Predictive Value of Remnant Lipoprotein-cholesterol and Atherogenic Index of Plasma for First-time Acute Myocardial Infarction in Young Adults

doi:10.12114/j.issn.1007-9572.2022.0564

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (06): 659-664.DOI: 10.12114/j.issn.1007-9572.2022.0564

Special Issue: 心血管最新文章合辑；心肌梗死最新文章合辑

• Original Research • Previous Articles Next Articles

Predictive Value of Remnant Lipoprotein-cholesterol and Atherogenic Index of Plasma for First-time Acute Myocardial Infarction in Young Adults

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

Received:2022-07-05 Revised:2022-09-02 Published:2023-02-20 Online:2022-09-22
Contact: ZHANG Jing
About author:
DENG Y F, ZHU M X, LIU J, et al. Predictive value of remnant lipoprotein-cholesterol and atherogenic index of plasma for first-time acute myocardial infarction in young adults[J]. Chinese General Practice, 2023, 26 (6) : 659-664.

残粒脂蛋白胆固醇和血浆致动脉粥样硬化指数对青年初发急性心肌梗死的预测价值研究

1．225001　江苏省扬州市，江苏省苏北人民医院心血管内科　扬州大学临床医学院
2．225001　江苏省扬州市，扬州大学医学院
3．225001　江苏省扬州市，大连医科大学扬州临床医学院

通讯作者: 张晶
作者简介:
邓毅凡，朱米雪，刘娟，等.残粒脂蛋白胆固醇和血浆致动脉粥样硬化指数对青年初发急性心肌梗死的预测价值研究[J].中国全科医学，2023，26（6）：659-664. [www.chinagp.net] 作者贡献：邓毅凡进行研究的构思、设计以及文章撰写；朱米雪、刘娟、聂日进行数据的收集、整理与统计学分析；何胜虎、张晶负责文章的修订；张晶负责文章的质量控制及审校，对文章整体负责，监督管理。
基金资助:
2021年江苏省研究生科研与实践创新计划项目(SJCX21-1647); 江苏省卫生健康委科研课题(Z2018032); 扬州市重点研发（社会发展）项目(YZ2020103)

Abstract

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

摘要：

背景

血脂代谢异常是急性心肌梗死（AMI）发生、发展的重要危险因素，但在一些血脂正常的人群中，仍有AMI的发生。残粒脂蛋白胆固醇（RLP-C）、血浆致动脉粥样硬化指数（AIP）作为非常规血脂指标，与AMI之间的研究尚少，同时两者对青年初发AMI的预测价值有待研究。

目的

探讨RLP-C、AIP对青年初发AMI的预测价值。

方法

选取江苏省苏北人民医院心血管内科于2014年11月至2021年11月拟诊冠心病入院的患者1 201例为研究对象，根据是否为AMI将其分为AMI组（627例）和非AMI组（574例）。收集两组患者的一般资料以及三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）等指标，根据公式计算出RLP-C和AIP，并进行比较。采用Logistic回归分析探讨青年初发AMI的影响因素；采用受试者工作特征曲线（ROC曲线）评估RLP-C、AIP对青年初发AMI的预测价值。

结果

两组患者男性、吸烟史、高血压史比例，TG、TC、HDL-C、LDL-C、RLP-C、AIP水平比较，差异有统计学意义（P<0.05）。多因素Logisitic回归分析结果显示，有吸烟史〔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）〕、AIP≥0.2〔OR=3.427，95%CI（2.106，5.576）〕为青年初发AMI的独立危险因素（P<0.05）；HDL-C≥1.19 mmol/L〔OR=0.049，95%CI（0.025，0.093）〕为青年初发AMI的独立保护因素（P<0.05）。RLP-C预测青年初发AMI的ROC曲线下面积（AUC）为0.851〔95%CI（0.830，0.873）〕，最佳截断值为0.535 mmol/L，灵敏度和特异度分别为0.848和0.699；AIP预测青年初发AMI的AUC为0.813〔95%CI（0.789，0.837）〕，最佳截断值为0.122，灵敏度和特异度分别为0.852和0.660。

