甘油三酯–葡萄糖指数联合脂蛋白a与早发急性冠脉综合征的相关性

Association of Triglyceride Glucose Index Combined with Lipoprotein a with Premature Acute Coronary Syndrome

摘要: 目的：分析甘油三酯–葡萄糖指数(TyG指数)、脂蛋白a [(Lp(a)]与早发急性冠脉综合征(PACS)的相关性。方法选取2020年1~12月就诊于青岛大学附属医院急诊胸痛中心诊断疑似为急性冠脉综合征(ACS)并行冠脉造影(CAG)患者的临床资料进行回顾性分析。其中早发急性冠脉综合征患者116例，晚发急性冠脉综合征患者155例；未达到ACS诊断标准患者106例设为正常对照组。比较3组患者的临床资料，分析早发ACS患者的危险因素并分析TyG指数和Lp(a)对早发ACS的预测效能。结果：对照组与早发ACS组相比，早发ACS组中ALT、AST、LDL-C、TG、Lp(a)、血糖(空腹)、尿酸、白细胞、血小板、TyG指数均明显升高，年龄、HDL-C明显低于健康组，差异均有统计学意义(P < 0.05)。晚发ACS与早发ACS组相比，早发ACS组中ALT、TG、Lp(a)、尿酸、血小板、TyG指数均明显升高，差异均有统计学意义(P < 0.05)。Logistic回归分析中，以是否为早发ACS为因变量，矫正早发ACS组与正常对照组单因素分析中P < 0.1的因素，行多因素Logistic回归。分析结果显示：Lp(a)、Tc、TyG指数为早发ACS的危险因素，年龄、HDL-C为保护因素(P < 0.05)。受试者工作特征曲线分析结果显示，TyG指数联合LP(a)二者联合预测的曲线下面积为0.817 (0.761~0.872)，敏感度为86.2%，特异度为66%。结论：TyG指数、Lp(a)是发生早发ACS的重要危险因子。TyG指数、Lp(a)联合较单项检测具有更好的预测价值。

Abstract: Objective: To analyze the correlation between triglyceride glucose index (TyG index), lipoprotein a and premature acute coronary syndrome (PACS). Methods: Clinical data of patients who underwent coronary angiography (CAG) in the Emergency Chest Pain Center of Affiliated Hospital of Qingdao University from January 2020 to December 2020 were retrospectively analyzed. There were 116 patients with premature acute coronary syndrome (PACS) and 155 patients with late onset acute coronary syndrome. 106 patients who did not meet ACS diagnostic criteria were set as normal control group. The clinical data of 3 groups were compared and the risk factors of premature acute coronary syndrome (PACS) patients were analyzed. The predictive performance of TyG index and Lp(a) was analyzed. Results: Compared with the premature ACS group, ALT, AST, LDL-C, TG, Lp(a), blood glucose (fasting), uric acid, white blood cells, platelets and TyG index in the premature ACS group were significantly increased, and age and HDL-C were significantly lower than those in the healthy group, with statistical significance (P < 0.05). Compared with premature ACS group, ALT, TG, Lp(a), uric acid, platelet and TyG index in premature ACS group were significantly increased, and the differences were statistically significant (P < 0.05). In Logistic regression analysis, with whether premature ACS was the dependent variable, the factors with P < 0.1 in the single-factor analysis between the premature ACS group and the normal control group were corrected, and multiple Logistic regression was performed. The analysis results showed that Lp(a), Tc and TyG index were risk factors for premature ACS, and age and HDL-C were protective factors (P < 0.05). The analysis results of the receiver operating characteristic curve showed that the area under the curve predicted by TyG index combined with LP(a) was 0.817 (0.761~0.872), the sensitivity was 86.2%, and the specificity was 66%. Conclusion: TyG index and Lp(a) are important risk factors for premature acute coronary syndrome. The combination of TyG index and Lp(a) has better predictive value than single detection.