中国全科医学 ›› 2026, Vol. 29 ›› Issue (24): 3447-3453.DOI: 10.12114/j.issn.1007-9572.2025.0234

• 论著 • 上一篇    下一篇

累积低密度脂蛋白胆固醇暴露量和尿酸/高密度脂蛋白胆固醇比值对老年急性心肌梗死的预测价值研究

孙沁瑜1,2,3, 邓毅凡1,2,3, 余吉玲1,2,3, 曹干3, 杨天笑3, 方震1,3, 纪军1,3, 何胜虎1,3, 张晶1,2,3,*()   

  1. 1.225001 江苏省扬州市,扬州大学附属苏北人民医院心血管内科
    2.225001 江苏省扬州市,扬州大学医学院
    3.225001 江苏省扬州市,苏北人民医院心血管内科
  • 收稿日期:2025-06-22 修回日期:2025-07-30 出版日期:2026-08-20 发布日期:2026-07-03
  • 通讯作者: 张晶

  • 作者贡献:

    孙沁瑜提出主要研究目标,负责研究的构思与设计,研究的实施,撰写论文;邓毅凡、余吉玲进行数据的收集与整理;曹干、杨天笑统计学处理,图、表的绘制与展示;方震、纪军进行论文的修订;何胜虎、张晶负责文章的质量控制与审查,对文章整体负责,监督管理。

  • 基金资助:
    2025年江苏省研究生科研与实践创新计划资助项目(SJCX25_2401); 2024年江苏省研究生科研与实践创新计划资助项目(SJCX24_1564); 苏北人民医院临床研究专项资金(SBLC25008)

Study on the Predictive Value of Cumulative LDL-C Exposure and Uric Acid/HDL-C Ratio in Elderly Patients with Acute Myocardial Infarction

SUN Qinyu1,2,3, DENG Yifan1,2,3, YU Jiling1,2,3, CAO Gan3, YANG Tianxiao3, FANG Zhen1,3, JI Jun1,3, HE Shenghu1,3, ZHANG Jing1,2,3,*()   

  1. 1. Department of Cardiology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
    2. Medical College of Yangzhou University, Yangzhou 225001, China
    3. Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou 225001, China
  • Received:2025-06-22 Revised:2025-07-30 Published:2026-08-20 Online:2026-07-03
  • Contact: ZHANG Jing

摘要: 背景 急性心肌梗死(AMI)极大威胁着老年人的健康与生存质量,既往研究发现低密度脂蛋白胆固醇(LDL-C)升高是AMI的独立危险因素,尿酸的增多与高密度脂蛋白胆固醇(HDL-C)的减少及AMI相关。然而累积LDL-C暴露量、尿酸/HDL-C比值(UHR)和老年AMI发生的相关性研究较少。 目的 探究累积LDL-C暴露量、UHR及两者联合对老年AMI发生的预测价值。 方法 回顾性纳入苏北人民医院2019—2023年诊断为AMI的737例老年患者(试验组)和同期入院并排除AMI的260例老年患者(对照组)为研究对象。收集患者一般资料及实验室检查指标,计算累积LDL-C暴露量和UHR值。采用单因素及多因素Logistic回归分析筛选老年AMI发生的独立危险因素。绘制累积LDL-C暴露量、UHR及两者联合预测老年AMI发生的ROC曲线,并计算ROC曲线下面积(AUC),评估累积LDL-C暴露量、UHR及两者联合对老年AMI发生的预测效能。 结果 试验组性别、吸烟史、酗酒史、高血压史、2型糖尿病史、BMI、糖化血红蛋白、白细胞计数、中性粒细胞计数、单核细胞计数、甘油三酯、总胆固醇、HDL-C、LDL-C、脂蛋白a、尿酸、累积LDL-C暴露量、UHR、载脂蛋白A1、白蛋白与对照组比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,男性(OR=3.026,95%CI=1.769~5.178,P<0.001)、2型糖尿病史(OR=4.834,95%CI=2.882~8.109,P<0.001)以及高水平的白细胞计数(OR=1.580,95%CI=1.368~1.825,P<0.001)、LDL-C(OR=3.801,95%CI=2.712~5.327,P<0.001)、累积LDL-C暴露量(OR=1.898,95%CI=1.042~3.457,P=0.036)和UHR(OR=10.658,95%CI=5.147~22.069,P<0.001)是老年AMI发生的独立危险因素,高水平的HDL-C(OR=0.426,95%CI=0.184~0.986,P=0.046)和白蛋白(OR=0.989,95%CI=0.979~0.999,P=0.031)为独立保护因素。ROC曲线结果显示,累积LDL-C暴露量和UHR预测老年AMI发生的AUC分别是0.726(95%CI=0.691~0.761)和0.700(95%CI=0.663~0.737),灵敏度分别为0.696和0.742,特异度分别为0.650和0.607,截断值分别为214.86和317.06。两者联合的AUC为0.813(95%CI=0.784~0.842),灵敏度为0.723,特异度为0.730。 结论 2型糖尿病史和高水平的白细胞计数、LDL-C、累积LDL-C以及UHR为发生老年AMI的独立危险因素,高水平的HDL-C和白蛋白为独立保护因素;累积LDL-C、UHR及两者联合均可作为有效识别老年AMI发生的早期生物标志物。

