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代谢综合征及各组分与急性心肌梗死患者冠状动脉病变程度及临床结局的相关性研究

王凯阳 刘凤双 刘永国 李国庆 杨毅宁 余小林

王凯阳, 刘凤双, 刘永国, 李国庆, 杨毅宁, 余小林. 代谢综合征及各组分与急性心肌梗死患者冠状动脉病变程度及临床结局的相关性研究[J]. 中华全科医学, 2024, 22(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.003368
引用本文: 王凯阳, 刘凤双, 刘永国, 李国庆, 杨毅宁, 余小林. 代谢综合征及各组分与急性心肌梗死患者冠状动脉病变程度及临床结局的相关性研究[J]. 中华全科医学, 2024, 22(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.003368
WANG Kaiyang, LIU Fengshuang, LIU Yongguo, LI Guoqing, YANG Yining, YU Xiaolin. The correlation between metabolic syndrome and its components with the degree of coronary artery stenosis and clinical outcomes in patients with acute myocardial infarction[J]. Chinese Journal of General Practice, 2024, 22(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.003368
Citation: WANG Kaiyang, LIU Fengshuang, LIU Yongguo, LI Guoqing, YANG Yining, YU Xiaolin. The correlation between metabolic syndrome and its components with the degree of coronary artery stenosis and clinical outcomes in patients with acute myocardial infarction[J]. Chinese Journal of General Practice, 2024, 22(2): 212-216. doi: 10.16766/j.cnki.issn.1674-4152.003368

代谢综合征及各组分与急性心肌梗死患者冠状动脉病变程度及临床结局的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003368
基金项目: 

新疆维吾尔自治区自然科学基金项目 2023D01C91

详细信息
    通讯作者:

    余小林,E-mail:yuxiaolin288@163.com

  • 中图分类号: R542.22 R589

The correlation between metabolic syndrome and its components with the degree of coronary artery stenosis and clinical outcomes in patients with acute myocardial infarction

  • 摘要:   目的  探讨代谢综合征(MS)与急性心肌梗死(AMI)患者冠状动脉病变程度及预后的相关性。  方法  选取2019年1月—2020年12月期间新疆维吾尔自治区人民医院心内科救治的726例AMI患者作为研究对象,Gensini评分用以定量评估冠脉病变程度,终点事件定义为主要心血管不良事件(MACEs)的发生。采用多重线性回归分析研究MS及各组分与Gensini评分的相关性;采用多因素Cox回归分析研究MACEs发生的独立危险因素。  结果  MS组348例(47.9%),非MS组378例(52.1%)。与非MS组相比,MS组年龄更大,合并高血压、糖尿病、腹型肥胖、血脂异常比例更高,腰围、收缩压、空腹血糖、血尿素氮、低密度脂蛋白胆固醇、Gensini评分水平更高,血红蛋白水平较低,氯吡格雷服用比例更高,MACEs发生率更高,差异均有统计学意义(P < 0.05)。组分内比较发现:腹型肥胖组和空腹血糖升高组的Gensini评分显著升高,差异均有统计学意义(P < 0.05)。多重线性回归分析结果显示:空腹血糖升高和腹型肥胖与Gensini评分呈独立相关。多因素Cox回归分析结果显示:糖尿病和腹型肥胖是MACEs发生的独立危险因素。  结论  AMI患者合并MS十分常见,糖代谢异常和腹型肥胖与冠脉病变程度密切相关,并且明显影响患者预后。

     

  • 图  1  MACEs风险因素的LASSO回归筛查结果

    注:A为LASSO回归的系数路径图,B为LASSO回归的交叉验证图。两条虚垂线分别为最优Lambda参数取值(Lambda.min=0.000 734 63和Lambda.1se=0.070 124 06)时,所纳入LASSO回归模型的MACEs发生的风险因素数目。

