Association of residual cholesterol with early-onset myocardial infarction and its clinical outcome
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摘要: 目的 观察残余胆固醇(RC)与早发心肌梗死(MI)及其临床结局的相关性。方法 连续纳入2019年1月—2022年8月于沧州市人民医院住院首次诊断为MI的患者637例，并依据发病年龄(男性≤50岁，女性≤60岁)分为早发MI组(129例)和非早发MI组(508例)，所有患者均接受经皮冠状动脉介入治疗和冠心病规律药物治疗，并将早发MI患者依据随访期间是否再住院分为再住院组(21例)和非再住院组(108例)。收集患者一般临床资料和总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)等指标，并根据公式计算出RC。比较组间患者的临床特征，采用多因素logistic回归分析早发MI的影响因素。绘制受试者工作特征曲线(ROC)，评估RC对早发MI患者再住院的预测价值。Kaplan-Meier生存曲线比较组间再住院事件率的差异。多因素Cox比例风险回归分析早发MI患者再住院的影响因素，确定RC与再住院的关系。结果 早发MI组TC、LDL-C、RC、尿酸水平均高于非早发MI组，均差异有统计学意义(P < 0.05)。再住院组TC、TG、RC水平均高于非再住院组，均差异有统计学意义(P < 0.05)。多因素logistic回归分析结果显示，尿酸(OR=1.002，95%CI 1.000~1.004，P=0.026)、LDL-C(OR=3.031，95%CI 1.253~7.333，P=0.014)和RC(OR=2.856，95%CI 1.253~6.507，P=0.013)均为早发MI的独立危险因素。RC预测早发MI患者再住院的ROC曲线下面积(AUC)为0.703(95%CI 0.644~0.762，P=0.000)。高RC组和低RC组再住院率比较，差异有统计学意义(Log-rank χ2=16.218，P=0.000)。多因素Cox回归分析结果显示，LDL-C(HR=23.905，95%CI 1.546~369.646，P=0.023)、RC(HR=29.837，95%CI 1.976~450.493，P=0.014)和TG(HR=2.045，95%CI 1.458~2.869，P=0.000)均为早发MI患者再住院的独立危险因素。结论 高RC是早发MI和预后不良的独立危险因素。Abstract: Objective To observe the association of residual cholesterol(RC) with early-onset myocardial infarction(MI) and its clinical outcomes.Methods A total of 637 patients who were hospitalized in Cangzhou People's Hospital for the first time from January 2019 to August 2022 were continuously included. According to the age of onset(male≤50 years old, female≤60 years old), it was divided into early-onset MI group(129 cases) and non-early-onset MI group(508 cases), and all patients received percutaneous coronary intervention and regular drug treatment for coronary heart disease, and the early-onset MI were divided into rehospitalized group(21 cases) and non-rehospitalized group(108 cases) according to whether they were rehospitalized during the follow-up period. The clinical characteristics of patients were compared between groups, and the influencing factors of early-onset MI were analyzed by multivariate logistic regression. Receiver operating characteristic curve(ROC) was plotted to evaluate the predictive value of RC for readmission in patients with early-onset MI. Kaplan-Meier survival curve was used to compare the rate of readmission events between the groups. Multivariate Cox proportional risk regression analysis was conducted to determine the relationship between RC and readmission in patients with early-onset MI.Results The levels of TC, LDL-C, RC and uric acid in the early-onset MI group were higher than those in the non-early-onset MI group, and the differences were statistically significant(P < 0.05). The levels of TC, TG and RC in the rehospitalization group were higher than those in the nonrehospitalization group(P < 0.05). The results of multivariate logistic regression analysis showed that uric acid(OR=1.002, 95%CI1.000-1.004, P=0.026), LDL-C(OR=3.031, 95%CI1.253-7.333, P=0.014) and RC(OR=2.856, 95%CI1.253-6.507, P=0.013) were independent risk factors for early-onset MI. AUC for RC predicting rehospitalization in patients with early-onset MI was 0.703(95%CI0.644-0.762, P=0.000). There were significant differences in the rehospitalization rates between the high RC group and the low RC group(Log-rank χ2=16.218, P=0.000). The results of multivariate Cox regression analysis showed that LDL-C(HR=23.905, 95%CI1.546-369.646, P=0.023), RC(HR=29.837, 95%CI1.976-450.493, P=0.014) and TG(HR=2.045, 95%CI1.458-2.869, P=0.000) were independent risk factors for rehospitalization of patients with early-onset MI.Conclusion High RC is an independent risk factor for early-onset MI risk and poor prognosis.
