(1.大连医科大学附属第二医院,辽宁省大连市 116023;2.大连睿康心血管病医院,辽宁省大连市 116086;3.北部战区总医院,辽宁省沈阳市 110016)
1.The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116023, China;2.Dalian Ruikang Cardiovascular Hospital, Dalian, Liaoning 116086, China;3.General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China)
目的]探讨残余胆固醇对血压正常高值冠心病患者发生主要不良心脑血管事件(MACCE)的预测价值。 [方法]回顾性分析2004年—2014年在北部战区总医院心内科进行冠状动脉造影且血压处于血压正常高值的患者共421例。选取该队列中发生MACCE的血压正常高值患者97例为病例组,采用随机数字表筛选同队列中未发生MACCE的血压正常高值患者97例为对照组,并进行病例对照研究。 [结果]病例组高盐饮食人数、糖尿病患者人数、左心室舒张期末内径、Gensini评分均高于对照组(分别为对照组的2.6、6.28、1.14、1.67倍),差异有统计学意义(P＜0.05)。在血脂相关的指标中,病例组残余胆固醇、甘油三酯及总胆固醇水平均高于对照组(分别为对照组的1.41、1.38、1.07倍),差异具有统计学意义(P＜0.05)。多因素Logistic回归分析显示,糖尿病(OR＝14.84,95%CI为5.13～42.89,P＜0.01)、高盐饮食(OR＝6.6,5%CI为3.00～13.90,P＜0.01)、残余胆固醇水平(OR＝10.07,95%CI为2.89～35.05,P＜0.01)与血压正常高值患者发生MACCE相关。采用ROC曲线评价残余胆固醇对血压正常高值患者发生MACCE的预测价值,结果显示残余胆固醇预测血压正常高值患者发生MACCE的ROC曲线下面积为0.644(95%CI为0.567～0.721),最佳截断值为0.52 mmol/L,灵敏度和特异度分别为72.2%和50.5%。 [结论]糖尿病、残余胆固醇水平及高盐饮食是导致血压正常高值人群发生MACCE的独立危险因素,残余胆固醇水平＞0.52 mmol/L可预测血压正常高值人群MACCE的发生。
Aim To investigate the predictive value of remnant cholesterol in the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in coronary heart disease patients with high-normal blood pressure. Methods A total of 421 patients with high-normal blood pressure who underwent coronary angiography in the Department of Cardiology, General Hospital of Northern Theater Command from 2004 to 2014 were retrospectively analyzed. In this study, 97 patients with high-normal blood pressure who developed MACCE in this cohort were selected as the case group, and 97 patients with high-normal blood pressure who did not develop MACCE in the same cohort were selected as the control group by random number table for a case-control study. Results The number of patients with high-salt diet, the number of diabetic patients, the value of left ventricular end-diastolic diameter (LVEDD) and Gensini score in the case group were higher than those in the control group (which were 2.6,6.8,1.14 and 1.67 times of the control group respectively), the differences were statistically significant (P＜0.05). In lipid-related indicators, the levels of remnant cholesterol, triglyceride and total cholesterol in the case group were higher than those in the control group (which were 1.1,1.38 and 1.07 times of the control group respectively), the differences were statistically significant (P＜0.05). Logistic regression analysis showed that diabetes mellitus (OR＝14.4,5%CI:5.13～42.89, P＜0.01), high salt diet (OR＝6.6,5%CI:3.00～13.90, P＜0.01) and remnant cholesterol levels (OR＝10.7,5%CI:2.89～35.05, P＜0.01) were associated with MACCE in patients with high-normal blood pressure. The predictive value of remnant cholesterol for MACCE was evaluated by receiver operating characteristic (ROC) curve. The results showed that the area under ROC curve for remnant cholesterol to predict MACCE was 0.644 (95%CI:0.567～0.721). The optimal cut-off value was 0.52 mmol/L, and the sensitivity and specificity were 72.2% and 50.5%, respectively. Conclusion Diabetes mellitus, remnant cholesterol level and high-salt diet were independent risk factors for MACCE in patients with high-normal blood pressure, and remnant cholesterol level ＞0.52 mmol/L could predict the occurrence of MACCE in patients with high-normal blood pressure.