ApoB/ApoA1比值对不稳定型心绞痛患者冠脉病变程度的预测价值

doi:10.3969/j.issn.1004-583X.2022.05.006

摘要/Abstract

摘要：

目的探讨ApoB/ApoA1比值对不稳定型心绞痛(UA)患者冠脉病变程度的预测价值。方法回顾性分析2019年10月至2021年8月于河北省人民医院心血管内科住院并接受冠状动脉造影检查的UA患者176名。收集入组患者临床资料,计算ApoB/ApoA1比值,依据冠状动脉造影结果计算Gensini评分。以UA患者Gensini评分中位数将其分为高Gensini评分组(Gensini评分≥40分)和低Gensini评分组(Gensini评分<40分),比较两组临床资料。对UA患者Gensini评分与ApoB/ApoA1比值进行相关性分析。采用二元多因素Logistic回归分析高Gensini评分的独立危险因素。应用ROC曲线分析ApoB/ApoA1比值及其他血脂指标对高Gensini评分的诊断价值,以约登指数确定最佳诊断阈值。结果高Gensini评分组ApoB/ApoA1比值明显高于低Gensini评分组(P<0.01)。UA患者Gensini评分与ApoB/ApoA1比值呈正相关(r=0.321,P<0.01)。二元多因素Logistic回归分析结果显示ApoB/ApoA1比值是UA患者冠脉严重病变(Gensini评分≥40)的独立危险因素(OR=4.593,95%CI=2.434-8.664,P<0.01)。ROC曲线分析显示ApoB/ApoA1比值的诊断价值高于ApoB、TG、TC和LDL-C,其AUC为0.723(P<0.01),最佳诊断阈值为0.69,敏感度为0.644,特异度为0.742。结论 ApoB/ApoA1比值与UA患者冠脉病变程度呈正相关,对UA患者冠脉严重病变具有一定的诊断和预测价值,且是其独立危险因素,在UA临床诊疗中具有指导意义。

关键词: 载脂蛋白B/载脂蛋白A1比值, 不稳定型心绞痛, 冠脉病变程度, Gensini评分

Abstract:

Objective To explore the predictive value of ApoB/ApoA1 ratio on the degree of coronary artery lesions in patients with unstable angina (UA). Methods One hundred and seventy six patients with UA who were hospitalized and underwent coronary angiography in the Department of Cardiovascular Medicine, Hebei General Hospital from October 2019 to August 2021 were retrospectively analyzed. Clinical data of the enrolled patients were collected, ApoB/ApoA1 ratio was calculated, and Gensini score was calculated based on coronary angiography results. The median Gensini score of UA patients was used to divide the patients into the high Gensini score group (Gensini score ≥40) and low Gensini score group (Gensini score <40), and clinical data of patients in two groups were compared. Correlation analysis on Gensini scores and ApoB/ApoA1 ratio in UA patients was performed. Binary multivariate Logistic regression was applied to analyze the independent risk factors for high Gensini score. ROC curves were applied to analyze the diagnostic value of ApoB/ApoA1 ratio and other lipid indices for high Gensini score, and the best diagnostic threshold was determined by the Yordon index. Results The ApoB/ApoA1 ratio of patients in the high Gensini score group was significantly higher than that of patients in the low Gensini score group (P<0.01). The Gensini score of UA patients was positively correlated with the ApoB/ApoA1 ratio (r=0.321, P<0.01). Binary multivariate Logistic regression analysis showed that ApoB/ApoA1 ratio was an independent risk factor for severe coronary lesions (Gensini score ≥40) in UA patients (OR=4.593, 95%CI=2.434-8.664, P<0.01). ROC curve analysis showed that the diagnostic value of ApoB/ApoA1 ratio was higher than that of ApoB, TG, TC and LDL-C, with an AUC of 0.723(P<0.01), an optimal diagnostic threshold of 0.69, a sensitivity of 0.644 and a specificity of 0.742.Conclusion The ApoB/ApoA1 ratio is positively correlated with the degree of coronary artery lesion in UA patients, and it has a certain diagnostic and predictive value and serves an independent risk factor for severe coronary artery lesions in UA patients, delivering guiding significance in the clinical diagnosis and treatment of UA.

Key words: Apolipoprotein B (ApoB)/Apolipoprotein A1 (ApoA1) ratio, unstable angina, degree of coronary artery lesions, gensini score

中图分类号:

R541.4

朱隽, 刘悦, 陈淑霞, 王贤, 郑露妍, 谷剑. ApoB/ApoA1比值对不稳定型心绞痛患者冠脉病变程度的预测价值[J]. 临床荟萃, 2022, 37(5): 422-426.

