The Association between Serum Homocysteine to High-Density Lipoprotein Cholesterol Ratio and Premature Coronary Heart Disease
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摘要:
目的 探讨血清同型半胱氨酸（Hcy）、高密度脂蛋白胆固醇（HDL-C）及Hcy/HDL-C比值（HHR）变化对早发冠心病（PCHD）患者的发生及短期预后的预测价值。 方法 回顾性选取2022年1月至2023年12月至云南省第三人民医院心血管内科就诊的疑似冠心病患者301 例（其中男性患者≤55岁，女性患者≤65岁），所有患者均行冠状动脉造影术（CAG）检查。分为早发冠心病（PCHD，n 98）组及非冠心病（NCHD，n 203）组；对PCHD患者出院后进行为期半年的随访，将是否出现胸闷及胸痛等临床症状加重、心律失常、心力衰竭甚至死亡分为预后良好组（n 55）和预后不良组（n 43）。收集患者一般信息、血脂、Hcy、左心功能超声指标以及是否合并高血压、2型糖尿病等信息。 结果 （1）PCHD组Hcy、HHR高于NCHD组，HDL-C水平低于NCHD组（P < 0.001）；预后不良组Hcy、HHR高于预后良好组，HDL-C水平低于预后良好组（P < 0.001）；（2）冠脉重度狭窄组中Hcy、HHR水平均显著高于冠脉正常组及轻、中度狭窄组，HDL-C低于冠脉正常组及轻、中度狭窄组（P < 0.001）；（3）多因素Logistic回归分析发现，男性、HHR、Hcy、低密度脂蛋白胆固醇（LDL-C）以及左心室射血分数（LVEF）均是早发冠心病患病的独立影响因素（ P < 0.05）；HHR是PCHD短期预后不良的独立危险因素；（4）受试者操作特征曲线分析显示，血清Hcy、HHR均对PCHD的发生具有预测价值（P < 0.05），HHR的预测价值较高 （ 曲线下面积0.713）；HHR对早发冠心病的短期预后具有较高的预测价值 （ 曲线下面积0.715）。 结论 PCHD合并重度冠脉病变的患者中HHR水平较高，且HHR可以在一定程度预测PCHD的发生以及短期预后。 -
关键词:
- 早发冠心病 /
- 同型半胱氨酸 /
- 高密度脂蛋白胆固醇 /
- 同型半胱氨酸/高密度脂蛋白胆固醇比值 /
- 相关性研究
Abstract:Objective To evaluate the predictive value of changes in serum homocysteine （Hcy）, high-density lipoprotein cholesterol （HDL-C）, and the homocysteine-to-HDL-C ratio （HHR） for the incidence and short-term prognosis of patients with premature coronary heart disease （PCHD）. Methods Between January 2022 and December 2023, 301 patients with suspected coronary heart disease （males ≤ 55 years, females ≤ 65 years） were retrospectively selected from the Department of Cardiology at the Third People’ s Hospital of Yunnan Province. All patients who underwent coronary angiography （CAG） were divided into two groups: the premature coronary heart disease （PCHD） group （n 98） and the non-coronary heart disease （NCHD） group （n 203）. Patients with PCHD were followed up six months after the discharge and were further classified into the good prognosis group （n 55） and the poor prognosis group （n 43） based on the presence of worsening clinical symptoms such as chest tightness, chest pain, arrhythmias, heart failure, or death. Data collected included general patient information, blood lipid levels, Hcy levels, left ventricular function ultrasound indicators, and the presence of hypertension and type 2 diabetes. Results Hcy and HHR levels were significantly higher in the PCHD group compared to the NCHD group, while HDL-C levels were lower （P < 0.001）. In the poor prognosis group, Hcy and HHR levels were elevated, and HDL-C levels were reduced compared to the good prognosis group （P < 0.001）. The Hcy and HHR levels in the severe coronary artery stenosis group were markedly higher than those in the normal coronary artery group and the mild to the moderate stenosis group, with HDL-C levels being lower （P < 0.001）. Multivariate logistic regression analysis identified that male sex, HHR, Hcy, low-density lipoprotein cholesterol （LDL-C）, and left ventricular ejection fraction （LVEF） were independent factors influencing premature coronary heart disease （P < 0.05）. HHR was found to be an independent risk factor for poor short-term prognosis in PCHD. The analysis of the operating characteristic curve of the subjects showed that serum Hcy and HHR had the predictive value for the occurrence of PCHD （P < 0.05）, with HHR showing higher predictive value （area under the curve [AUC] = 0.713）. HHR also had the substantial predictive value for the short-term prognosis of PCHD （AUC = 0.715）. Conclusion Elevated HHR levels are associated with severe coronary artery disease in patients with PCHD. HHR serves as a significant predictor for both the occurrence and short-term prognosis of PCHD. -
