冠状动脉周围脂肪衰减指数联合实验室指标预测急性冠脉综合征的研究

Study on the prediction of acute coronary syndrome based on coronary fat attenuation index and laboratory indicators

目的探讨冠状动脉周围脂肪衰减指数(fat attenuation index,FAI)联合实验室指标预测冠心病(coronary heart disease,CHD)患者发生急性冠状动脉综合征(acute coronary syndrome,ACS)风险的价值。方法回顾性分析2015年至2020年南方医科大学附属广东省人民医院确诊的CHD患者454例病历资料,将其分为稳定性冠心病(stable coronary artery disease,SCAD)组(n=233)与ACS组(n=221)。采用Logistic回归分析冠状动脉主要分支[右冠状动脉(right coronary artery,RCA)、左前降支(left anterior descending branch,LAD)及左旋支(left circumflex branch,LCX)]的FAI值、实验室指标及临床资料,筛选CHD患者发生ACS的独立影响因素;构建受试者操作特征曲线,并计算曲线下面积(area under the curve,AUC),评价独立影响因素及其联合应用的预测效能。结果LAD-FAI、RCA-FAI及高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)是CHD患者发生ACS的独立影响因素。LAD-FAI、RCA-FAI、hs-CRP值升高单独预测CHD患者发生ACS的AUC分别为0.568、0.703、0.749,三者联合预测的AUC为0.815。结论LAD-FAI、RCA-FAI与hs-CRP联合对CHD患者发生ACS的风险具有较好的预测效能。

Objective To explore the value of coronary fat attenuation index(FAI)combined with laboratory indicators in predicting the risk of acute coronary syndrome(ACS)in patients with coronary heart disease(CHD).Methods A retrospective analysis was conducted on 454 patients who were diagnosed with CHD in Guangdong Provincial People’s Hospital SCAD group(n=233)and an ACS group(n=221).Univariate and multivariate Logistic regression analyses were performed on the FAI values of the main coronary branches[right coronary artery(RCA),left anterior descending branch(LAD),left circumflex branch(LCX)],laboratory indicators,and clinical data,to identify independent risk factors for ACS in CHD patients.Receiver operating characteristic curves were constructed,and area under the curve(AUC)was calculated to evaluate the predictive performance of the independent risk factors and their combinations.Results LAD-FAI,RCA-FAI,and high-sensitivity C-reactive protein(hs-CRP)were independent influencing factors for ACS in CHD patients.The AUC for the prediction of ACS occurrence in CHD patients based on LAD-FAI,RCA-FAI,and elevated hs-CRP values alone were 0.568,0.703,and 0.749,respectively.When these three factors were analyzed in combination,the AUC was 0.815.Conclusion The combined analysis of LAD-FAI,RCA-FAI,and hs-CRP has good predictive performance for assessing the risk of ACS in CHD patients.