不同血脂指标与早发急性心肌梗死相关性:一项横断面调查的事后分析

Associations between various lipid components and premature myocardial infarction:a cross-sectional study

目的探讨各种血脂成分及其比值与急性心肌梗死(AMI)早发风险的相关性。方法本研究为横断面调查事后分析。连续纳入2020年10月1日至2022年9月30日完成冠状动脉造影检查的急性ST段抬高型心肌梗死(STEMI)患者,并分为早发AMI组(首次发病年龄男性<55岁、女性<65岁)和晚发AMI组。收集总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、脂蛋白(a)[Lp(a)]、载脂蛋白B(ApoB)、载脂蛋白A-1(ApoA-1)、non-HDL-C/HDL-C及ApoB/ApoA-1等血脂指标,采用连续变量和分类变量两种形式来分析。通过logistic回归模型、限制性立方样条图和受试者工作特征曲线(ROC)分析比较上述血脂指标与早发AMI相关性。结果本研究共纳入STEMI患者1626例,平均年龄61岁,74.6%为男性,其中早发AMI组409例,晚发AMI组1217例。Logistic回归分析发现,早发AMI风险随TG、non-HDL-C/HDL-C、non-HDL-C、ApoB/ApoA-1、TC和ApoB五分位数增加而显著增高;LDL-C、ApoA-1和Lp(a)与早发AMI无明显相关。限制性立方样条图显示,除Lp(a)、LDL-C、ApoA-1和ApoB/ApoA-1外,其他血脂指标水平均与早发AMI显著相关。ROC曲线分析表明,TG和non-HDL-C/HDL-C对早发AMI具有较好的预测价值。不一致性分析发现,在高TG合并高non-HDL-C/HDL-C组,患者早发AMI发生率和风险最高。结论早发AMI患者TG和non-HDL-C/HDL-C等多项血脂指标显著增高,其中TG与早发AMI关系最为密切,应得到早期关注和进一步研究。

Objective Hyperlipidemia is closely related to premature acute myocardial infarction(AMI).The present study was performed to explore the correlation between various blood lipid components and the risk of premature AMI.Methods This is a cross-sectional retrospective study.Consecutive patients with acute ST-segment elevation myocardial infarction(STEMI),who completed coronary angiography from October 1,2020 to September 30,2022 in our hospital,were enrolled and divided into premature AMI group(male<55 years old,female<65 years old)and late-onset AMI group.Total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),non-HDL-C,lipoprotein(a)(Lp(a)),apolipoprotein B(ApoB),apolipoprotein A-1(ApoA-1),non-HDL-C/HDL-C and ApoB/ApoA-1 were analyzed.The correlation between the above blood lipid indexes and premature AMI was analyzed and compared by logistic regression,restricted cubic spline and receiver operating characteristic curve(ROC).Results A total of 1626 patients with STEMI were enrolled in this study,including 409 patients with premature AMI and 1217 patients with late-onset AMI.Logistic regression analysis showed that the risk of premature AMI increased significantly with the increase of TG,non-HDL-C/HDL-C,non-HDL-C,ApoB/ApoA-1,TC and ApoB quintiles;while LDL-C,ApoA-1 and Lp(a)had no significant correlation with premature AMI.The restricted cubic spline graph showed that except Lp(a),LDL-C,ApoA-1 and ApoB/ApoA-1,other blood lipid indicators were significantly correlated with premature AMI.The ROC curve showed that TG and non-HDL-C/HDL-C had better predictive value for premature AMI.Inconsistency analysis found that the incidence and risk of premature AMI were the highest in patients with high TG and high non-HDL-C/HDL-C.Conclusion TG,non-HDL-C/HDL-C and other blood lipid indexes are significantly increased in patients with premature AMI,among which TG is the parameter,most closely related to premature AMI,and future studies are needed to explore the impact of controlling TG on incidence of premature AMI.