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表 1 早发MI组和非早发MI组临床资料
Table 1. Clinical data of early-onset MI group and non-early-onset MI group
例(%), X±S, M(P25, P75) 指标 早发MI组(129例) 非早发MI组(508例) χ2/t/Z P值 男性 90(69.77) 347(68.31) 0.102 0.750 吸烟史 34(26.36) 132(25.98) 0.007 0.931 饮酒史 30(23.26) 106(20.87) 0.350 0.554 高血压史 69(53.49) 308(60.63) 2.172 0.141 糖尿病史 26(20.16) 130(25.59) 1.644 0.200 白蛋白/(g/L) 42.01±4.01 42.04±3.96 0.455 0.932 肌酐/(μmol/L) 61.75±10.51 61.97±11.40 1.901 0.842 尿酸/(μmol/L) 307.42±103.80 287.19±101.03 0.697 0.044 谷丙转氨酶/(U/L) 21.67±13.42 20.25±12.26 2.884 0.247 TC/(mmol/L) 4.98±1.24 4.54±0.98 3.424 0.000 TG/(mmol/L) 1.96±1.22 1.80±1.34 0.006 0.216 HDL-C/(mmol/L) 1.09±0.27 1.12±0.29 1.542 0.454 LDL-C/(mmol/L) 2.98(2.43，3.86) 2.79(2.22，3.34) 5.432 0.001 RC/(mmol/L) 0.72±0.73 0.61±0.43 2.798 0.025 
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表 2 早发MI的多因素logisitic回归分析
Table 2. Multivariate logisitic regression analysis of early onset MI
变量 B SE Wald OR 95%CI P 尿酸 0.002 0.001 4.982 1.002 1.000~1.004 0.026 LDL-C 1.109 0.451 6.055 3.031 1.253~7.333 0.014 RC 1.049 0.420 6.235 2.856 1.253~6.507 0.013
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表 3 再住院组和非再住院组临床资料
Table 3. Clinical data of readmission group and non-readmission group
例(%), X±S, M(P25, P75) 指标 再住院组(21例) 非再住院组(108例) χ2/t/Z P值 年龄/岁 43.76±8.34 46.44±7.15 1.409 0.129 男性 14(66.67) 76(70.37) 0.114 0.735 吸烟史 5(23.81) 29(26.85) 0.084 0.772 饮酒史 5(23.81) 25(23.15) 0.004 0.948 高血压史 10(47.62) 59(54.63) 0.347 0.556 糖尿病史 5(23.81) 21(19.44) 0.208 0.648 白蛋白/(g/L) 41.95±3.56 42.02±4.09 0.682 0.946 肌酐/(μmol/L) 62.71±10.00 61.58±10.63 0.319 0.669 尿酸/(μmol/L) 321.84±114.09 304.93±02.27 0.676 0.514 谷丙转氨酶/(U/L) 22.95±15.51 21.46±13.09 0.941 0.656 TC/(mmol/L) 5.95(4.70，6.38) 4.63(4.16，5.37) 6.356 0.007 TG/(mmol/L) 2.73(1.77，3.65) 1.51(1.11，2.03) 10.385 0.004 HDL-C/(mmol/L) 1.07±0.34 1.10±0.26 1.795 0.632 LDL-C/(mmol/L) 3.39(2.53，4.48) 2.93(2.42，3.74) 10.161 0.185 RC/(mmol/L) 1.10(0.68，1.42) 0.55(0.38，0.74) 30.343 0.017
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表 4 早发MI患者再住院的多因素Cox回归分析
Table 4. Multivariate Cox regression analysis of re-hospitalization in early MI
变量 B SE Wald HR 95%CI P LDL-C 3.174 1.397 5.161 23.905 1.546~369.646 0.023 RC 3.396 1.385 6.011 29.837 1.976~450.493 0.014 TG 0.716 0.173 17.172 2.045 1.458~2.869 0.000
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