糖化血红蛋白A1c与载脂蛋白A-1比值评估急性冠状动脉综合征患者预后的临床研究

Value of glycosylated hemoglobin A1c and apolipoprotein A-1 ratio on predicting outcome of patients with acute coronary syndrome

目的探讨糖化血红蛋白A1c(HbA1c)与载脂蛋白A-1(ApoA-1)比值(HbA1c/ApoA-1)对急性冠状动脉综合征(ACS)患者随访期间主要不良心血管事件(MACEs)的预测价值。方法本研究为回顾性队列研究,连续入选2017年3月至2019年3月于北京医院住院并接受冠状动脉造影的ACS患者,收集性别、年龄、既往史、Gensini评分、HbA1c和ApoA-1等基线资料。依据随访期间有无MACEs发生分为MACEs组和无MACEs组,分析2组间HbA1c/ApoA-1的差异。按HbA1c/ApoA-1水平的三分位数将患者分为高、中、低HbA1c/ApoA-1组,使用Cox比例风险模型评估3组间MACEs、全因死亡率等终点事件的差异。使用Kaplan-Meier生存分析比较各HbA1c/ApoA-l组间无MACEs生存率差异。使用Spearman秩相关分析评价HbA1c/ApoA-1与Gensini评分的相关性。结果共纳入ACS患者366例,59例发生MACEs,10例发生全因死亡。所有患者平均年龄为(65.9±10.3)岁,随访(22.3±4.4)个月,校正年龄、收缩压、糖尿病病史、冠状动脉病变严重程度后,高HbA1c/ApoA-1组患者MACEs发生率是低HbA1c/ApoA-1组患者的2.45倍(95%CI:1.16~5.18,P=0.019),但2组全因死亡率差异无统计学意义(P=1.000)。Kaplan-Meier生存分析显示高HbA1c/ApoA-l组MACEs风险最高,低HbA1c/ApoA-l组风险最低,差异有统计学意义(P<0.01)。Spearman秩相关分析结果显示,HbA1c/ApoA-1比值高低与ACS患者Gensini评分呈正相关(r=0.274,P<0.01)。结论HbA1c/ApoA-1是ACS患者MACEs的独立危险因素。高HbA1c/ApoA-1患者冠状动脉病变程度更重。HbA1c/ApoA-1水平可能作为评估ACS患者心血管风险的潜在指标,用于早期识别高危人群,预测MACEs的发生。

Objective To investigate the predictive value of glycosylated hemoglobin A1c/apolipoprotein A-1(HbA1c/ApoA-1)ratio for major adverse cardiovascular events(MACEs)in patients with acute coronary syndrome(ACS).Methods The present study is a retrospective cohort study.ACS patients who were hospitalized and underwent coronary angiography at Beijing Hospital from March 2017 to March 2019 were enrolled.Baseline information such as sex,age,previous history,Gensini score,HbA1c and ApoA-1 were analyzed.Patients were divided into two groups according to presence or absence of MACEs and the difference on HbA1c/ApoA-1 ratio was compared between the two groups.According to the tertiles of HbA1c/ApoA-1 levels,patients were divided into high(5.87-16.12),medium(4.50-5.83)and low(2.11-4.48)HbA1c/ApoA-1 groups.Cox proportional risk model was used to evaluate the differences in MACEs and all-cause mortality among the three groups.Kaplan-Meier survival analysis was used to compare the differences of MACEs between the various HbA1c/ApoA-1 groups.Results A total of 366 ACS patients were included in this study.The mean age of the patients was(65.9±10.3)years.There were 59 MACEs and 10 all-cause deaths during the mean of(22.3±4.4)months follow-up.After adjusting for age,systolic blood pressure,history of diabetes and Gensini score,the incidence of MACEs was 2.45 times higher in the high HbA1c/ApoA-1 group than in the low HbA1c/ApoA-1 group(95%CI 1.16-5.18,P=0.019).There was no significant difference in all-cause mortality between the high and low HbA1c/ApoA-1 groups(P=1.000).Kaplan-Meier survival analysis showed that patients in the high HbA1c/ApoA-1 group had the highest risk of MACEs,while patients in the low HbA1c/ApoA-1 group had the lowest risk of MACEs(P<0.01).Spearman rank correlation analysis showed that HbA1/ApoA-1 ratio was positively correlated with Gensini score in ACS patients(r=0.274,P<0.01).Conclusion High HbA1c/ApoA-1 ratio was an independent risk factor for MACEs in ACS patients.Patients with high HbA1c/ApoA-1 ratio had more severe coronary artery disease lesions.HbA1c/ApoA-1 ratio may be used as a potential risk stratification biomarker for ACS patients,it might be useful for the early identification of high-risk population and for predicting the incidence of MACEs among ACS patients.