2023 年第 1 期 第 18 卷

血脂和凝血指标与冠心病患者冠状动脉狭窄程度的相关性

Relationship between blood lipid, blood coagulation indexes and the degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease

作者：王洁肖珉李玉峰蔡轶

英文作者：Wang Jie Xiao Min Li Yufeng Cai Yi

单位：北京中医药大学东直门医院心内科，北京100700

英文单位：Department of Cardiology Dongzhimen Hospital Beijing University of Chinese Medicine Beijing 100700 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；冠状动脉狭窄；血脂指标；凝血指标

英文关键词：Coronaryatheroscleroticheartdisease;Coronaryarterystenosis;Bloodlipidindex;Bloodcoagulationindex

• 摘要：

• 目的  探讨血脂、凝血指标与冠心病（冠状动脉粥样硬化性心脏病）患者冠状动脉狭窄程度的相关性。方法 回顾性分析2019年3月至2021年1月于北京中医药大学东直门医院心内科住院治疗的中老年冠心病患者205例，根据Gensini评分分为重度狭窄组（≥60分，55例）与非重度狭窄组（＜60分，150例）。比较2组患者基础资料及血脂和凝血指标。采用Logistic回归方法分析冠心病患者冠状动脉重度狭窄的预测因子。采用受试者工作特征曲线分析各指标预测冠心病患者冠状动脉重度狭窄的价值。结果 重度狭窄组男性比例、体重指数、凝血酶原时间（PT）、纤维蛋白原水平均明显高于/长于非重度狭窄组［90.9%(50/55)比66.7%(100/150)、(27±4)kg/m2比(26±3)kg/m2、（11.2±1.0）s比（10.9±0.8）s、（3.5±1.0）g/L比（3.1±0.7）g/L］，高密度脂蛋白胆固醇（HDL-C）水平明显低于非重度狭窄组［（0.98±0.22）mmol/L比（1.09±0.26）mmol/L］，差异均有统计学意义（均P＜0.05）。Logistic回归分析结果显示，HDL-C、PT及凝血酶时间(TT)为冠心病患者冠状动脉重度狭窄的独立预测因子（均P＜0.05）。受试者工作特征曲线分析结果显示，HDL-C、PT、TT对于预测冠心病重度狭窄的曲线下面积分别为0.613、0.605、0.612，敏感度分别为76.6%、72.5%、67.2%，特异度分别为43.5%、63.0%、47.8%。结论 HDL-C、PT及TT对于预测冠心病患者冠状动脉重度狭窄有较好的敏感度，然而特异度较低。

• Objective To explore the relationship between blood lipid, blood coagulation indexes and the degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease. Methods From March 2019 to January 2021, 205 middle-aged and elderly patients with coronary atherosclerotic heart disease admitted to Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine were retrospectively analyzed. According to Gensini score, they were divided into severe stenosis group (the score≥60, 55 cases) and non severe stenosis group (the score＜60, 150 cases). The basic data, blood lipid and blood coagulation indexes of the two groups were compared. Logistic regression method was used to analyze the predictors of severe coronary artery stenosis in patients with coronary atherosclerotic heart disease. The value of each index in predicting severe coronary artery stenosis in patients with coronary atherosclerotic heart disease was analyzed by receiver operating characteristic curve. Results The proportion of male, body mass index, prothrombin time(PT) and the level of fibrinogen in severe stenosis group were significantly higher/longer than those in non severe stenosis group［90.9%(50/55) vs 66.7%(100/150), (27±4)kg/m2 vs (26±3)kg/m2, （11.2±1.0）s vs （10.9±0.8）s, （3.5±1.0）g/L vs （3.1±0.7）g/L］, and the level of high-density lipoprotein cholesterol(HDL-C) in severe stenosis group was significantly lower than that in non severe stenosis group［（0.98±0.22）mmol/L vs （1.09±0.26）mmol/L］(all P＜0.05). Logistic regression analysis showed that HDL-C, PT and thrombin time(TT) were independent predictors of severe coronary artery stenosis in patients with coronary atherosclerotic heart disease (all P＜0.05). Receiver operating characteristic curve analysis showed that the areas under the curve of HDL-C, PT and TT for predicting severe coronary artery stenosis were 0.613, 0.605 and 0.612, the sensitivities were 76.6%, 72.5% and 67.2%, and the specificities were 43.5%, 63.0% and 47.8%, respectively. Conclusion HDL-C, PT and TT have a good sensitivity in predicting severe coronary stenosis in patients with coronary atherosclerotic heart disease, but the specificity is low.