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血清磷脂酶A2联合不同代谢指标与冠状动脉病变的相关性分析
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Abstract:
目的：探讨脂蛋白相关磷脂酶A2 (lipoprotein-associated phospholipase A2，下称磷脂酶A2)与甘油三酯葡萄糖指数(Triglyceride-Glucose index，下称TyG指数)、甘油三酯葡萄糖身体质量指数(Triglyceride-Glucose-Body Mass Index，下称TyG-BMI)与合并2型糖尿病的慢性冠状动脉综合征(Chronic Coronary Syndrome，下称CCS)患者冠状动脉Gensini评分及主要心血管不良事件(Major Cardiovascular Advertise Events，下称MACEs)的相关性。方法：回顾性收集2021年10月至2022年10月在青岛大学附属医院诊治的289例行非急症冠状动脉造影的2型糖尿病患者作为研究对象，按Gensini评分分为对照(非CCS)组69例(Gensini积分 = 0分)、低积分组77例(2.5分 ≤ Gensini积分 < 33分)、中积分组97例(33分 ≤ Gensini积分 < 68分)、高积分组56例(Gensini积分 ≥ 68分)。采用多因素Logistic回归分析CCS患者Gensini评分高低的危险因素。分别于患者出院后6月、12月、18月对患者进行电话随访，记录患者的MACEs，以18月内的MACEs作为主要终点事件，终点事件的发生或随访截止时间为研究数据分析截止时间，根据随访结果将220例CCS患者分为未发生心血管不良事件组(170例)和发生心血管不良事件组(50例)，将磷脂酶A2分别和TyG指数、TyG-BMI进行二元Logistic回归分析，即可获得新的指标，即联合指标1、联合指标2。通过受试者操作特征(Receiver Operating Characteristic，下称ROC)曲线评估磷脂酶A2和TyG指数、TyG-BMI单一或联合指标预测MACEs的价值。采用单 + 多因素Cox回归分析评价上述指标对MACEs的影响。P < 0.05表示差异具有统计学意义。结果：与对照组相比，各积分组患者间血清磷脂酶A2、TyG指数、TyG-BMI水平均升高(P < 0.05)；合并2型糖尿病的CCS患者磷脂酶A2、TyG指数、TyG-BMI、低密度脂蛋白水平、高血压史、吸烟史与冠脉Gensini评分相关(P < 0.05)；多因素Logistic回归分析提示，血清磷脂酶A2水平、甘油三酯葡萄糖指数是冠脉Gensini评分升高的危险因素(P < 0.05)；ROC曲线分析显示，以血清磷脂酶A2分别和TyG指数、TyG-BMI联合应用绘制的ROC曲线下面积分别为0.767 (95%CI 0.704~0.831)、0.789 (95%CI 0.727~0.851)，磷脂酶A2联合TyG指数预测CCS患者MACEs的价值最高；多因素Cox比例风险模型显示，血清磷脂酶A2水平和TyG指数变化可能是糖尿病CCS患者主要心血管不良事件的影响因素。结论：血清磷脂酶A2、TyG指数水平是冠脉Gensini评分升高的危险因素，磷脂酶A2联合TyG指数、TyG-BMI对合并2型糖尿病的慢性冠脉综合征患者主要心血管不良事件的发生可能具有一定的预测价值。
Objective: To explore the correlation of lipoprotein-associated phospholipase A2 (hereinafter referred to as phospholipase A2) on Triglyceride-Glucose index (hereinafter referred to as TyG index) and Triglyceride-Glucose-Body Mass Index (hereinafter referred to as TyG-BMI) in coronary Gensini score and Major Adverse Cardiovascular Events (hereinafter referred to as MACEs) in Chronic Coronary Syndrome (hereinafter referred to as CCS) patients combined with type 2 diabetes mellitus. Methods: 289 patients with type 2 diabetes mellitus who underwent non-emergency coronary angiography in the Affiliated Hospital of Qingdao University from October 2021 to October 2022 were retrospectively collected as study objects, and according to Gensini scores, there were 69 cases in the observation (non-CCS) group (Gensini score = 0), 77 cases in the low score group (2.5 points ≤ Gensini score < 33 points), 97 cases in the medium score group (33 points ≤
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