高三酰甘油血症腰围表型与SYNTAX评分和血液流变学及内皮功能的相关性

Relationship of hypertriglyceridemia-WC phenotype with SYNTAX score,hemorrheology and endothelial function

目的分析高TG血症-腰围表型(HTWC)与SYNTAX评分、血液流变学、内皮功能的关系及对心血管事件的预测价值。方法选择2017年12月~2019年11月济南市人民医院心内科收治的冠心病患者230例,根据TG水平和腹型肥胖分为TG和腰围正常组79例(A组)、单纯高TG组66例(B组)、单纯腹型肥胖组50例(C组)、HTWC组35例(D组)。又根据有无心血管事件分为心血管事件组67例,无心血管事件组163例。计算患者SYNTAX评分,检测全血高切黏度、血浆黏度、全血低切黏度、红细胞聚集指数、纤维蛋白原、血小板最大聚集率、颈动脉内膜中层厚度(IMT)、肱动脉内皮依赖性舒张功能(FMD)、硝酸甘油介导的非内皮依赖性舒张功能(NMD)。采用logistic回归模型分析HTWC及各指标与心血管事件发生的关系,并绘制ROC曲线。结果D组SYNTAX评分、全血高切黏度、血浆黏度、全血低切黏度、红细胞聚集指数、纤维蛋白原、血小板最大聚集率、IMT水平较A组、B组、C组明显增高,FMD和NMD水平较A组、B组、C组明显降低(P<0.05)。心血管事件组HTWC、SYNTAX评分、全血高切黏度、血浆黏度、全血低切黏度、红细胞聚集指数、纤维蛋白原、血小板最大聚集率及IMT明显高于无心血管事件组,差异有统计学意义(P<0.05)。HTWC、SYNTAX评分、全血高切黏度、血浆黏度、全血低切黏度、红细胞聚集指数、纤维蛋白原及IMT是冠心病患者心血管事件发生的独立影响因素(P<0.05,P<0.01)。logistic回归模型预测心血管事件的敏感性为94.03%,特异性为96.32%,曲线下面积为0.985。结论冠心病患者HTWC与SYNTAX评分、血液流变学、内皮功能密切相关,且临床中通过联合分析HTWC与相关指标可有效评估心血管事件发生。

Objective To analyze the relationship of hypertriglyceridemia-waist circumference phenotype(HTWC)with SYNTAX score,hemorrheology,endothelial function and its value in predicting the cardiovascular events.Methods Two hundred and thirty CHD patients admitted our hospital from December 2017 to Dovember 2019 were divided into TG±normal WC group or group A(n=79),simple high TG group or group B(n=66),simple abdominal obesity group or group C(n=50),and HTWC group or group D(n=35)and into cardiovascular event group(n=67)and cardiovascular event-free group(n=163).Their SYNTAX score was recorded.Their whole blood high shear viscosity,plasma viscosity,whole blood low shear viscosity,erythrocyte aggregation index,serum fibrinogen level,maximal platelet aggregation rate,carotid IMT,FMD,NMD were measured.The relationship of HTWC,SYNTAX score,hemorrheology and endothelial function with cardiovascular events was analyzed by logistic regression model analysis.ROC curve was plotted for logistic regression model analysis in predicting the incidence of cardiovascular events in CHD patients.Results The SYNTAX score,whole blood high shear viscosity,plasma viscosity,whole blood low shear viscosity,erythrocyte aggregation index,serum fibrinogen level,maximal platelet aggregation rate and IMT were significantly higher while the FMD and NMD were significantly lower in group D than in groups A,B,C(P<0.05).The HTWC,SYNTAX score,whole blood high shear viscosity,plasma viscosity,whole blood low shear viscosity,erythrocyte aggregation index,serum fibrinogen level,and IMT were significantly higher in cardiovascular event group than cardiovascular event-free group(P<0.05)and were the independent risk factors for cardiovascular events in CHD patients(P<0.05,P<0.01).The sensitivity of logistic regression model analysis was 94.03%and the specificity of logistic regression model analysis was 96.32%in predicting the incidence of cardiovascular events.The AUC for logistic regression model analysis in predicting the incidence of cardiovascular events was 0.985.Conclusion HTWC is closely related with SYNTAX score,hemorheology and endothelial function.Analysis of HTWC,SYNTAX score,hemorheology and endothelial function can effectively assess the incidence of cardiovascular events in CHD patients.