高密度脂蛋白胆固醇与总胆固醇比值在糖尿病合并冠心病患者再发血运重建的预测价值

Predictive value of HDL-C/TC ratio for recurrent revascularization events in elderly diabetes patients with coronary heart disease

目的探讨基于决策曲线分析检测HDL-C/TC对老年糖尿病合并PCI患者再发血运重建事件的预测价值。方法收集2012年1月至2021年11月我院老年医学与特勤医学科收治的老年糖尿病合并PCI患者512例,根据是否存在血运重建事件分为对照组391例,病例组121例。通过Cox回归分析血运重建事件的危险因素,Kaplan-Meier曲线检测HDL-C/TC对血运重建事件的影响,决策曲线分析评估风险模型的临床效益。结果与对照组比较,病例组复杂血管病变、LDL-C、TC和TG水平明显升高,HDL-C/LDL-C及HDL-C/TC明显降低(P<0.05,P<0.01)。HDL-C/TC、复杂血管病变是老年糖尿病合并PCI患者术后再发血运重建事件的独立危险因素(95%CI:0.267~0.565,P=0.000;95%CI:1.149~2.409,P=0.007)。第24、36、48和60个月,HDL-C/TC>0.26患者再发血运重建事件发生率明显低于HDL-C/TC≤0.26患者(P<0.01)。纳入HDL-C/TC的曲线下面积明显高于未纳入HDL-C/TC。结论HDL-C/TC降低是老年糖尿病合并PCI患者再发血运重建事件的危险因素。

Objective To explore the clinical predictive value of HDL-C/TC ratio based on DCA for recurrent revascularization events in elderly diabetes patients after PCI.Methods A total of 512 elderly diabetes patients with a history of PCI admitted in our department from January 2012 to November 2021 were enrolled in this study.According to occurrence of revascularization events,they were divided into control group(n=391)and case group(n=121).The risk factors related to revascularization events were analyzed by Cox regression model.The effect of HDL-C/TC on the events was detected by Kaplan-Meier curve,and the clinical benefit of risk model was evaluated by DCA.Results Complex vascular disease,higher LDL-C,TC and TG levels,while lower HDL-C/LDL-C and HDL-C/TC ratios were observed in the case group than the control group(P<0.05,P<0.01).The HDL-C/TC ratio and complex vascular disease were independent risk factors for recurrent revascularization events after PCI in elderly diabetes patients(95%CI:0.267-0.565,P=0.000;95%CI:1.149-2.409,P=0.007).At the 24th,36th,48th and 60th months of observation,the recurrence rate of revascularization events in the patients with HDL-C/TC>0.26 was significantly lower than that in those with the ratio≤0.26(P<0.01).DCA suggested that the area under the clinical DCA curve was significantly higher when HDL-C/TC was included than when HDL-C/TC was not.Conclusion Low HDL-C/TC is a risk factor for recurrent revascularization events in elderly diabetes patients after PCI.