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RLP-C、AIP与青年初发急性心肌梗死相关性研究

摘要:背景 血脂代谢异常是急性心肌梗死(AMI)发生发展的重要危险因素,但在一些血脂正常的人群中,仍有AMI的发生。残粒脂蛋白胆固醇(RLP-C)、血浆致动脉粥样硬化指数(AIP)作为非常规血脂指标,与AMI之间的研究尚少,同时对于青年AMI患者致病作用关系不明确。目的 探讨RLP-C、AIP与青年初发急性心肌梗死相关性。方法 选取江苏省苏北人民医院2014年11月-2021年11月初诊住院并行冠脉造影且年龄位于18-45岁者共1201人,其中将急性心肌梗死者共627人作为研究组,非急性心肌梗死者574人为对照组。统计两组患者一般资料以及甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)等指标,根据公式计算出RLP-C和AIP,进行统计分析。并将所有研究者依据年龄中位数37岁分为两组,>37岁为A组,≤37岁为B组,分析不同年龄阶段罹患急性心肌梗死的危险因素。结果 研究组RLP-C、AIP水平明显高于对照组(P<0.05);多因素Logistic相关分析显示吸烟、TC、RPL-C、AIP均为青年罹患急性心肌梗死发生的独立危险因素,HDL-C为急性心肌梗死的独立保护因素(P<0.05)。在RLP-C、AIP预测正常人群罹患急性心肌梗死ROC曲线中,RLP-C约登指数为0.547,ROC曲线下面积为0.851(95%CI 0.83-0.873,P<0.001)敏感性84.8% 特异性为69.9%;AIP约登指数为0.544,ROC曲线下面积为0.813(95% CI 0.789-0.837,P<0.001)敏感性85.2%,特异性为66%;两项指标联合约登指数为0.587,ROC曲线下面积为0.861(95% CI 0.840-0.882,P<0.001)敏感性83.1%,特异性为75.6%。根据年龄分层之后,AIP、RLP-C仍为两组不同年龄段青年患者罹患急性心肌梗死的独立危险因素,HDL-C为不同年龄段罹患急性心肌梗死的独立保护因素。结论:RLP-C、AIP是青年人群初发急性心肌梗死的独立危险因素,随着年龄的增大,两项指标预测价值逐渐增大;并且和传统血脂指标相比,两项指标及其联合指标对青年急性心肌梗死更具有临床预测价值。

英文摘要:Background Abnormal lipid metabolism is an important risk factor for the occurrence and development of acute myocardial infarction (AMI), but the occurrence of AMI is still common in some patients with normal blood lipid. There are few studies on the relationship between residual lipoprotein cholesterol (RLP-C) and plasma atherogenic index (AIP) as unconventional lipid indexes and AMI, and the relationship between the pathogenesis of AMI in young patients is not clear. Objective To investigate the correlation between RLP-C, AIP and young patients with initial acute myocardial infarction. Methods A total of 1201 patients aged 18-45 years old who were newly hospitalized and underwent coronary angiography from November 2014 to November 2021 in North Jiangsu People's Hospital were selected, including 627 patients with acute myocardial infarction as the study group and 574 patients without acute myocardial infarction as the control group. General information and triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and other indicators of patients in the two groups were collected. RPL-C and AIP were calculated according to the formula for statistical analysis. All the researchers were divided into two groups according to the median age of 37 years, >37 years old was group A, and ≤37 years old was group B, and the risk factors of acute myocardial infarction at different ages were analyzed. Results The levels of RLP-C and AIP in the study group were significantly higher than those in the control group (P<0.05). Multivariate Logistic correlation analysis showed that smoking, TC, RPL-C and AIP were independent risk factors for acute myocardial infarction in young people (P<0.05), and HDL-C was independent protective factor for acute myocardial infarction. In the ROC curve of RLP-C and AIP to predict the incidence of acute myocardial infarction in the normal population, the RLP-C Yorden index was 0.547, the area under the ROC curve was 0.851(95%CI 0.83-0.873,P<0.001), the sensitivity was 84.8%, the specificity was 69.9%. AIP Yorden index was 0.544, area under ROC curve was 0.813(95% CI 0.789-0.837, P<0.001), sensitivity was 85.2%, specificity was 66%. The combined Yuden index of the two indexes was 0.587, the area under ROC curve was 0.861 (95%CI 0.840-0.882, P<0.001). The sensitivity was 83.1%, and the specificity was 75.6%. After stratification according to age, AIP and RLP-C were still independent risk factors for ACUTE myocardial infarction in the two groups of young patients of different ages, while HDL-C was independent protective factor for acute myocardial infarction in different ages. Conclusion RLP-C and AIP are independent risk factors for initial acute myocardial infarction in young people, and their predictive value increases with age. In addition, compared with the traditional lipid indexes, the two indexes and their combined indexes have more clinical predictive value for young people with acute myocardial infarction.

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[V1] 2022-08-12 18:31:09 chinaXiv:202208.00091V1 下载全文
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