Zhu Jun, Liu Yue, Chen Shuxia, Wang Xian, Zheng Luyan, Gu Jian. Predictive value of ApoB/ApoA1 ratio on the extent of coronary artery disease in patients with unstable angina pectoris[J]. Clinical Focus, 2022, 37(5): 422-426.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.05.006

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I5/422

图/表 5

参考文献 16

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项目	高Gensini评分组(n=87)	低Gensini评分组(n=89)	t/Z/χ²值	P值
男性[例(%)]	57(65.5)	52(58.4)	0.938	0.333
年龄(岁)	59.10±10.59	61.43±8.78	1.582	0.115
BMI(kg/m²)	26.12(24.12,29.07)	25.95(24.15,28.41)	-0.330	0.741
查体指标
心率(次/min)	74(65,81)	70(64,78)	-1.511	0.131
收缩压(mmHg)	132(122,143)	135(122,147)	-0.975	0.329
舒张压(mmHg)	81(72,89)	82(74,88.5)	-0.240	0.810
既往情况[例(%)]
高血压	57(65.5)	66(74.2)	1.561	0.212
糖尿病	22(25.3)	19(21.3)	0.382	0.537
吸烟	31(35.6)	37(41.6)	0.655	0.418
饮酒	11(12.6)	14(15.7)	0.344	0.558
化验指标
空腹血糖(mmol/L)	5.48(4.90,6.97)	5.12(4.65,6.03)	-2.020	0.043
肌酐(μmol/L)	69.2(58.1,77.8)	66.2(58.15,75.60)	-0.607	0.544
尿酸(μmol/L)	331.0(275.6,426.0)	309.3(266.5,388.05)	-1.542	0.123
TG(mmol/L)	1.60(1.12,2.21)	1.22(0.93,1.79)	-2.833	0.005
TC(mmol/L)	4.39(3.88,5.13)	4.00(3.39,4.79)	-2.814	0.005
HDL-C(mmol/L)	1.01(0.89,1.15)	1.08(0.97,1.23)	-2.309	0.021
LDL-C(mmol/L)	2.93(2.41,3.47)	2.61(2.00,3.19)	-3.146	0.002
VLDL-C(mmol/L)	0.48(0.35,0.68)	0.40(0.27,0.53)	-3.131	0.002
ApoB(g/L)	0.81(0.69,0.95)	0.70(0.60,0.85)	-3.757	<0.01
ApoA1(g/L)	1.09(0.97,1.23)	1.17(1.07,1.33)	-3.182	0.001
ApoB/ApoA1比值	0.75(0.60,0.90)	0.59(0.51,0.69)	-5.103	<0.01
LPa(mg/L)	210.8(97.1,481.7)	195.6(94.55,347.95)	-0.747	0.455

项目	高Gensini评分组(n=87)	低Gensini评分组(n=89)	t/Z/χ²值	P值
男性[例(%)]	57(65.5)	52(58.4)	0.938	0.333
年龄(岁)	59.10±10.59	61.43±8.78	1.582	0.115
BMI(kg/m²)	26.12(24.12,29.07)	25.95(24.15,28.41)	-0.330	0.741
查体指标
心率(次/min)	74(65,81)	70(64,78)	-1.511	0.131
收缩压(mmHg)	132(122,143)	135(122,147)	-0.975	0.329
舒张压(mmHg)	81(72,89)	82(74,88.5)	-0.240	0.810
既往情况[例(%)]
高血压	57(65.5)	66(74.2)	1.561	0.212
糖尿病	22(25.3)	19(21.3)	0.382	0.537
吸烟	31(35.6)	37(41.6)	0.655	0.418
饮酒	11(12.6)	14(15.7)	0.344	0.558
化验指标
空腹血糖(mmol/L)	5.48(4.90,6.97)	5.12(4.65,6.03)	-2.020	0.043
肌酐(μmol/L)	69.2(58.1,77.8)	66.2(58.15,75.60)	-0.607	0.544
尿酸(μmol/L)	331.0(275.6,426.0)	309.3(266.5,388.05)	-1.542	0.123
TG(mmol/L)	1.60(1.12,2.21)	1.22(0.93,1.79)	-2.833	0.005
TC(mmol/L)	4.39(3.88,5.13)	4.00(3.39,4.79)	-2.814	0.005
HDL-C(mmol/L)	1.01(0.89,1.15)	1.08(0.97,1.23)	-2.309	0.021
LDL-C(mmol/L)	2.93(2.41,3.47)	2.61(2.00,3.19)	-3.146	0.002
VLDL-C(mmol/L)	0.48(0.35,0.68)	0.40(0.27,0.53)	-3.131	0.002
ApoB(g/L)	0.81(0.69,0.95)	0.70(0.60,0.85)	-3.757	<0.01
ApoA1(g/L)	1.09(0.97,1.23)	1.17(1.07,1.33)	-3.182	0.001
ApoB/ApoA1比值	0.75(0.60,0.90)	0.59(0.51,0.69)	-5.103	<0.01
LPa(mg/L)	210.8(97.1,481.7)	195.6(94.55,347.95)	-0.747	0.455

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
ApoB/ApoA1比值	1.524	0.324	22.156	<0.01	4.593	2.434	8.664

变量	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
变量	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
ApoB/ApoA1比值	1.524	0.324	22.156	<0.01	4.593	2.434	8.664

项目	AUC	最佳诊断阈值	敏感度	特异度	P值
ApoB/ApoA1比值	0.723	0.69	0.644	0.742	<0.01
ApoB	0.664	0.73	0.701	0.607	<0.01
LDL-C	0.637	2.23	0.851	0.449	0.002
TG	0.624	1.51	0.586	0.652	0.005
TC	0.623	3.86	0.793	0.438	0.005