关键词: 急性心肌梗死, 累积低密度脂蛋白胆固醇暴露量, 尿酸与高密度脂蛋白胆固醇比值, 老年人, 风险评估

Abstract:

Background

Acute myocardial infarction (AMI) poses a significant threat to the health and quality of life of the elderly. Previous studies have found that higher low-density lipoprotein cholesterol (LDL-C) is an independent risk factor for AMI, and increased uric acid and decreased high-density lipoprotein cholesterol are also associated with AMI.

Objective

To investigate the predictive value of cumulative LDL-C exposure, uric acid to high-density lipoprotein cholesterol ratio (UHR), and their combination on the occurrence of AMI in the elderly.

Methods

A retrospective study was conducted on 737 elderly patients diagnosed with AMI at Northern Jiangsu People's Hospital from January 2019 to December 2023 (experimental group) and 260 elderly patients admitted during the same period who were excluded from the AMI diagnosis (control group). Patient demographics and laboratory test results were collected, and cumulative LDL-C exposure and UHR values were calculated. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for AMI in the elderly. ROC curves were plotted for cumulative LDL-C exposure, UHR, and their combined prediction of AMI in the elderly, and the area under the ROC curve (AUC) was calculated to assess the predictive efficacy of cumulative LDL-C exposure, UHR, and their combination for AMI in the elderly.

Results

The characteristics of male gender, smoking history, alcohol abuse history, history of hypertension, history of type 2 diabetes, BMI, glycated hemoglobin A1c, white blood cell count, neutrophil count, monocyte count, triglycerides, total cholesterol, HDL-C, LDL-C, lipoprotein a, uric acid, cumulative LDL-C exposure, UHR, apolipoprotein A1, and albumin of the experimental group were compared with the control group, results showed statistically significant differences (P<0.05). Results of multivariate Logistic regression analysis showed that male gender (OR=3.026, 95%CI=1.769-5.178, P<0.001), history of type 2 diabetes (OR=4.834, 95%CI=2.882-8.109, P<0.001), and high level of white blood cell count (OR=1.580, 95%CI=1.368-1.825, P<0.001), LDL-C (OR=3.801, 95%CI=2.712-5.327, P<0.001), cumulative LDL-C exposure (OR=1.898, 95%CI=1.042-3.457, P=0.036), UHR (OR=10.658, 95%CI=5.147-22.069, P<0.001) were independent risk factors for AMI in the elderly, while high level of HDL-C (OR=0.426, 95%CI=0.184-0.986, P=0.046) and albumin (OR=0.989, 95%CI=0.979-0.999, P=0.031) were independent protective factors. ROC curve results showed that the AUC for predicting occurrence of AMI in the elderly based on cumulative LDL-C exposure and UHR was 0.726 (95%CI=0.691-0.761) and 0.700 (95%CI=0.663-0.737), respectively, with sensitivities of 0.696 and 0.742, specificities of 0.650 and 0.607, and cutoff values of 214.86 and 317.06, respectively. The combined AUC was 0.813 (95%CI=0.784-0.842), with a sensitivity of 0.723 and a specificity of 0.730.

Conclusion

History of type 2 diabetes mellitus and high level of leukocytes counts, LDL-C, cumulative LDL-C, UHR are independent risk factors for AMI in the elderly, high level of HDL-C and albumin are independent protective factors. Cumulative LDL-C exposure, UHR and the combination of the two can be used as early biomarkers to effectively identify the occurrence of AMI in the elderly.

Key words: Acute myocardial infarction, Cumulative low-density lipoprotein cholesterol exposure, Uric acid to high-density lipoprotein cholesterol ratio, Aged, Risk assessment

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