冠脉多支病变的相关危险因素分析

Analysis of risk factors related to multivessel coronary artery disease

目的探究冠脉多支病变(multivessel disease,MVD)患者的临床特征及相关危险因素。方法本研究采用回顾性分析,纳入冠心病患者229例,根据冠脉造影结果分为MVD组和单支病变(single vessel disease,SVD)组,其中MVD组153例,SVD组76例,比较两组基本信息(如年龄、性别、BMI等)及生化指标(如白蛋白、尿酸、血脂等)的差异,并分析各指标与MVD的关系。结果与SVD组相比,MVD组患者合并高血压病比例和合并糖尿病比例较高(P<0.05),白蛋白和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)较低(P<0.05),甘油三酯和残粒胆固醇(remnant cholesterol,RC)较高(P<0.05);二元logistic回归结果显示RC(OR=2.875,P=0.025)为MVD的独立危险因素,此外,高血压病史(OR=2.520,P=0.003)、糖尿病史(OR=2.306,P=0.019)、白蛋白(OR=0.875,P=0.003)也是MVD的独立危险因素;利用ROC曲线预测MVD,其中单独应用RC计算AUC为0.610(P<0.05),约登指数为0.232;单独应用白蛋白计算AUC为0.624(P<0.05),约登指数为0.206;而将这两项指标联合高血压病史及糖尿病史计算AUC为0.730(P<0.001),约登指数为0.391。结论RC是冠脉MVD的独立危险因素之一,当其升高时,冠脉MVD的发病风险增加,RC对冠脉MVD的预测价值较低,而综合多项危险因素在预测冠脉MVD方面具有一定的价值。

Objective To investigate the clinical characteristics of patients with coronary multivessel disease(MVD)and the relationship between MVD and remnant cholesterol(RC).Methods Totally,229 patients with coronary artery disease were enrolled in this study.They were divided into MVD group(153 cases)and single vessel disease(SVD)group(76 cases)according to the results of coronary angiography.The relationship between MVD and basic information(such as age,sex,BMI,etc.)and biochemical indicators(such as albumin,uric acid,blood lipid,etc.)of the subjects was analyzed.Results Compared with SVD group,MVD group had higher proportion of hypertension and diabetes(P<0.05),lower albumin and high-density lipoprotein cholesterol(P<0.05),higher triglyceride and RC(P<0.05).Binary logistic regression analysis revealed that RC(OR=2.875,P=0.025)was an independent risk factor for MVD.In addition,the history of hypertension(OR=2.520,P=0.003),diabetes(OR=2.306,P=0.019)and albumin(OR=0.875,P=0.003)were also independent risk factors for MVD.ROC curve was used to predict MVD and AUC calculated by RC alone was 0.610(P<0.05),and the Youden index was 0.232;AUC calculated by albumin alone was 0.624(P<0.05),and Youden index was 0.206;AUC calculated by combining the two items with the history of hypertension and diabetes was 0.730(P<0.001),and the Youden index was 0.391.Conclusion RC is one of the independent risk factors of MVD.Higher RC is associated with increased risk of MVD.However,the predictive value of RC alone for MVD is low.The combination of multiple risk factors has a certain value in predicting MVD.