血浆致动脉粥样硬化指数联合低密度脂蛋白胆固醇对老年STEMI患者冠状动脉内血栓负荷的预测价值

doi:10.3969/j.issn.1003-9198.2025.12.011

摘要/Abstract

摘要： 目的探究血浆致动脉粥样硬化指数(AIP)联合LDL-C对接受急诊经皮冠状动脉介入治疗(PCI)的老年ST段抬高型心肌梗死(STEMI)患者冠状动脉内血栓负荷程度的预测价值。方法回顾性收集2019年1—12月在宁夏医科大学总医院因STEMI入院并接受急诊PCI治疗的387例老年患者的临床资料。依据心肌梗死溶栓(TIMI)血栓分级将患者分为小血栓负荷组(STB组,273例)和大血栓负荷组(LTB组,114例)。比较2组患者的一般临床资料,采用多因素logistic回归分析患者冠状动脉内大血栓负荷的独立相关因素。采用ROC曲线评估AIP与LDL-C对大血栓负荷的预测价值。结果 LTB组Killip 1级比例、收缩压、舒张压、LVEF及术后TIMI血流3级比例低于STB组(均P＜0.05),而血清肌酐、肌钙蛋白Ⅰ、TG、LDL-C、AIP、门-球时间、术前TIMI血流0～2级比例均显著高于STB组(均P＜0.05)。多因素logistic回归分析结果显示,AIP、LDL-C、门-球时间、术前TIMI血流0～2级是LTB的独立危险因素,Killip 1级为独立保护因素。ROC曲线分析显示,AIP联合LDL-C预测LTB的曲线下面积为0.707(95%CI:0.648～0.765;P＜0.001),灵敏度为73.7%,特异度为36.3%。结论 AIP与LDL-C是老年STEMI患者冠状动脉内大血栓负荷的独立危险因素,二者联合对血栓负荷具有一定的预测价值,可作为临床风险评估的辅助指标。

关键词: ST段抬高型心肌梗死, 血浆致动脉粥样硬化指数, 低密度脂蛋白胆固醇, 血栓负荷

Abstract: Objective To investigate the predictive value of atherogenic index of plasma (AIP) combined with low-density lipoprotein cholesterol (LDL-C) for intracoronary thrombus load in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods A retrospective analysis was performed on 387 elderly STEMI patients who underwent emergency PCI at General Hospital of Ningxia Medical University from January to December 2019. According to the thrombolysis in myocardial infarction (TIMI) thrombus grading criteria, the patients were divided into small thrombus load (STB) group (273 cases) and large thrombus load (LTB) group (114 cases). The clinical data of the two groups were compared.Multivariate logistic regression was used to identify independent risk factors for LTB, and receiver operating characteristic (ROC) curve analysis was applied to evaluate the predictive performance of AIP and LDL-C. Results Compared to the STB group, the LTB group had significantly lower rates of Killip grade 1 and postoperative TIMI flow grade 3, lower levels of systolic/diastolic blood pressure and left ventricular ejection fraction(LVEF), but higher levels of serum creatinine, troponin Ⅰ, triglyceride(TG), LDL-C, AIP, door-to-balloon time, and a higher proportion of preoperative TIMI flow grade 0-2 (all P<0.05). Multivariate logistic regression analysis showed that AIP, LDL-C, portal time, and preoperative TIMI blood flow grade 0-2 were independent risk factors for LTB, while Killip grade 1 was a protective factor. The area under the ROC curve of AIP combined with LDL-C for predicting LTB was 0.707 (95%CI: 0.648-0.765; P<0.001), with a sensitivity of 73.7% and a specificity of 36.3%. Conclusions AIP and LDL-C are independent risk factors for high thrombus burden in elderly STEMI patients, and their combination shows certain predictive value for intracoronary LTB, which may serve as an auxiliary indicator for clinical risk assessment.

Key words: ST segment elevation myocardial infarction, atherogenic index of plasma, low-density lipoprotein cholesterol, thrombus load

中图分类号:

R 542.22

马小军, 李娜, 李小琴. 血浆致动脉粥样硬化指数联合低密度脂蛋白胆固醇对老年STEMI患者冠状动脉内血栓负荷的预测价值[J]. 实用老年医学, 2025, 39(12): 1243-1247.

MA Xiaojun, LI Na, LI Xiaoqin. Predictive value of atherogenic index of plasma combined with low-density lipoprotein cholesterol for coronary thrombotic burden in elderly STEMI patients[J]. Practical Geriatrics, 2025, 39(12): 1243-1247.

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