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[多种脂质成分与早发性心肌梗死之间的关联:一项横断面研究]

[Associations between various lipid components and premature myocardial infarction: a cross-sectional study].

作者信息

Shi J, Zhang H Y, Wang D Y, Gao Q, Sheng L, Song P W, Zhang Y, Li Y

机构信息

Cardiovascular Department, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2023 Mar 24;51(3):278-287. doi: 10.3760/cma.j.cn112148-20221201-00957.

Abstract

Hyperlipidemia is closely related to premature acute myocardial infarction (AMI). The present study was performed to explore the correlation between various blood lipid components and the risk of premature AMI. This is a cross-sectional retrospective study. Consecutive patients with acute ST-segment elevation myocardial infarction (STEMI), who completed coronary angiography from October 1, 2020 to September 30, 2022 in our hospital, were enrolled and divided into premature AMI group (male<55 years old, female<65 years old) and late-onset AMI group. Total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, lipoprotein (a) (Lp (a)), apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1), non-HDL-C/HDL-C and ApoB/ApoA-1 were analyzed. The correlation between the above blood lipid indexes and premature AMI was analyzed and compared by logistic regression, restricted cubic spline and receiver operating characteristic curve (ROC). A total of 1 626 patients with STEMI were enrolled in this study, including 409 patients with premature AMI and 1 217 patients with late-onset AMI. Logistic regression analysis showed that the risk of premature AMI increased significantly with the increase of TG, non-HDL-C/HDL-C, non-HDL-C, ApoB/ApoA-1, TC and ApoB quintiles; while LDL-C, ApoA-1 and Lp (a) had no significant correlation with premature AMI. The restricted cubic spline graph showed that except Lp (a), LDL-C, ApoA-1 and ApoB/ApoA-1, other blood lipid indicators were significantly correlated with premature AMI. The ROC curve showed that TG and non-HDL-C/HDL-C had better predictive value for premature AMI. Inconsistency analysis found that the incidence and risk of premature AMI were the highest in patients with high TG and high non-HDL-C/HDL-C. TG, non-HDL-C/HDL-C and other blood lipid indexes are significantly increased in patients with premature AMI, among which TG is the parameter, most closely related to premature AMI, and future studies are needed to explore the impact of controlling TG on incidence of premature AMI.

摘要

高脂血症与早发急性心肌梗死(AMI)密切相关。本研究旨在探讨各种血脂成分与早发AMI风险之间的相关性。这是一项横断面回顾性研究。纳入2020年10月1日至2022年9月30日在我院完成冠状动脉造影的连续急性ST段抬高型心肌梗死(STEMI)患者,并分为早发AMI组(男性<55岁,女性<65岁)和晚发AMI组。分析总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、非HDL-C、脂蛋白(a)[Lp(a)]、载脂蛋白B(ApoB)、载脂蛋白A-1(ApoA-1)、非HDL-C/HDL-C和ApoB/ApoA-1。通过逻辑回归、限制性立方样条和受试者工作特征曲线(ROC)分析并比较上述血脂指标与早发AMI之间的相关性。本研究共纳入1626例STEMI患者,其中早发AMI患者409例,晚发AMI患者1217例。逻辑回归分析显示,随着TG、非HDL-C/HDL-C、非HDL-C、ApoB/ApoA-1、TC和ApoB五分位数的增加,早发AMI的风险显著增加;而LDL-C、ApoA-1和Lp(a)与早发AMI无显著相关性。限制性立方样条图显示,除Lp(a)、LDL-C、ApoA-1和ApoB/ApoA-1外,其他血脂指标与早发AMI显著相关。ROC曲线显示,TG和非HDL-C/HDL-C对早发AMI具有较好的预测价值。不一致性分析发现,TG和非HDL-C/HDL-C升高的患者早发AMI的发生率和风险最高。早发AMI患者的TG、非HDL-C/HDL-C等血脂指标显著升高,其中TG是与早发AMI关系最密切的参数,未来需要进一步研究探讨控制TG对早发AMI发生率的影响。

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