Page 19 - 2023-06-中国全科医学

·660· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn February 2023, Vol.26 No.6

Predictive Value of Remnant Lipoprotein-cholesterol and Atherogenic Index of Plasma for First-time Acute Myocardial
1
Infarction in Young Adults DENG Yifan 1，2 ，ZHU Mixue 1，3 ，LIU Juan 1，2 ，NIE Ri 1，2 ，HE Shenghu ，ZHANG Jing 1*
1.Department of Cardiovascular Medicine，Northern Jiangsu People's Hospital/Clinical Medical School，Yangzhou University，
Yangzhou 225001，China
2.Medical College，Yangzhou University，Yangzhou 225001，China
3.Yangzhou School of Clinical Medicine，Dalian Medical University，Yangzhou 225001，China
*
Corresponding author：ZHANG Jing，Associate chief physician；E-mail：zhangjingyjs@163.com
【Abstract】 Background Acute myocardial infarction（AMI）can be found in some patients with normal serum lipids
although abnormal lipid metabolism is a major risk of AMI. The association of AMI with two unconventional lipid parameters，
namely residual lipoprotein-cholesterol（RLP-C）and atherogenic index of plasma（AIP），has been studied rarely，and the
predictive value of RLP-C and AIP for first-time AMI in young adults still needs to be explored. Objective To assess the value
of RLP-C and AIP in predicting first-time AMI in young adults. Methods A total of 1 201 inpatients aged 18-45 years old
with an initial diagnosis of coronary heart disease（CHD）were selected from Northern Jiangsu People's Hospital from November
2014 to November 2021，including 627 with first-time AMI and 574 without. General demographics，triglyceride（TG），total
cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C）and other
indicators were collected，and RPL-C and AIP were calculated according to the formula for statistical analysis. Logistic regression
analysis was used to explore the influencing factors of first-time AMI. Receiver operating characteristic（ROC）analysis was used
to evaluate the predictive value of RLP-C and AIP for first-time AMI. Results CHD patients with and without first-time AMI
had significant differences in male ratio，smoking history，hypertension history，and average levels of TG，TC，HDL-C，
LDL-C，RLP-C and AIP（P<0.05）. Multivariate Logistic regression analysis showed that smoking history〔OR=2.541，95%CI
（1.824，3.538）〕，TC ≥ 5.17 mmol/L〔OR=2.787，95%CI（1.405，5.531）〕，RLP-C ≥ 0.6 mmol/L〔OR=3.786，
95%CI（2.648，5.413）〕 and AIP ≥ 0.2〔OR=3.427，95%CI（2.106，5.576）〕independently increased the risk for
first-time AMI（P<0.05），while HDL-C ≥ 1.19 mmol/L〔OR=0.049，95%CI（0.025，0.093）〕independently decreased
the risk of first-time AMI（P<0.05）. In ROC analysis，the performance of RLP-C and AIP predicting first-time AMI was as
follows：RLP-C had an AUC of 0.851〔95%CI（0.830，0.873）〕，with 0.535 mmol/L as the optimal cut-off value，0.848
sensitivity and 0.699 specificity；AIP had an AUC of 0.813〔95%CI（0.789，0.837）〕，with 0.122 as the optimal cut-
off value，0.852 sensitivity and 0.660 specificity. Conclusion The risk of first-time AMI in young adults may be increased
by smoking history，TC ≥ 5.17 mmol/L，RLP-C ≥ 0.6 mmol/L and AIP ≥ 0.2，and decreased by HDL-C ≥ 1.19 mmol/L.
RLP-C and AIP may partially predict first-time AMI.
【Key words】 Myocardial infarction；Acute myocardial infarction；Cholesterol；Residual lipoprotein-cholesterol；
Atherogenic index of plasma；Young adult；Coronary atherosclerosis

急性心肌梗死（AMI）是由冠状动脉急性闭塞引起 1 资料与方法
的心肌急性缺血坏死，多由冠状动脉粥样硬化（AS） 1.1 研究对象 选取江苏省苏北人民医院心血管内科
进展所致。随着生活节奏、饮食方式的改变，AMI 发病 于 2014 年 11 月至 2021 年 11 月拟诊冠心病（CHD）入
人群逐渐年轻化 ［1］ 。据统计，近 10 年的 AMI 患者中， 院的患者 1 201 例为研究对象，根据是否为 AMI 将其分
年轻人（<45 岁）比例达到 32%，然而这一数据在 21 为 AMI 组（627 例）和非 AMI 组（574 例，其中 CHD
世纪初期仅有 20% 左右 ［2］ 。血脂代谢异常被公认为是 患者 304 例，通过冠状动脉造影排除的非 CHD 者 270
AS 重要的致病因素，控制常见的血脂指标如总胆固醇 例）。本研究项目已通过江苏省苏北人民医院伦理委员
（TC）、低密度脂蛋白胆固醇（LDL-C）等已作为 AMI 会审批（2018KY-197）。
高危人群的有效防治手段 ［3］ 。近年来，更多的非传统 纳入标准：（1）年龄 18~45 岁；（2）初诊为 CHD（包
血脂指标如残粒脂蛋白胆固醇（RLP-C）、血浆致动 括 AMI）患者，诊断符合《急性 ST 段抬高型心肌梗死
脉粥样硬化指数（AIP）、小而密低密度脂蛋白胆固醇 诊断和治疗指南》 ［6］ ；（3）均已完善冠状动脉造影术，
（sdLDL-C）等被发现可能与 AS 密切相关 ［4-5］ 。为进 其中 CHD 诊断造影提示任意冠状动脉或其主要分支狭
一步明确上述非传统血脂指标与青年 AMI 的关系，本 窄程度≥ 50%。排除标准：（1）日常服用抗凝、抗血
研究回顾性分析了 RLP-C、AIP 对青年初发 AMI 的预 小板等 CHD 二级预防药物；（2）入院前已服用他汀类、
测作用及效应，旨在为此类高风险发病人群提供更健全 贝特类等影响血脂药物；（3）存在冠状动脉肌桥、冠
的评估指标。 状动脉痉挛等非阻塞性 AMI；（4）陈旧性心肌梗死、