结论

研究结果提示有吸烟史、TC≥5.17 mmol/L、RLP-C≥0.6 mmol/L、AIP≥0.2可能为青年初发AMI的独立危险因素；HDL-C≥1.19 mmol/L可能为青年初发AMI的独立保护因素。RLP-C、AIP对青年初发AMI具有一定的临床预测价值。

关键词: 心肌梗死, 急性心肌梗死, 胆固醇, 残粒脂蛋白胆固醇, 血浆致动脉粥样硬化指数, 青年人, 冠状动脉粥样硬化

DENG Yifan,ZHU Mixue,LIU Juan, et al. Predictive Value of Remnant Lipoprotein-cholesterol and Atherogenic Index of Plasma for First-time Acute Myocardial Infarction in Young Adults[J]. Chinese General Practice, 2023, 26(06): 659-664. DOI: 10.12114/j.issn.1007-9572.2022.0564.
邓毅凡,朱米雪,刘娟等. 残粒脂蛋白胆固醇和血浆致动脉粥样硬化指数对青年初发急性心肌梗死的预测价值研究[J]. 中国全科医学, 2023, 26(06): 659-664. DOI: 10.12114/j.issn.1007-9572.2022.0564.

Figures/Tables 5

References 28

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组别	例数	男性〔n（%）〕	年龄〔M（P₂₅，P₇₅），岁〕	吸烟史〔n（%）〕	饮酒史〔n（%）〕	高血压史〔n（%）〕	糖尿病史〔n（%）〕	BMI〔M（P₂₅，P₇₅），kg/m²〕
非AMI组	574	362（63.07）	37.0（33.0，41.0）	218（37.98）	114（19.86）	232（40.42）	108（18.82）	24.6（21.6，27.9）
AMI组	627	468（74.64）	37.0（33.2，41.0）	404（64.43）	153（24.40）	299（47.69）	138（22.01）	24.0（21.6，27.4）
Z（χ²）值		18.807^a	-0.471	83.996^a	3.575^a	6.420^a	1.877^a	-1.224
P值		<0.001	0.638	<0.001	0.059	0.011	0.171	0.221
组别	TG〔M（P₂₅，P₇₅），mmol/L〕	TC〔M（P₂₅，P₇₅），mmol/L〕	HDL-C〔M（P₂₅，P₇₅），mmol/L〕	LDL-C〔M（P₂₅，P₇₅），mmol/L〕	RLP-C〔M（P₂₅，P₇₅），mmol/L〕	AIP〔M（P₂₅，P₇₅）〕
非AMI组	1.28（1.02，1.90）	4.10（3.55，4.75）	1.20（1.00，1.40）	2.40（1.95，2.93）	0.40（0.24，0.59）	0.04（-0.09，0.22）
AMI组	1.94（1.43，2.92）	4.50（3.81，5.34）	0.85（0.73，1.00）	2.69（2.11，3.36）	0.85（0.63，1.20）	0.36（0.20，0.56）
Z（χ²）值	-13.083	-7.098	-21.306	-5.293	-21.044	-18.746
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	男性〔n（%）〕	年龄〔M（P₂₅，P₇₅），岁〕	吸烟史〔n（%）〕	饮酒史〔n（%）〕	高血压史〔n（%）〕	糖尿病史〔n（%）〕	BMI〔M（P₂₅，P₇₅），kg/m²〕
非AMI组	574	362（63.07）	37.0（33.0，41.0）	218（37.98）	114（19.86）	232（40.42）	108（18.82）	24.6（21.6，27.9）
AMI组	627	468（74.64）	37.0（33.2，41.0）	404（64.43）	153（24.40）	299（47.69）	138（22.01）	24.0（21.6，27.4）
Z（χ²）值		18.807^a	-0.471	83.996^a	3.575^a	6.420^a	1.877^a	-1.224
P值		<0.001	0.638	<0.001	0.059	0.011	0.171	0.221
组别	TG〔M（P₂₅，P₇₅），mmol/L〕	TC〔M（P₂₅，P₇₅），mmol/L〕	HDL-C〔M（P₂₅，P₇₅），mmol/L〕	LDL-C〔M（P₂₅，P₇₅），mmol/L〕	RLP-C〔M（P₂₅，P₇₅），mmol/L〕	AIP〔M（P₂₅，P₇₅）〕
非AMI组	1.28（1.02，1.90）	4.10（3.55，4.75）	1.20（1.00，1.40）	2.40（1.95，2.93）	0.40（0.24，0.59）	0.04（-0.09，0.22）
AMI组	1.94（1.43，2.92）	4.50（3.81，5.34）	0.85（0.73，1.00）	2.69（2.11，3.36）	0.85（0.63，1.20）	0.36（0.20，0.56）
Z（χ²）值	-13.083	-7.098	-21.306	-5.293	-21.044	-18.746
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

