低密度脂蛋白亚型和其他血脂残余风险指标与老年缺血性心脑血管病终点事件的关系

Relationship of low-density lipoprotein subtypes and other residual lipid risk indicators with endpoint events of ICCVD in elderly

目的分析低密度脂蛋白(LDL)亚型和其他血脂残余风险指标对老年缺血性心脑血管病(ICCVD)患者随访期间主要不良心脑血管事件(MACCE)的影响。方法回顾性分析2021年7月至2022年5月于沧州市人民医院心血管内科和神经内科收治的老年ICCVD患者762例,所有患者均经过临床规范化治疗,并定期进行随访,依据随访期间是否发生MACCE(全因死亡、心源性死亡、急性心肌梗死、急性脑梗死、频发心绞痛及短暂性脑缺血发作)的情况,分为MACCE组76例和非MACCE组686例。分析2组患者临床资料,采用多因素logistic回归模型分析影响患者预后的危险因素。结果MACCE组TC、LDL、LDL3型(LDL-3)、小而密低密度脂蛋白(sdLDL)、非高密度脂蛋白(非HDL)、载脂蛋白B与载脂蛋白A-Ⅰ比值(apoB/apoA-Ⅰ)、脂蛋白a[LP(a)]及非HDL/HDL均高于非MACCE组[(4.89±1.02)mmol/L vs(4.40±1.15)mmol/L,(2.94±0.89)mmol/L vs(2.61±0.99)mmol/L,(240.64±127.03)mg/L vs(176.46±117.09)mg/L,(320.50±183.24)mg/L vs(262.93±219.71)mg/L,(3.87±1.06)mmol/L vs(3.17±1.03)mmol/L,0.94±0.32 vs 0.83±0.45,271.30 mg/L vs 194.70 mg/L,3.36 vs 2.58,P<0.05,P<0.01]。多因素回归分析显示,LDL、LDL-3、sdLDL、非HDL、apoB/apoA-Ⅰ、LP(a)及非HDL/HDL是老年ICCVD患者发生MACCE的独立危险因素(P<0.05,P<0.01)。结论LDL、LDL-3、sdLDL、非LDL、apoB/apoA-Ⅰ、LP(a)及非HDL/HDL均与老年ICCVD患者预后密切相关。

Objective To investigate the effects of low-density lipoprotein(LDL)subtypes and other lipid residual risk indicators on the occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)during follow-up in the elderly with ischemic cardio-cerebrovascular diseases(ICCVD).Methods A retrospective analysis was conducted on 762 elderly patients hospitalized for ICCVD in Cangzhou People􀆳s Hospital from July 2021 to May 2022.All patients underwent clinically standardized treatment and were regularly followed up.According to whether MACCE(all-cause death,cardiogenic death,acute myocardial infarction,acute cerebral infarction,frequent angina pectoris,and transient ischemic attack)occurred during the follow-up period,they were divided into MACCE group(76 cases)and non-MACCE group(686 cases).Multivariate logistic regression model was used to analyze the risk factors affecting the prognosis of the ICCVD patients.Results The MACCE group had significantly higher TC(4.89±1.02 mmol/L vs 4.40±1.15 mmol/L),LDL(2.94±0.89 mmol/L vs 2.61±0.99 mmol/L),LDL-3(240.64±127.03 mg/L vs 176.46±117.09 mg/L),small dense LDL(sdLDL,320.50±183.24 mg/L vs 262.93±219.71 mg/L),non-HDL(3.87±1.06 mmol/L vs 3.17±1.03 mmol/L),apoB/apoA-Ⅰ(0.94±0.32 vs 0.83±0.45),lipoprotein a[LP(a),271.30 mg/L vs 194.70 mg/L]and non-HDL/HDL(3.36 vs 2.58)than the non-MACCE group(P<0.05,P<0.01).Regression analysis revealed that LDL,LDL-3,sdLDL,non-HDL,apoB/apoA-Ⅰ,LP(a)and non-HDL/HDL were all risk factors for MACCE in elderly ICCVD patients during follow-up(P<0.05).Conclusion LDL,LDL-3,sdLDL,non-HDL,apoB/apoA-Ⅰ,LP(a)and non-HDL/HDL are all closely associated with the prognosis of ICCVD in elderly patients.