图 2 对PCHD短期预后的预测价值ROC曲线图
Figure 2. ROC curve of predictive value for short-term prognosis of PCHD
表 1 NCHD组与PCHD组一般资料比较[n（%）/（$ \bar x \pm s $）/M（P25，P75）]
Table 1. Comparison of general data between NCHD group and PCHD group [n（%）/（$ \bar x \pm s $）/M（P25，P75）]
临床指标 NCHD组
（n = 203）PCHD组
（n = 98）t/z/χ2 P 年龄（岁） 51.70 ± 8.92 49.81 ± 8.18 1.772 0.077 性别 45.979 < 0.001* 男 77（37.93） 71（72.45） 女 126（62.07） 27（27.55） 吸烟史 26（12.81） 39（39.80） 28.432 < 0.001* 左心功能超声指标 LVESV（mL） 40（40，44） 42（40，50） −2.894 0.004* LVEDV（mL） 104（104，110） 109.5（104，120） −3.379 < 0.001* LVSV（mL） 65.25 ± 4.88 65.15 ± 7.39 0.137 0.891 LVEF（%） 63（63，65） 63（60，64） −4.898 < 0.001* 血脂 TC（mmol/L） 4.61 ± 0.99 4.86 ± 1.27 −1.841 0.067 LDL-C（mmol/L） 2.71（2.15.3.37） 2.89（2.17，3.73） −1.989 0.047* HDL-C（mmol/L） 1.18（0.99，1.37） 1.01（0.88，1.23） −3.960 < 0.001* TG（mmol/L） 1.63（1.07，2.47） 2.10（1.43，2.71） −2.565 0.100* Hcy（μmol/L） 10.5（8.5，12.9） 13.5（10.63，17.90） −5.267 < 0.001* HHR 9.37（7.07，11.56） 13.30（9.10，19.49） −5.987 < 0.001* 既往病史 HTN 100（49.26） 85（86.73） 2.776 0.096 T2DM 31（15.27） 26（26.53） 4.693 0.030* *P < 0.05。 
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表 2 PCHD组中预后良好者与预后不良者一般资料比较[n（%）/（$ \bar x \pm s $）/M（P25，P75）]
Table 2. Comparison of general data of good prognosis and poor prognosis in PCHD group [n（%）/（$ \bar x \pm s $）/M（P25，P75）]
临床指标 预后良好（n = 55） 预后不良（n = 43） t/z/χ2 P 年龄（岁） 52（47，59） 49（43，51） −2.984 0.003* 性别 16.248 < 0.001* 男 31（56.36） 40（93.02） 女 24（43.64） 3（6.97） 吸烟史[n（%）] 20（42.00） 27（56.25） 6.753 0.009* 左心功能超声指标 LVESV（mL） 46.78 ± 14.76 51.14 ± 20.60 −1.220 0.226 LVEDV（mL） 111.75 ± 16.03 116.56 ± 21.23 −1.279 0.204 LVSV（mL） 64.96 ± 7.27 65.40 ± 7.61 −0.286 0.776 LVEF（%） 59.71 ± 8.04 58.16 ± 11.07 0.801 0.425 血脂 TC（mmol/L） 5.11 ± 1.21 4.54 ± 1.29 2.250 0.027* LDL-C（mmol/L） 3.16 ± 1.14 2.76 ± 1.14 1.719 0.089 HDL-C（mmol/L） 1.09（0.93，1.36） 0.96（0.78，1.12） −3.240 0.001* TG（mmol/L） 2.45 ± 2.11 2.52 ± 1.45 −0.187 0.852 Hcy（μmol/L） 11.5（9.5，13.5） 17.6（13.9，28.1） −6.090 < 0.001* HHR 9.76（7.85，13.01） 19.78（14.58，33.20） −6.708 < 0.001* 既往病史 HTN 34（61.82） 34（79.07） 3.381 0.066 T2DM 12（21.82） 11（25.58） 0.190 0.663 *P < 0.05。
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表 3 冠状动脉不同程度狭窄组中Hcy、HDL-C、HHR的差异
Table 3. Differences of Hcy，HDL-C and HHR in groups with different degrees of coronary artery stenosis
变量 冠脉正常
（n = 99）轻度狭窄
（n = 104）中度狭窄
（n = 25）重度狭窄
（n = 73）F P Hcy 10.919 ± 4.126 12.617 ± 7.744 16.121 ± 14.222 19.877 ± 14.283 6.769 < 0.001* HDL-C 1.259 ± 0.326 1.156 ± 0.322 1.141 ± 0.270 1.033 ± 0.281 7.562 < 0.001* HHR 9.183 ± 4.150 11.752 ± 7.789 14.668 ± 12.565 20.947 ± 17.374 9.406 < 0.001* *P < 0.05。
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表 4 对PCHD患病的危险因素Logistic回归分析
Table 4. Logistic regression analysis of risk factors for PCHD
变量 β OR 95%CI P 女性 −0.892 0.410 0.222～0.756 0.004* Hcy 0.072 −0.908 0.833～0.990 0.029* HHR 0.148 1.159 1.062～1.265 < 0.001* LDL-C 0.497 1.643 1.225～2.205 < 0.001* LVEF −0.098 0.907 0.860～0.995 < 0.001* *P < 0.05。
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表 5 对PCHD短期预后不良的危险因素Logistic回归分析
Table 5. Logistic regression analysis of risk factors for poor short-term prognosis of PCHD
变量 β OR 95%CI P HHR 0.330 1.301 1.209～1.601 < 0.001* *P < 0.05。
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