sdLDL/HDL与急性STEMT合并2型糖尿病患者行急诊介入术后造影剂肾病发生的关系

目的 探讨小而密低密度脂蛋白胆固醇（small dense low density lipoprotein cholesterol，sdLDL-C）与高密度脂蛋白胆固醇(high density lipoprotein cholesterol，HDL-C)两者的比值与急性ST段抬高型心肌梗死（ST segment elevation myocardial infarction，STEMI）合并2型糖尿病（type 2 diabetes mellitus，T2DM）患者行急诊介入（percutaneous coronary intervention，PCI）术后造影剂肾病（contrast nephropathy，CIN）发生的关系。方法 选取2021年5月至2023年11月STEMI合并T2DM患者187例，均行急诊冠状动脉介入治疗。术后48~72h内检测患者肌酐水平，分为CIN组52例和非CIN组135例。测定所有患者血浆sdLDL-C和HDL-C水平，计算两者的比值，比较两组sdLDL-C/HDL-C的差异，并分析其与急诊介入术后造影剂肾病发生的关系。结果 CIN组sdLDL-C（1.283±0.432）mmol/L高于非CIN组（0.884±0.436）mmol/L，CIN组HDL-C（0.822±0.213）mmol/L低于非CIN组（1.013±0.224）mmol/L，CIN组sdLDL-C/HDL-C（1.712±0.793）高于非CIN组（0.843±0.484），差异均有统计学意义（P<0.05）。Logistic回归分析结果表明，冠心病的危险因素中，sdLDL-C/HDL-C是STEMI合并T2DM患者急诊介入术后发生CIN的独立危险因素[OR=9.003，95% CI：3.510~23.089，P<0.001]；ROC曲线分析结果显示，sdLDL-C/HDL-C预测STEMI合并T2DM患者行急诊介入治疗发生CIN的曲线下面积为0.836，最佳截断为1.159，敏感度为76.1%，特异性为83.7%。结论 sdLDL-C/HDL-C与急性STEMI合并2型糖尿病患者行急诊介入术后CIN的发生密切相关，可能作为预测CIN发生风险的指标，具有临床指导意义。

Relationship between the ratio of small dense low density lipoprotein and high-density lipoprotein and contrast nephropathy after emergency percutaneous coronary intervention in patients with acute STEMI and type 2 diabetes mellitus

Objective To explore the relationship between the ratio of small dense low density lipoprotein (HDL-C) and high-density lipoprotein (HDL-C) and contrast nephropathy (CIN) after emergency percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI) complicated with type 2 diabetes mellitus (T2DM). Method Totally 187 patients with STEMI complicated with T2DM from May 2021 to November 2023 were selected for emergency percutaneous coronary intervention. The creatinine level was measured within 48-72 hours after operation, which was divided into 52 cases in CIN group and 135 cases in non CIN group. The levels of sdLDL and HDL-c in all patients were measured, and the ratio between them was calculated. The difference of sdLDL/HDL-c between the two groups was compared, and its relationship with contrast nephropathy after emergency percutaneous coronary intervention was analyzed. Results SdLDL-C (1.283±0.432) mmol/L in CIN group was higher than that in non CIN group (0.884±0.436)mmol/L. HDL-C (0.822±0.213) mmol/L in CIN group was lower than that in non CIN group (1.013±0.224) mmol/L. sdLDL/HDL-C (1.712±0.793) in CIN group was higher than that in non CIN group (0.843±0.484).The difference was statistically significant (P<0.05). Logistic regression analysis showed that among the risk factors of coronary heart disease, sdLDL-C/HDL-C was an independent risk factor for CIN after emergency intervention in STEMI patients with T2DM [OR=9.003, 95%CI: 3.510-23.089, P<0.001]. ROC curve showed that the area under the curve of sdLDL-C/HDL-C to predict the occurrence of CIN in STEMI patients with T2DM was 0.836, optimal truncation was 1.159, the sensitivity was 76.1%, and the specificity was 83.7%. Conclusion SdLDL-C/HDL-C is closely related to the occurrence of CIN after emergency percutaneous coronary intervention in patients with STEMI complicated with T2DM. It may be used as an indicator for predicting the risk of CIN and has clinical guiding significance.