残余胆固醇与青年心肌梗死首次发病的相关性研究

The levels of remnant cholesterol is independently associated with the development of premature myocardial infarction in very young individuals

目的探讨残余胆固醇与青年心肌梗死首次发病的相关性。方法回顾性分析2015年7月至2021年12月就诊于徐州市中心医院心内科明确诊断为急性心肌梗死,且首次发病(年龄≤40岁)的患者共190例为心肌梗死组。同时选取同时期就诊于徐州市中心医院,行心脏CT血管造影或冠脉造影术明确排除冠心病、按照年龄和性别匹配的健康人群190例为对照组,收取患者入院后次日相关生化包括血脂指标、血糖指标,按照同一标准由同一实验室化验,记录一般基线资料及血脂水平,探讨残余胆固醇与首发青年心肌梗死的相关性。结果两组相比,青年心梗患者的吸烟、高血压、糖尿病比例高于对照组,总胆固醇、低密度脂蛋白、载脂蛋白B、LP(a)、N-HDL、RC水平高于对照组,高密度脂蛋白、载脂蛋白A1水平低于对照组,上述差异有统计学意义(P<0.05)。两组患者的其他指标比较,差异无统计学意义(P>0.05)。Logistic回归分析的结果显示,总胆固醇(OR=1.411)、低密度脂蛋白(OR=1.269)、载脂蛋白B(OR=2.545)、LP(a)(OR=1.002)、N-HDL(OR=1.525)、残余胆固醇(OR=2.808)是患者发生心梗的危险因素,有统计学意义(P<0.05);上述指标水平每增加一个SD的数值,发生心梗的风险升高为原来的1.411、1.269、2.545、1.002、1.525和2.208倍。相对于其他血脂指标,残余胆固醇与青年心肌梗死首次发病更有关联性,且是独立危险因素。载脂蛋白A1(OR=0.074)、高密度脂蛋白(OR=0.489)是患者发生心梗的保护因素,有统计学意义(P<0.05);上述指标水平每增加一个SD的数值,发生心梗的风险降低为原来的0.074、0.489倍。结论残余胆固醇水平升高可明显增加青年首发心肌梗死发病率,有可能作为这一年龄群体新的心梗危险标记物。

Objective This study evaluated the association of remnant cholesterol with premature AMI in very young individuals.Methods We prospectively enrolled 380 patients into our multicenter case-control study,Comprising190 consecutive myocardial infarction survivors and 190 hospital control(non—coronary heart disease),all the patients were admitted to the Department of Cardiology,Xuzhou Central Hospital from July 2015 to December 2021.Myocardial infarction patients were frequency matched for age,gender,and center.Blood samples were collected after hospitalized,hematology parameters and biochemical parameters,including lipid profiles,blood glucose,were measured by standard laboratory techniques.General baseline data and biochemical parameters were collected to investigate the role of remnant cholesterol in premature AMI in very young individuals.Results Compared with the control group,the proportion of smoking,hypertension and diabetes in Myocardial infarction patients was higher than that in the control group,the levels of total cholesterol,low-density lipoprotein,apolipoprotein B,LP(a),N-HDL and remnant cholesterol were higher than those in the control group,and the levels of high-density lipoprotein and apolipoprotein A1 were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in other indexes between the two groups(P>0.05).Multivariate logistic regression analysis showed that RC(OR=2.808),apolipoprotein B(OR=2.545),N-HDL(OR=1.525),Total cholesterol(OR=1.411),low-density lipoprotein(OR=1.269),LP(a)(OR=1.002)were associated with premature AMI,and remnant cholesterol was the most strongly associated with premature myocardial infarction in very young individuals.Aolipoprotein A1(OR=0.074)and high-density lipoprotein(OR=0.489)were the protective factors for myocardial infarction.Conclusion In conclusion,The level of remnant cholesterol is independently associated with the development of premature myocardial infarction in very young individuals,and might serve as a new potent risk marker in this young patient population.