总胆固醇/高密度脂蛋白胆固醇比值对老年急性心肌梗死患者PCI预后的预测效能

doi:10.3760/cma.j.cn441417-20250331-15011

摘要/Abstract

摘要：

目的　探究总胆固醇（TC）/高密度脂蛋白胆固醇（HDL-C）对老年急性心肌梗死（AMI）患者经皮冠脉介入术（PCI）预后的预测效能。方法　回顾性分析2020年1月至2024年1月间烟台市莱阳中心医院收治的231例AMI患者临床资料，根据PCI术后1年主要不良心血管事件（MACE）发生情况分为MACE组（48例）和非MACE组（183例）。MACE组男37例，女11例，年龄66（63，68）岁；非MACE组男156例，女27例，年龄65（62，67）岁。收集患者基线资料，绘制受试者操作特征曲线（ROC）、Kaplan-Meier曲线，分析TC/HDL-C比值在AMI患者PCI术后发生MACE中的应用价值。建立Cox回归模型分析PCI术后发生MACE的影响因素。采用Mann-Whitney U检验、χ²检验、t检验进行统计分析。结果　MACE组TC/HDL-C比值高于非MACE组（4.65±0.99比3.43±0.84），差异均有统计学意义（t=8.579，P<0.001）；且TC/HDL-C比值辅助预测AMI患者PCI术后发生MACE的曲线下面积为0.823（95%置信区间0.768～0.870），截断值为3.96，敏感度为79.17%，特异度为71.58%。纤维蛋白原、TC/HDL-C比值升高是AMI患者PCI术后发生MACE的独立危险因素，左心室射血分数升高是保护因素（均P<0.05）。根据ROC截断值（3.96）将TC/HDL-C比值分为高TC/HDL-C组（>3.96，90例）和低TC/HDL-C组（≤3.96，141例），高TC/HDL-C组患者PCI术后MACE发生率高于低TC/HDL-C组［42.22%（38/90）比7.09%（10/141）］（χ²=41.185，P<0.001）。结论　PCI术后发生MACE患者的TC/HDL-C比值显著升高，TC/HDL-C比值是AMI患者PCI术后发生MACE的独立危险因素，为AMI的临床诊疗提供了新思路。

关键词:

急性心肌梗死, 经皮冠脉介入术, 总胆固醇, 高密度脂蛋白胆固醇

Abstract:

Objective　To investigate the predictive efficacy of total cholesterol (TC)/high-density lipoprotein cholesterol (HDL-C) ratios on the prognosis of elderly patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods　A retrospective analysis was conducted on the clinical data of 231 AMI patients admitted to Laiyang Central Hospital from January 2020 to January 2024. Patients were divided into the major adverse cardiovascular events (MACE) group (48 cases) and the non-MACE group (183 cases) based on the occurrence of MACE one year after PCI. In the MACE group, there were 37 males and 11 females, aged 63 (63, 68) years; in the non-MACE group, there were 156 males and 27 females, aged 65 (62, 67) years. Baseline data for the patients were collected, and receiver operating characteristic (ROC) curves and Kaplan-Meier curves were drawn to analyze the application value of the TC/HDL-C ratio in predicting MACE after PCI in AMI patients. A Cox regression model was established to analyze the influencing factors for MACE occurrence after PCI. Statistical analyses were performed using the Mann-Whitney U test, χ² test, and t test. Results　The TC/HDL-C ratio in the MACE group was higher than that in the non-MACE group (4.65±0.99 vs. 3.43±0.84), with a statistically significant difference (t=8.579, P<0.001). The area under the curve (AUC) for the TC/HDL-C ratio in predicting MACE after PCI in AMI patients was 0.823 (95% confidence interval 0.768–0.870), with a cutoff value of 3.96, sensitivity of 79.17%, and specificity of 71.58%. Elevated fibrinogen and TC/HDL-C ratios were identified as independent risk factors for MACE after PCI in AMI patients, while an increased left ventricular ejection fraction was a protective factor (all P<0.05). Based on the ROC cutoff value (3.96), patients were divided into a high TC/HDL-C group (>3.96, 90 cases) and a low TC/HDL-C group (≤3.96, 141 cases). The incidence of MACE in the high TC/HDL-C group was significantly higher than that in the low TC/HDL-C group [42.22% (38/90) vs. 7.09% (10/141)] (χ²=41.185, P<0.001). Conclusion　The TC/HDL-C ratio is significantly increased in patients with MACE after PCI, which is an independent risk factor for MACE in AMI patients after PCI. Our finding provides new ideas for the clinical diagnosis and treatment of AMI.

Key words:

Acute myocardial infarction, PCI, Total cholesterol, High density lipoprotein cholesterol

尤玉伟曹晓媚刘中丽.

总胆固醇/高密度脂蛋白胆固醇比值对老年急性心肌梗死患者PCI预后的预测效能 [J]. 国际医药卫生导报, 2025, 31(15): 2520-2525.

You Yuwei, Cao Xiaomei, Liu Zhongli.

Value of total cholesterol/high-density lipoprotein cholesterol ratio in predicting the prognosis of elderly patients with acute myocardial infarction after PCI [J]. International Medicine and Health Guidance News, 2025, 31(15): 2520-2525.

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