    Figure  1.  LASSO regression results of risk factors in MACEs

    表  1  2组AMI患者基线资料比较

    Table  1.   Comparison of baseline data between the two groups of AMI patients

    项目 MS组(n=348) 非MS组(n=378) 统计量 P
    年龄[M(P25, P75), 岁] 63.0(54.0, 70.0) 58.0(49.2, 65.0) -5.280a < 0.001
    男性[例(%)] 247(71.0) 281(74.3) 1.032b 0.351
    高血压[例(%)] 310(89.1) 103(27.2) 282.447b < 0.001
    糖尿病[例(%)] 239(68.7) 45(11.9) 245.221b < 0.001
    腹型肥胖[例(%)] 209(60.1) 80(21.2) 114.388b < 0.001
    血脂异常[例(%)] 346(99.4) 333(88.1) 38.415b < 0.001
    吸烟史[例(%)] 118(33.9) 152(40.2) 3.082b 0.093
    冠状动脉性疾病家族史[例(%)] 59(17.0) 44(11.6) 4.202b 0.052
    腰围[M(P25, P75), cm] 88.0(67.4, 100.0) 72.0(62.0, 83.6) -8.016a < 0.001
    SBP[M(P25, P75), mmHg] 130(119, 143) 124(111, 136) -3.644a < 0.001
    DBP[M(P25, P75), mmHg] 78(70, 85) 75.0(70, 81) -1.793a 0.073
    RBC[M(P25, P75), ×1012/L] 4.53(4.19, 4.90) 4.56(4.19, 4.91) -0.389a 0.697
    WBC[M(P25, P75), ×109/L] 7.12(5.90, 8.44) 7.04(5.80, 8.51) -0.358a 0.720
    NE[M(P25, P75), %] 4.30(3.36, 5.37) 4.21(3.25, 5.58) -0.517a 0.605
    LY[M(P25, P75), %] 1.93(1.52, 2.43) 1.96(1.51, 2.48) -0.220a 0.826
    Hb[M(P25, P75), g/L] 137(127, 148) 140(130, 150) -2.153a 0.031
    FBG[M(P25, P75), mmol/L] 6.72(5.19, 9.17) 5.37(4.63, 6.87) -7.481a < 0.001
    BUN[M(P25, P75), nmol/L] 5.70(4.69, 6.79) 5.10(4.20, 6.30) -4.539a < 0.001
    UA[M(P25, P75), nmol/L] 328(275, 396) 322(267, 389) -0.943a 0.346
    TG[M(P25, P75), mmol/L] 1.65(1.19, 2.53) 1.56(1.09, 2.27) -1.951a 0.051
    TC[M(P25, P75), mmol/L] 4.00(3.22, 4.79) 3.79(3.19, 4.50) -1.775a 0.076
    HDL-C[M(P25, P75), mmol/L] 0.94(0.82, 1.18) 0.96(0.79, 1.13) -1.085a 0.278
    LDL-C[M(P25, P75), mmol/L] 2.49(1.88, 3.13) 2.34(1.80, 2.89) -2.107a 0.035
    TBIL[M(P25, P75), nmol/L] 11.50(8.48, 14.60) 11.30(8.20, 14.70) -0.271a 0.786
    Gensini评分[M(P25, P75), 分] 25.0(10.8, 56.5) 20.0(6.3, 44.0) -3.210a < 0.001
    随访时间[M(P25, P75), 月] 12.4(6.8, 18.9) 13.2(7.9, 19.2) -0.889a 0.374
    MACEs[例(%)] 81(23.3) 57(15.1) 6.236b 0.020
    阿司匹林[例(%)] 231(66.4) 256(67.7) 0.149b 0.759
    氯吡格雷[例(%)] 127(36.5) 105(27.8) 6.331b 0.015
    他汀类[例(%)] 202(58.0) 194(51.3) 3.303b 0.081
    ACEI/ARB[例(%)] 100(28.7) 82(21.7) 0.459b 0.336
    Β受体阻滞剂[例(%)] 146(42.0) 154(40.7) 0.110b 0.798
    注:aZ值,b为χ2值。NE为中性粒细胞(neutrophil),LY为淋巴细胞(lymphocyte),UA为尿酸(uric acid),TBIL为总胆红素(total bilirubin),ACEI为血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor),ARB为血管紧张素Ⅱ受体阻滞剂(angiotensinⅡreceptor blocker)。
    下载: 导出CSV

