observation. Cox proportional hazard analysis was estimation. Results The median HDL-C level was 1.27 mmol/L, with 587 patients having HDL-C below and 489 patients HDL-C above the median level. The incidence rates of non-fatal myocardial infarction and MACCE at one-year follow-up period, was higher in low HDL-C group （4.8% vs. 0.9%, P〈0.001 ;23.7% vs. 18.1%, P=0.03, respectively）. At one month follow-up, the incidence rate of non-fatal myocardial infarction was higher in low HDL-C group （1.4% vs. 0.0%, P=0.01 ）. At six month follow-up, the incidence rates of non-fatal myocardial infarction and MACCE on one-year follow-up was higher in low HDL-C group （2.8% vs. 0.4%, P= 0.003; 18.3% vs. 13.7%, P=0.04, respectively）. Results from Cox proportional hazards analysis indicated that age （HR= 1.02,95%CI： 1.006-1.035, P=0.005）, diabetes （HR= 1.05,95%CI： 1.053- 2.171, P=0.03）, HDL-C level （HR=0.56,95%CI： 0.340-0.921, P=0.02） were significantly related to the incidence of MACCE. Conclusion The incidence rates of one year and six month MACCE （mainly non-fatal myocardial infarction） and one month non-fatal myocardial infarction were significant higher in patients with low than high HDL-C levels at admission while kept on the ascending along with time. Age, diabetes, HDL-C level were independent risk factors related to the incidence of MACCE.