2025 年第 3 期 第 20 卷

非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值与非ST段抬高型急性冠状动脉综合征合并慢性肾脏病患者预后的相关性分析

The relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol and the prognosis of patients with non ST segment elevation acute coronary syndrome complicated with chronic kidney disease

作者：谢佳宏1鲜中2朱昱睿3周泽恺4蒋宏峰2

英文作者：Xie Jiahong1 Xian Zhong2 Zhu Yurui3 Zhou Zekai4 Jiang Hongfeng2

单位：1首都医科大学附属北京安贞医院心内冠心病中心5区，北京100029；2首都医科大学附属北京安贞医院北京市心肺血管疾病研究所实验研究中心，北京100029；3南通大学（启秀校区）医学院临床医学系，南通226006；4首都医科大学第八临床医学院首都医科大学附属复兴医院，北京100038

英文单位：1The Fifth Ward of Coronary Heart Disease Center Department of Cardiology Beijing Anzhen Hospital Capital Medical University，Beijing 100029 China; 2Beijing Anzhen Hospital Capital Medical University Experimental Research Center Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China; 3Department of Clinical Medicine Nantong University（Qixiu Campus） Nantong 226006 China; 4The Eighth Clinical School of Capital Medical University Fu Xing Hospital Capital Medical University Beijing 100038 China

关键词：非ST段抬高型急性冠状动脉综合征；慢性肾脏病；非高密度脂蛋白胆固醇；高密度脂蛋白胆固醇；支架置入术

英文关键词：NonSTsegmentelevationacutecoronarysyndrome;Chronickidneydisease;Non-high-densitylipoproteincholesterol;High-densitylipoproteincholesterol;Stentimplantation

• 摘要：

• 目的 探讨非高密度脂蛋白胆固醇（non-HDL-C）/高密度脂蛋白胆固醇（HDL-C）比值与非ST段抬高型急性冠状动脉综合征（NSTE-ACS）合并慢性肾脏病（CKD）患者行冠状动脉支架置入术预后的关系。方法 回顾性纳入2018年1月至2020年12月首都医科大学附属北京安贞医院565例NSTE-ACS合并CKD且成功行冠状动脉支架置入术的患者。根据non-HDL-C/HDL-C比值四分位数分为4组：组1（non-HDL-C/HDL-C比值≤2.32，n=141）,组2（2.32＜non-HDL-C/HDL-C比值≤2.96，n=142），组3（2.96＜non-HDL-C/HDL-C比值≤3.78，n=141），组4（non-HDL-C/HDL-C比值＞3.78，n=141）。随访3年，主要终点为主要不良心血管事件（MACE），包括全因死亡、非致死性心肌梗死和再次血运重建。采用Cox比例风险回归模型、Kaplan-Meier曲线、受试者工作特征曲线、局部加权回归散点平滑法（Lowess）曲线进行统计分析。结果 Cox比例风险回归模型分析表明，与组1相比，组4的MACE（风险比=2.06,95%置信区间：1.28～3.29，P=0.001）、全因死亡（风险比=2.09，95%置信区间：1.03～4.22，P=0.004）和再次血运重建发生风险显著增加。Kaplan-Meier曲线分析显示，随着non-HDL-C/HDL-C比值增高，MACE、全因死亡和再次血运重建发生风险显著增高(均Log-rank P＜0.05)。non-HDL-C/HDL-C比值对MACE发生风险预测能力［曲线下面积(AUC)为0.68］优于HDL-C和低密度脂蛋白胆固醇（LDL-C）(AUC分别为0.60、0.51)。Lowess曲线分析显示，non-HDL-C/HDL-C比值与MACE发生风险呈正相关。结论 在NSTE-ACS合并CKD行冠状动脉支架置入术后患者中，non-HDL-C/HDL-C比值增高显著增加患者MACE、全因死亡和再次血运重建的发生风险，且对MACE发生风险的预测能力优于HDL-C和LDL-C。

• Objective  To investigate the relationship between the ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high density lipoprotein cholesterol (HDL-C) and the prognosis of patients with non ST segment elevation acute coronary syndrome (NSTE-ACS) and chronic kidney disease (CKD) after coronary stent implantation. Methods This study retrospectively enrolled 565 NSTE-ACS patients with CKD who underwent successful coronary stent implantation in Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2020. They were divided into four groups based on non-HDL-C/HDL-C quartiles: group 1 (non-HDL-C/HDL-C≤2.32, n=141), group 2 (2.32<non-HDL-C/HDL-C≤2.96, n=142), group 3 (2.96<non-HDL-C/HDL-C≤3.78, n=141), group 4 (non-HDL-C/HDL-C>3.78, n=141). The patients were followed up for 3 years. The primary endpoint was major adverse cardiovascular events (MACE), including all-cause death, nonfatal myocardial infarction, and revascularization. Cox proportional hazards regression model, Kaplan-Meier curve, receiver operating characteristic curve, local weighted regression scatter smoothing method (Lowess) curve were used for statistical analysis. Results Cox proportional hazards regression model analysis showed that the risks of MACE ［hazard ratio (HR)=2.06, 95% confidence interval (CI):1.28-3.29, P=0.001］, all-cause death (HR=2.09, 95% CI:1.03-4.22, P=0.004), and repeat revascularization in group 4 were significantly higher than those in group 1. The Kaplan-Meier curve showed that the risk of MACE, all-cause mortality and repeat revascularization increased significantly with the increase of non-HDL-C/HDL-C quartiles (all Log-rank P＜0.05). The predictive ability of the non-HDL-C/HDL-C ［the area under the curve (AUC)=0.68］ was superior to HDL-C (AUC=0.60) and LDL-C (AUC=0.51). Lowess curve showed that non-HDL-C/HDL-C was positively correlated with MACE. Conclusions  Increased levels of non-HDL-C/HDL-C significantly increase the risk of MACE, all-cause death and repeat revascularization in NSTE-ACS patients with CKD after coronary stent implantation, and it was better than HDL-C and LDL-C in predicting the risk of MACE.