    表  2  MS及各组分AMI患者Gensini评分比较[M(P25, P75), 分]

    Table  2.   Comparison of Gensini scores in patients with MS and each component of AMI patients [M(P25, P75), points]

    组别 例数 Gensini评分 Z P
    MS组 348 25.0(10.8, 56.5) -3.210 0.001
    非MS组 378 20.0(6.3, 44.0)
    高血压组 413 22.0(10.0, 52.0) -1.567 0.117
    非高血压组 313 20.0(7.0, 48.0)
    糖尿病组 284 23.5(10.0, 56.0) -1.817 0.069
    非糖尿病组 442 20.0(8.0, 44.0)
    FBG正常组 384 19.5(7.0, 44.0) -2.131 0.033
    FBG升高组 342 24.0(10.0, 56.0)
    腹型肥胖组 289 25.0(10.0, 57.0) -2.656 0.008
    非腹型肥胖组 437 20.0(7.0, 44.0)
    HDL-C降低组 630 22.0(9.0, 49.0) -1.718 0.086
    HDL-C正常组 96 15.0(5.0, 50.0)
    TG正常组 391 20.0(7.5, 52.0) -0.095 0.924
    TG升高组 335 22.0(9.5, 45.0)
    下载: 导出CSV

    表  3  MS及其各组分与Gensini评分的线性回归分析

    Table  3.   Linear regression analysis between MS components and Gensini scores

    变量 简单线性回归分析 多重线性回归分析
    B SE B' t P B SE B' t P
    MS 8.040 2.705 0.110 2.972 0.003
    高血压 2.881 2.743 0.039 1.050 0.294
    糖尿病 4.554 2.781 0.061 1.638 0.102
    FBG升高 5.963 2.715 0.081 2.196 0.028 6.269 2.698 0.086 2.323 0.020
    腹型肥胖 8.793 2.758 0.118 3.188 0.001 9.014 2.752 0.121 3.276 0.001
    HDL-C降低 3.639 4.011 0.034 0.907 0.365
    TG升高 2.425 2.726 0.033 0.889 0.374
    下载: 导出CSV

    表  4  MS及其各组分与MACEs的Cox回归分析

    Table  4.   Cox regression analysis of MS components and MACEs

    变量 单因素回归分析结果 多因素回归分析结果
    B SE Waldχ2 HR(95% CI) P B SE Waldχ2 HR(95% CI) P
    年龄 0.015 0.008 1.970 1.016(1.000~1.031) 0.049
    MS 0.840 0.183 4.591 2.316(1.618~3.314) < 0.001 0.070 0.251 0.280 1.073(0.656~1.756) 0.779
    高血压 0.748 0.188 3.987 2.114(1.463~3.054) < 0.001
    糖尿病 0.805 0.173 4.652 2.236(1.593~3.139) < 0.001 0.796 0.221 3.601 2.217(1.437~3.420) < 0.001
    FBG升高 0.036 0.171 0.213 1.037(0 742~1.449) 0.831
    腹型肥胖 0.755 0.174 4.339 2.127(1.513~2.992) < 0.001 0.761 0.198 3.840 2.140(1.451~3.155) < 0.001
    HDL-C降低 0.292 0.267 1.096 1.339(0.794~2.259) 0.273
    TG升高 -0.114 0.173 -0.659 0.892(0.636~1.252) 0.510
    Gensini评分 0.004 0.002 1.886 1.004(1.000~1.008) 0.059
    下载: 导出CSV
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  • 收稿日期:  2023-07-19
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