低密度脂蛋白胆固醇对老年糖尿病患者心血管事件的预测价值

Predictive value of low-density lipoprotein cholesterol in cardiovascular events in elderly diabetic patients

目的 分析低密度脂蛋白胆固醇(LDL-c)对老年糖尿病患者心血管事件的预测价值,为临床老年糖尿病患者预防心血管事件提供理论指导价值。方法 选取湖北江汉油田总医院心血管内科2019年6月~2020年6月来治疗的老年糖尿病患者180例,根据LDL-c水平分为高危组(LDL-c<2.6mmol/L)和低危组(LDL-c≥2.6mmol/L),对照组选择同期来该院体检的不伴有糖尿病的老年人群90例,对照组在体检时及实验组患者在入院时抽取空腹肘静脉血5mL,对照组在体检时及实验组患者在入院时抽取空腹肘静脉血5mL,测定所有患者年龄、性别、CRP、TC、TG、HDL-c、LDL-c水平及Gensini积分,采用Spearman相关分析提示LDL-C与DM患者血脂水平和Gensini积分的相关性,所有研究对象均随访1年,统计所有患者发生MACE情况,采用Spearman相关分析提示LDL-c与DM患者MACE发生率的相关性,采用多因素logistic回归分析DM患者发生MACE的危险因素。结果 根据血清LDL-c水平高危组74例(41.11%)和低危组106例(58.89%);高危组和低危组间年龄、性别、CRP、TC间两两组间比较差异无统计学意义(P>0.05);高危组血清TG、TC、LDL-c、Gensini积分显著高于低危组,高危组血清LDL-c水平显著低于低危组(P<0.05);DM患者血清LDL-c水平与TG、Gensini积分呈正相关(r=0.382,0.359,P<0.05),与LDL-c呈负相关(r=-0.378,P<0.05);多元线性回归分析显示,LDL-c与Gensini积分独立相关(P<0.05,校正R;=0.089);高危组MACE发生率为31.08%,低危组MACE发生率为14.15%,高危组MACE发生率明显高于低危组(χ^(2)=7.500,P<0.05);Spearman相关分析提示LDL-C与MACE发生率呈正相关(r=0.781,P<0.05);多因素Logistic回归分析提示LDL-c≥2.6mmol/L是老年DM患者发生MACE的独立危险因素(P<0.05);LDL-c预测DM患者发生MACE的ROC曲线下面积为0.814(95%CI:0.767~0.912),敏感度和特异度分别为78.40%和84.80%;结论 老年DM患者LDL-c水平明显增高,LDL-c≥2.6mmol/L对糖尿病患者发生心血管事件的预测具有一定的价值。

Objective To analyze the predictive value of low-density lipoprotein cholesterol(LDL-c) on cardiovascular events in elderly patients with diabetes, and to provide theoretical guidance for the prevention of cardiovascular disease in elderly patients with diabetes. Methods A total of 180 elderly patients with diabetes treated at the Department of Cardiovascular Medicine, Hubei Jianghan Oilfield General Hospital from June 2019 to June 2020 were selected.According to the LDL-c level, they were divided into low-risk group(LDL-c<2.6 mmol/L) and high-risk group(LDL-c≥2.6 mmol/L).Ninety elderly people without diabetes who underwent physical examination during the same periodwere selected as the control group.During the physical examination, 5 mL of fasting elbow venous blood was drawn from the elderly in the control group, and 5 mL of fasting elbow venous blood was drawn from the patients in the experimental group upon admission.The age, gender, CRP,TC,TG,HDL-c, LDL-c levels and Gensini scores of all patients were determined.Spearman correlation analysis was used to analyze the correlation between LDL-c and blood lipid levels and Gensini scores of DM patients.All subjects were followed up for 1 year, and the incidence of MACE in all patients was analyzed.Spearman correlation analysis was used to analyze the correlation between LDL-c and the incidence of MACE in DM patients, and multivariate logistic regression was used to analyze the risk factors of MACE in DM patients. Results According to the serum LDL-c levels, 74 cases(41.11%) were in the high-risk group and 106 cases(58.89%) were in the low-risk group.There were no significant differences in age, gender, CRP and TC between the high-risk group and the low-risk group(P>0.05).The serum TG,TC,and LDL-c levels, and Gensini scores in the high-risk group were significantly higher than those in the low-risk group, and the serum LDL-c level in the high-risk group was significantly lower than that in the low-risk group(P<0.05).Serum LDL-c level of DM patients was positively correlated with TG and Gensini score(r=0.382,0.359,P<0.05),and negatively correlated with LDL-c(r=-0.378,P<0.05).Multiple linear regression analysis showed that LDL-c was independently correlated with Gensini score(P<0.05,corrected R2=0.089).The incidence of MACE was 31.08% in the high-risk group and 14.15% in the low-risk group.The incidence of MACE in the high-risk group was significantly higher than that in the low-risk group(χ^(2)=7.500,P<0.05).Spearman correlation analysis showed that LDL-C was positively correlated with the incidence of MACE(r=0.781,P<0.05).Multivariate logistic regression analysis showed that LDL-c≥2.6 mmol/L was an independent risk factor for cardiovascular disease in elderly diabetic patients(P<0.05).The area under ROC curve for LDL-c to predict cardiovascular events in DM patients was 0.814(95% CI:0.767~0.912),and the sensitivity and specificity were 78.40% and 84.80%,respectively. Conclusion LDL-c level is significantly increased in elderly patients with diabetes, and LDL-c≥2.6 mmol/L is of certain value in predicting cardiovascular events in patients with diabetes.