CHR对稳定型冠心病患者PCI术后的预后价值研究

Prognostic value of CHR after percutaneous coronary intervention in patients with stable coronary artery disease

目的研究C反应蛋白(CRP)与高密度脂蛋白-胆固醇(HDL-C)比值(CHR)预测稳定型冠心病(SCAD)患者经皮冠状动脉介入治疗(PCI)术后全因死亡的临床价值。方法选取2019年6月至2021年12月该院收治的SCAD行PCI患者189例作为研究对象。收集患者资料,包括高血压史、糖尿病史、高脂血症史、吸烟史、药物使用情况等,记录患者心电图、超声心动图、肝功能、肾功能、血脂、血糖、Hb、CRP、出院后药物治疗方案及院外随访结果等。计算患者CHR水平,并绘制CHR的受试者工作特征(ROC)曲线,根据截断值进行分组,比较两组患者临床资料。采用Kaplan-Meier生存曲线和多因素Cox风险模型分析CHR与全因死亡事件之间的关系。结果随访时间为730 d,随访期间共发生全因死亡16例。CHR预测全因死亡的曲线下面积(AUC)为0.833(95%CI:0.735~0.930,P<0.001),截断值为2.446。以CHR=2.446进行分组,高CHR组(CHR≥2.446)52例,低CHR组(CHR<2.446)137例。高CHR组患者的舒张压水平、CRP水平、全因死亡比例高于低CHR组,糖尿病比例、Hb水平、总胆固醇(TC)水平、HDL-C水平低于低CHR组,差异均有统计学意义(P<0.05)。Kaplan-Meier生存分析结果显示,高CHR组全因死亡事件的发生率高于低CHR组(Log-Rankχ^(2)=26.127,P<0.001)。多因素Cox回归分析结果显示,调整性别、年龄、舒张压、糖尿病、左心室射血分数、Hb、TC后,CHR是全因死亡发生的独立影响因素(P<0.05)。结论CHR是SCAD患者PCI术后发生全因死亡的独立预测因素,临床需加以重视。

Objective To investigate the clinical value of C reactive protein(CRP)to high-density lipoprotein-cholesterol(HDL-C)ratio(CHR)in predicting the all-cause mortality after percutaneous coronary intervention(PCI)in the patients with stable coronary artery disease(SCAD).Methods A total of 189 patients with SCAD undergoing PCI admitted and treated in this hospital were selected as the study subjects.The patients’data were collected,including the history of hypertension,diabetes,hyperlipidemia,smoking,drug use,etc.,and the relevant indicators such as electrocardiogram,echocardiography,liver function,renal function,blood lipids,blood glucose,Hb,CRP,post-discharge drug treatment regimen and out-of-hospital follow-up results were recorded.The CHR level of the patients was calculated,and the receiver operating characteristic(ROC)curve of CHR was plotted,the grouping was performed according to the cutoff value and the clinical data were compared between the two groups.The Kaplan-Meier survival curve and multivariate Cox risk model were used to analyze the relationship between CHR and all-cause mortality events.Results The follow-up time was 730 d,and 16 cases of all-cause death occurred during the follow-up period.The area under the curve(AUC)of CHR for predicting the all-cause mortality was 0.833(95%CI:0.735-0.930,P<0.001),and the cut-off value was 2.446.The grouping was performed according to CHR=2.446,there were 52 cases in the high CHR group(CHR≥2.446)and 137 cases in the low CHR group(CHR<2.446).The diastolic blood pressure level,CRP level and proportion of all-cause mortality in the high CHR group were higher than those in the low CHR group,and the proportion of diabetes mellitus,Hb level,TC level and HDL-C level were lower than those in the low CHR group,and the differences were statistically significant(P<0.05).The results of Kaplan-Meier survival analysis showed that the incidence rate of all-cause mortality in the high CHR group was higher than that in the low CHR group(Log-Rankχ^(2)=26.127,P<0.001).The multivariate Cox regression analysis results showed that CHR was the independent influencing factor of the occurrence of all-cause mortality after adjusting age,gender,diastolic blood pressure,diabetes mellitus,left ventricular ejection fraction,Hb and TC(P<0.05).Conclusion CHR is an independent predictive factor of all-cause mortality after PCI in the patients with SCAD,and clinic needs to pay attention to.