中青年急性冠脉综合征患者TyG 指数、HCY 和HDL-C 表达水平及临床价值研究

目的 分析三酰甘油葡萄糖乘积(triglyceride and glucose，TyG)指数、同型半胱氨酸(homocysteine，HCY)、高密度脂蛋白胆固醇(high density liptein cholesterol，HDL-C)在中青年急性冠脉综合征(acute coronary syndrome，ACS)患者体内的表达水平及与患者病情相关性。方法 回顾性分析2019 年1 月～ 2020 年12 月于沧州市人民医院住院行冠脉造影检查的18 ～ 59 周岁的334 例患者临床资料，其中ACS 患者236 例，包括急性心肌梗死(AMI)患者102 例，不稳定型心绞痛(UA)患者134 例；98 例无冠心病患者作为对照组；检测受试者血中HCY，HDL-C，空腹血糖(fastingblood-glucose，FBG) 和三酰甘油(triacylglycerol，TG)水平并计算TyG 指数；利用Gensini 评分及SYNTAX II 评分对患者冠状动脉狭窄程度进行评估；采用Spearman 相关性检验分析TyG 指数、HCY，HDL-C 与中青年ACS 患者病情相关性，采用Logistic 回归分析方法确定ACS 的危险因素；绘制ROC 曲线分析各指标预测价值。结果 AMI 组、UA 组及对照组患者TyG 指数(3.49±0.65, 3.01±0.71,1.37±0.28)，HCY(19.05±2.88,15.64±2.74,10.14±1.34μmol/L) 和HDL-C(0.78±0.23,1.02±0.44,1.34±0.34mmol/L) 水平差异均有统计学意义(F=8.958，10.372，9.034，均P ＜ 0.05)，其中AMI组患者TyG 指数和HCY 水平最高，HDL-C 水平最低，对照组TyG 指数和HCY 水平最低，HDL-C 水平最高，且差异均有统计学意义。AMI 组、UA 组及对照组患者Gensini 评分(32.94±4.09，28.76±5.13, 13.28±3.44)及SYNTAX II 评分(55.49±5.91,48.54±4.38,42.03±4.55)，差异均有统计学意义(F=15.498，13.238，均P ＜ 0.05)，其中AMI 组患者Gensini 评分及SYNTAX II 评分最高，对照组Gensini 评分及SYNTAX II 评分最低，且差异有统计学意义。Gensini 评分及SYNTAX II 评分均与TyG 指数、HCY 呈显著正相关(r=0.765, 0.811；0.801, 0.893, 均P ＜ 0.05)，与HDL-C 呈显著负相关(r= -0.574, -0.419, 均P ＜ 0.05)；患者血中高TyG 指数、高HCY、低HDL-C 水平是影响中青年急性冠脉综合征发生的独立危险因素(均P ＜ 0.05)；TyG 指数、HCY，HDL-C 预测患者病情的AUC 均高于0.90，且存在统计学意义(P ＜ 0.05)。结论 在中青年急性冠脉综合征患者中TyG 指数，HCY 呈明显高表达，HDL-C 水平明显低表达，高TyG 指数、HCY，低HDL-C 水平是影响中青年急性冠脉综合征发生的独立性危险因素。

Study on TyG Index,HCY and HDL-C Expression Levels and Clinical Value in Young and Middle-aged Patients with Acute Coronary Syndrome

Objective To analyze the expression levels of triglyceride and glucose(TyG)index, homocysteine(HCY), high density liptein cholesterol(HDL-C)in young and middle-aged patients with acute coronary syndrome(ACS)and their correlation with their condition. Methods The total of 334 patients hospitalized in Cangzhou People’s Hospital from January 2019 to December 2020 were selected for retrospective analysis, including 236 patients with ACS, including 102 patients in AMI group, 134 patients in UA group and 98 healthy patients as the control group. HCY, HDL-C, fasting blood-glucose(FBG) and triacylglycerol(TG)were measured and TyG index was calculated. The degree of coronary artery stenosis was evaluated by Gensini score and syntax II score. Spearman correlation test was used to analyze the correlation between TyG index, HCY, HDL-C and the condition of young and middle-aged patients with ACS. Logistic regression analysis was used to determine the risk factors of ACS. Draw ROC curve and analyze the predictive value of each index. Results There were significant differences in TyG index(3.49±0.65,3.01±0.71,1.37±0.28), HCY (19.05±2.88,15.64±2.74,10.14±1.34μmol/L)and HDL -C(0.78±0.23,1.02±0.44,1.34±0.34 mmol/L) levels among AMI group, UA group and control group, the differences were statistical significance(F=8.958，10.372，9.034，all P ＜ 0.05). The TyG index and HCY level of AMI group were the highest, the HDL-C level was the lowest, the TyG index and HCY level of control group were the lowest, and the HDL-C level was the highest, and the difference was statistically significant. There were significant differences in Gensini score(32.94±4.09， 28.76±5.13,13.28±3.44) and SYNTAX II score (55.49±5.91,48.54±4.38,42.03±4.55)among AMI group, UA group and control group, the differences were statistical significant(F=15.498，13.238，all P ＜ 0.05)，Gensini score and SYNTAX II score were the highest in AMI group and the lowest in control group. Gensini score and syntax II score were significantly positively correlated with TyG index and HCY(r=0.765, 0.811；0.801, 0.893, all P ＜ 0.05), and negatively correlated with HDL-C (r= -0.574, -0.419, all P ＜ 0.05). High TyG index, high HCY and low HDL-C level were independent threat factors affecting the risk factors of acute coronary syndrome in young and middle-aged patients (all P ＜ 0.05). The AUC predicted by TyG index, HCY and HDL-C were higher than 0.90 (P ＜ 0.05). Conclusion In young and middle-aged patients with acute coronary syndrome, the expression of TyG index and HCY was significantly high, and the expression of HDL-C is significantly low. High TyG index, high HCY and low HDL-C are independent threat factors affecting the risk factors of young and middleaged patients with acute coronary syndrome.