急性心肌梗死ox-LDL及HbA1c水平与冠脉病变程度及预后的相关性分析

The Correlation Analysis of the Serum Levels of ox-LDL and HbA1c with the Degree of Coronary Arterial Stenosis and Prognosis to Patients with Acute Myocardial Infarction

目的分析急性心肌梗死(AMI)患者氧化低密度脂蛋白(ox-LDL)及糖化血红蛋白(HbA1c)水平与冠脉病变程度的相关性,探讨对AMI患者预后结局的预判价值。方法选择本院的124例AMI患者为研究对象,根据患者随访2年预后情况分为:研究组,46例,发生主要心血管不良事件(MACE);对照组,78例,未发生MACE。测定并比较2组患者血清ox-LDL、HbA1c、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及Gensini积分差异;采用Pearson相关分析评估血清ox-LDL、HbA1c、FPG、TC、TG、LDL-C及HDL-C与冠脉Gensini积分相关性。应用多元Logistic回归分析上述指标与随访2年AMI患者MACE的危险性。绘制受试者工作特征曲线(ROC)评估血清ox-LDL及HbA1c水平对随访2年MACE的预测价值。结果研究组血清ox-LDL、HbA1c及Gensini积分高于对照组(均P<0.05),两组患者FPG、TC、TG、LDL-C及HDL-C差异无统计学意义(均P>0.05)。Pearson相关分析显示,AMI患者血清ox-LDL、HbA1c、LDL-C与冠脉Gensini积分正相关(r=0.781,P=0.026、r=0.726,P=0.031、r=0.602,P=0.047)。多元Logistic回归分析显示,血清ox-LDL、HbA1c与Gensini积分为AMI患者随访2年MACE发生的危险因素(OR=3.254,P=0.020;OR=3.705,P=0.029;OR=3.025,P=0.016)。ROC曲线显示,血清ox-LDL截断值为62.5μg/dL,HbA1c截断值为6.0%,预测AMI患者MACE发生的AUC为0.726,灵敏度为88.6%,特异性为84.8%。结论血清ox-LDL及HbA1c水平能较好评估AMI患者冠脉病变程度,预测患者短期预后结局。

Objective To analyze the correlation of the serum levels of oxidized low-density lipoprotein(ox-LDL)and glycosylated hemoglobin A1c(HbA1c)with the degree of coronary arterial stenosis in patients with acute myocardial infarction(AMI),and to explore the clinical value of ox-LDL and HbA1c on the short-term prognosis to patients with AMI.Methods A total of 124 patients with AMI in our hospital were divided into two groups:the research group(46 cases,the occurrence of MACE)and the control group(78 cases,non-occurrence of MACE).The indexes of ox-LDL,HbA1c,FPG,TC,TG,LDL-C,HDL-C and Gensini score were compared between the two groups.The correlations of Gensini score with the serum levels of ox-LDL,HbA1c,FPG,TC,TG,LDL-C,HDL-C were analyzed by Pearson linear analysis.The risk factors of the 2-year follow-up occurrence of MACE were analyzed by multivariate logistic analysis.The diagnostic value of the serum levels of ox-LDL and HbA1c for the occurrence of MACE in the patients with AMI were analyzed by receiver operating characteristic curves(ROC).Results The serum levels of ox-LDL,HbA1c and Gensini scores in the research group were higher than in the control group(all P<0.05).The serum levels of FPG,TC,TG,LDL-C and HDL-C were no different between the two groups(all P>0.05).The positive correlations of Gensini scores with the serum levels of ox-LDL,HbA1c and LDL were confirmed by Pearson linear correlation analysis(r=0.781,P=0.026;r=0.726,P=0.031;r=0.602,P=0.047).Multivariate logistic analysis showed that the serum levels of ox-LDL,HbA1c and Gensini scores were independent risk factors for the occurrence of MACE in patients with AMI(OR=3.254,P=0.020;OR=3.705,P=0.029;OR=3.025,P=0.016).When the cut-off point of serum ox-LDL level was 62.5μg/dl and the cut-off point of HbA1c was 6.0%,the AUC of predictions to the occurrence of MACE in AMI was 0.726 with the sensitivity 88.6%and specificity 84.8%.Conclusion The serum levels of ox-LDL and HbA1c can be used to assess the degree of coronary arterial stenosis to patients with AMI,and also can predict the short-term prognosis of patients with AMI.