变量	β	SE	Wald χ²值	P值	OR（95%CI）
男性	0.545	0.126	18.641	<0.001	1.724（1.346，2.207）
高血压史	0.296	0.117	6.408	0.011	1.344（1.069，1.689）
吸烟史	1.085	0.120	81.955	<0.001	2.958（2.339，3.742）
TG≥1.7 mmol/L	1.342	0.123	119.309	<0.001	3.826（3.007，4.868）
TC≥5.17 mmol/L	1.101	0.153	51.725	<0.001	3.009（2.228，4.062）
HDL-C≥1.19 mmol/L	-3.670	0.303	146.345	<0.001	0.025（0.014，0.046）
LDL-C≥3.37 mmol/L	0.790	0.155	26.153	<0.001	2.204（1.628，2.983）
RLP-C≥0.6 mmol/L	2.240	0.138	262.122	<0.001	9.389（7.159，12.313）
AIP≥0.2	2.135	0.132	260.196	<0.001	8.458（6.525，10.963）

变量	β	SE	Wald χ²值	P值	OR（95%CI）
男性	0.545	0.126	18.641	<0.001	1.724（1.346，2.207）
高血压史	0.296	0.117	6.408	0.011	1.344（1.069，1.689）
吸烟史	1.085	0.120	81.955	<0.001	2.958（2.339，3.742）
TG≥1.7 mmol/L	1.342	0.123	119.309	<0.001	3.826（3.007，4.868）
TC≥5.17 mmol/L	1.101	0.153	51.725	<0.001	3.009（2.228，4.062）
HDL-C≥1.19 mmol/L	-3.670	0.303	146.345	<0.001	0.025（0.014，0.046）
LDL-C≥3.37 mmol/L	0.790	0.155	26.153	<0.001	2.204（1.628，2.983）
RLP-C≥0.6 mmol/L	2.240	0.138	262.122	<0.001	9.389（7.159，12.313）
AIP≥0.2	2.135	0.132	260.196	<0.001	8.458（6.525，10.963）

变量	β	SE	Wald χ²值	P值	OR（95%CI）
吸烟史	0.932	0.169	30.453	<0.001	2.541（1.824，3.538）
TC≥5.17 mmol/L	1.025	0.350	8.593	0.003	2.787（1.405，5.531）
HDL-C≥1.19 mmol/L	-3.024	0.329	84.390	<0.001	0.049（0.025，0.093）
RLP-C≥0.6 mmol/L	1.331	0.182	53.293	<0.001	3.786（2.648，5.413）
AIP≥0.2	1.232	0.248	24.592	<0.001	3.427（2.106，5.576）

Predictive Value of Remnant Lipoprotein-cholesterol and Atherogenic Index of Plasma for First-time Acute Myocardial Infarction in Young Adults

残粒脂蛋白胆固醇和血浆致动脉粥样硬化指数对青年初发急性心肌梗死的预测价值研究

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指标	约登指数	AUC（95%CI）	灵敏度	特异度	最佳截断值	P值
RLP-C	0.547	0.851（0.830，0.873）	0.848	0.699	0.535 mmol/L	<0.001
AIP	0.544	0.813（0.789，0.837）	0.852	0.660	0.122	<0.001

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