尿酸/高密度脂蛋白胆固醇比值预测老年慢性心力衰竭患者主要心血管不良事件的价值

doi:10.3760/cma.j.cn441417-20250123-11003

摘要/Abstract

摘要：

目的　探讨尿酸/高密度脂蛋白胆固醇比值（UHR）预测老年慢性心力衰竭（CHF）患者主要心血管不良事件（MACE）的价值。方法　选取2021年1月至2023年12月烟台市莱阳中心医院收治的96例老年CHF患者作为研究对象，男57例，女39例，年龄60～80（70.46±8.25）岁。所有患者出院后随访1年，根据MACE发生情况，将患者分为MACE组（27例）和无MACE组（69例）。收集患者入院时的临床资料，包括年龄、体重指数、性别、合并疾病（高血压、冠心病、心肌病、瓣膜病）、总胆固醇（TC）、甘油三酯（TG）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）、吸烟史、饮酒史、尿酸（UA）、高密度脂蛋白胆固醇（HDL-C）、UHR。采用二元logistic回归分析老年CHF患者发生MACE的影响因素。采用受试者操作特征曲线（ROC）分析老年CHF患者发生MACE的预测效能。采用独立样本t检验、χ2检验进行统计学分析。结果　本研究共纳入96例老年CHF患者，出院后随访1年，共27例发生MACE。MACE组LVEDD、LVESD均长于无MACE组［（65.21±8.34）mm比（48.57±8.63）mm、（64.97±5.74）mm比（48.02±5.28）mm］，LVEF低于无MACE组［（40.83±5.12）%比（46.29±6.45）%］（均P<0.05）。MACE组UA水平和UHR均高于无MACE组［（467.12±84.08）μmol/L比（409.86±73.75）μmol/L、657.92±118.43比333.22±66.65］，HDL-C水平低于无MACE组［（0.71±0.13）mmol/L比（1.23±0.21）mmol/L］（均P<0.05）。二元logistic回归分析结果显示，高UA水平（OR=2.109，95%CI 1.109～4.010）、低HDL-C水平（OR=0.438，95%CI 0.254～0.756）、高UHR（OR=10.549，95%CI 3.123～35.629）均是发生MACE的独立危险因素（均P<0.05）。ROC结果显示，UHR预测老年CHF患者发生MACE的曲线下面积（95%CI）为0.904（0.859～0.954），截断值为469.68，特异度为86.71%，灵敏度为85.48%。结论　UHR与老年CHF患者MACE密切相关，有望成为预测老年CHF患者发生MACE的生物标志物。

关键词: 慢性心力衰竭, 主要心血管不良事件, 老年人, 尿酸/高密度脂蛋白胆固醇比值, 预测

Abstract:

Objective　To explore the value of the uric acid/high-density lipoprotein cholesterol ratio (UHR) in predicting major adverse cardiovascular events (MACE) in elderly patients with chronic heart failure (CHF). Methods　A total of 96 elderly patients with CHF who were admitted to Yantai Laiyang Central Hospital from January 2021 to December 2023 were selected as the study subjects. There were 57 males and 39 females, with ages ranging from 60 to 80 (70.46±8.25) years old. All patients were followed up for one year after discharge. Based on the occurrence of MACE, the patients were divided into the MACE group (27 cases) and the non-MACE group (69 cases). Collect the clinical data of the patients at the time of admission, including age, body mass index, gender, coexisting diseases (hypertension, coronary heart disease, cardiomyopathy, valvular disease), total cholesterol (TC), triglycerides (TG), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), smoking history, drinking history, uric acid (UA), high-density lipoprotein cholesterol (HDL-C), and UHR. Using binary logistic regression analysis, the influencing factors for the occurrence of MACE in elderly patients with CHF were investigated. The predictive efficacy of the receiver operating characteristic curve (ROC) was used to analyze the occurrence of MACE in elderly patients with CHF. Independent sample t test, and χ² test were used for statistical analysis. Results　A total of 96 elderly patients with CHF were included in this study. They were followed up for one year after discharge, and a total of 27 cases developed MACE. The LVEDD and LVESD in the MACE group were longer than those in the non-MACE group [(65.21±8.34) mm vs. (48.57±8.63) mm, (64.97±5.74) mm vs. (48.02±5.28) mm], and the LVEF was lower in the MACE group [(40.83±5.12)% vs. (46.29±6.45)%] (all P<0.05). The levels of UA and UHR in the MACE group were higher than those in the non-MACE group [(467.12±84.08) μmol/L vs. (409.86±73.75) μmol/L, 657.92±118.43 vs. 333.22±66.65], while the level of HDL-C was lower in the MACE group [(0.71±0.13) mmol/L vs. (1.23±0.21) mmol/L] (all P<0.05). The results of the binary logistic regression analysis showed that high UA levels (OR=2.109, 95%CI 1.109-4.010), low HDL-C levels (OR=0.438, 95%CI 0.254-0.756), and high UHR (OR=10.549, 95%CI 3.123-35.629) were all independent risk factors for the occurrence of MACE (all P<0.05). The ROC results showed that the area under the curve (95%CI) of UHR in predicting the occurrence of MACE in elderly patients with CHF was 0.904 (0.859-0.954), the cut-off value was 469.68, the specificity was 86.71%, and the sensitivity was 85.48%. Conclusion　UHR is closely related to MACE in elderly patients with CHF and is expected to become a biomarker for predicting the occurrence of MACE in elderly patients with CHF.

Key words: Chronic heart failure, Major cardiovascular adverse events, Elderly, Uric acid/high-density lipoprotein cholesterol ratio, Forecast

胡人月曹晓媚夏雪艳.

尿酸/高密度脂蛋白胆固醇比值预测老年慢性心力衰竭患者主要心血管不良事件的价值 [J]. 国际医药卫生导报, 2025, 31(11): 1775-1779.

Hu Renyue, Cao Xiaomei, Xia Xueyan.

The value of the uric acid/high-density lipoprotein cholesterol ratio in predicting major cardiovascular adverse events in elderly patients with chronic heart failure [J]. International Medicine and Health Guidance News, 2025, 31(11): 1775-1779.

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