非高密度脂蛋白胆固醇水平对急性冠状动脉综合征患者事件的预测价值

目的:探讨非高密度脂蛋白胆固醇(non-HDL-C)对急性冠状动脉综合征(ACS)患者事件的预测价值。方法:对2008-2010年期间324例出院的ACS患者进行随访,通过多元Logistic回归方法分析血清基线non-HDL-C水平对随访期间初级终点事件(全因死亡、非致死性心肌梗死及卒中)及次级终点事件(Ⅳ级心功能衰竭和再血管化治疗)的相关性。结果:①初级终点事件组患者血清non-HDL-C水平高于未发生事件组患者[(3.75±1.12)mmol/L∶(3.07±0.69)mmol/L,P<0.05]。②多因素Logistic回归分析发现,血清基线non-HDL-C对初级终点(OR值2.996,95%CI1.269～7.072,P=0.012)和全因死亡(OR值2.983,95%CI 1.189～7.482,P=0.020)的发生有预测价值,但对次级终点事件的发生无预测价值。结论:血清non-HDL-C对ACS患者初级终点事件及全因死亡的发生有预测价值,可以作为监测ACS预后及指导调脂治疗的重要临床指标。

Prognostic value of non high density lipoprotein cholesterol for the occurrence of cardiovascular events in patients with acute coronary syndrome

Objective:To investigate the prognostic value of non high density lipoprotein cholesterol(non-HDL-C) for the occurrence of cardiovascular events in patients with acute coronary syndrome(ACS). Method:This study enrolled 324 cases with ACS from 2008 to 2010,and followed up 18 months.Cardiovascular events in this study included primary(all-cause mortality,nonfatal myocardial infarction and nonfatal stroke) and secondary(class Ⅳ heart failure and revascularization treatment) end-point events.The association between baseline non-HDL-C level and the risk of primary and secondary end-point events was analyzed by multivariable logistic regression. Result:①The baseline level of non-HDL-C of patients with primary end-point events was higher(3.75±1.12 mmol/L) than that in patients without the events(3.07±0.69 mmol/L,P<0.05).②Multivariate logistic regression analysis showed that high level of non-HDL-C at baseline was a key predictor of primary end-point events(OR 2.996,95%CI 1.269-7.072,P=0.012) and all-cause mortality(OR 2.983,95%CI 1.189-7.482,P=0.020),but no prognostic value for the occurrence of secondary end point events. Conclusion:Baseline level of non-HDL-C has a prognostic value of primary end-point events and all-cause mortality,and plays an important clinical target for monitoring ACS prognosis and guiding lipid management.