解放军医学杂志

临床指标	非冠心病组(n=245)	冠心病组(n=332)	χ²/t/Z	P
男性[例(%)]	130(53.1)	251(75.6)	31.934	<0.001
高血压[例(%)]	102(41.6)	197(59.3)	17.699	<0.001
糖尿病[例(%)]	40(16.3)	101(30.4)	15.168	<0.001
吸烟[例(%)]	84(34.3)	190(57.2)	30.534	<0.001
年龄(岁，$\bar{x}±s$)	60.5±9.7	65.0±9.1	–5.726	<0.001
心力衰竭[例(%)]	14(5.7)	28(8.43)	1.545	0.214
房颤[例(%)]	21(8.6)	20(6.02)	1.386	0.239
LVEF[%, M(Q₁, Q₃)]	61(60,62)	60.0(58.0, 62.0)	–3.147	0.002
HGB[g/L, M(Q₁, Q₃)]	139.0(127.0,151.0)	140.0(129.3, 153.0)	–1.769	0.077
PLT[×10⁹/L, M(Q₁, Q₃)]	192.0(162.0,232.0)	197.0(165.0, 238.0)	–1.682	0.093
WBC[×10⁹/L, M(Q₁, Q₃)]	5.730(4.900,6.960)	6.605(5.499, 8.118)	–5.525	<0.001
NE[×10⁹/L, M(Q₁, Q₃)]	3.530(2.730,4.550)	4.005(3.130, 5.378)	–4.580	<0.001
LY[×10⁹/L, M(Q₁, Q₃)]	1.720(1.350,2.100)	1.710(1.320, 2.133)	–0.111	0.911
TC[mmol/L, M(Q₁, Q₃)]	4.220(3.630,4.920)	4.290(3.605, 4.890)	–0.314	0.753
TG[mmol/L, M(Q₁, Q₃)]	1.460(0.980,2.220)	1.415(0.963, 2.138)	–0.170	0.865
LDL-C[mmol/L, M(Q₁, Q₃)]	2.300(1.690,2.850)	2.355(1.820, 2.850)	–1.307	0.191
HDL-C[mmol/L, M(Q₁, Q₃)]	1.150(1.00,1.380)	1.075(0.950, 1.238)	–4.173	<0.001
ApoA-1[g/L, M(Q₁, Q₃)]	1.030(0.940,1.260)	1.000(0.870, 1.078)	–5.578	<0.001
ApoB[g/L, M(Q₁, Q₃)]	0.750(0.600,0.930)	0.780(0.603, 0.928)	–1.650	0.099
HCY[μmol/L, M(Q₁, Q₃)]	10.60(8.70,12.60)	12.20(9.93, 14.40)	–5.658	<0.001
CysC[mg/L, M(Q₁, Q₃)]	0.890(0.780,0.990)	0.920(0.810, 1.070)	–2.384	0.017
CRP[mg/dl, M(Q₁, Q₃)]	1.20(0.70,2.30)	2.10(1.00, 6.48)	–6.673	<0.001
ALB[mg/dl, M(Q₁, Q₃)]	39.30(37.40,41.50)	38.70(36.10, 41.00)	–2.704	0.007
Scr[mg/dl, M(Q₁, Q₃)]	68.0(58.0,78.0)	72.0(63.0, 83.0)	–3.378	0.001
UA[μmol/L, M(Q₁, Q₃)]	363.0(300.0,433.0)	366.5(305.0, 441.8)	–1.040	0.298
β₂-MG[mg/L, M(Q₁, Q₃)]	1.84(1.49,2.27)	1.97(1.65, 2.47)	–2.547	0.011
α₁-MG[mg/L, M(Q₁, Q₃)]	27.0(23.0,30.0)	28.0(24.0, 33.0)	–2.652	0.008
CAR×100	3.061(1.828,5.959)	5.495(2.566, 17.125)	–6.768	<0.001
HCY/HDL-C	9.158(6.812,12.261)	11.267(8.976, 14.862)	–6.568	<0.001

临床指标	非冠心病组(n=245)	冠心病组(n=332)	χ²/t/Z	P
男性[例(%)]	130(53.1)	251(75.6)	31.934	<0.001
高血压[例(%)]	102(41.6)	197(59.3)	17.699	<0.001
糖尿病[例(%)]	40(16.3)	101(30.4)	15.168	<0.001
吸烟[例(%)]	84(34.3)	190(57.2)	30.534	<0.001
年龄(岁，$\bar{x}±s$)	60.5±9.7	65.0±9.1	–5.726	<0.001
心力衰竭[例(%)]	14(5.7)	28(8.43)	1.545	0.214
房颤[例(%)]	21(8.6)	20(6.02)	1.386	0.239
LVEF[%, M(Q₁, Q₃)]	61(60,62)	60.0(58.0, 62.0)	–3.147	0.002
HGB[g/L, M(Q₁, Q₃)]	139.0(127.0,151.0)	140.0(129.3, 153.0)	–1.769	0.077
PLT[×10⁹/L, M(Q₁, Q₃)]	192.0(162.0,232.0)	197.0(165.0, 238.0)	–1.682	0.093
WBC[×10⁹/L, M(Q₁, Q₃)]	5.730(4.900,6.960)	6.605(5.499, 8.118)	–5.525	<0.001
NE[×10⁹/L, M(Q₁, Q₃)]	3.530(2.730,4.550)	4.005(3.130, 5.378)	–4.580	<0.001
LY[×10⁹/L, M(Q₁, Q₃)]	1.720(1.350,2.100)	1.710(1.320, 2.133)	–0.111	0.911
TC[mmol/L, M(Q₁, Q₃)]	4.220(3.630,4.920)	4.290(3.605, 4.890)	–0.314	0.753
TG[mmol/L, M(Q₁, Q₃)]	1.460(0.980,2.220)	1.415(0.963, 2.138)	–0.170	0.865
LDL-C[mmol/L, M(Q₁, Q₃)]	2.300(1.690,2.850)	2.355(1.820, 2.850)	–1.307	0.191
HDL-C[mmol/L, M(Q₁, Q₃)]	1.150(1.00,1.380)	1.075(0.950, 1.238)	–4.173	<0.001
ApoA-1[g/L, M(Q₁, Q₃)]	1.030(0.940,1.260)	1.000(0.870, 1.078)	–5.578	<0.001
ApoB[g/L, M(Q₁, Q₃)]	0.750(0.600,0.930)	0.780(0.603, 0.928)	–1.650	0.099
HCY[μmol/L, M(Q₁, Q₃)]	10.60(8.70,12.60)	12.20(9.93, 14.40)	–5.658	<0.001
CysC[mg/L, M(Q₁, Q₃)]	0.890(0.780,0.990)	0.920(0.810, 1.070)	–2.384	0.017
CRP[mg/dl, M(Q₁, Q₃)]	1.20(0.70,2.30)	2.10(1.00, 6.48)	–6.673	<0.001
ALB[mg/dl, M(Q₁, Q₃)]	39.30(37.40,41.50)	38.70(36.10, 41.00)	–2.704	0.007
Scr[mg/dl, M(Q₁, Q₃)]	68.0(58.0,78.0)	72.0(63.0, 83.0)	–3.378	0.001
UA[μmol/L, M(Q₁, Q₃)]	363.0(300.0,433.0)	366.5(305.0, 441.8)	–1.040	0.298
β₂-MG[mg/L, M(Q₁, Q₃)]	1.84(1.49,2.27)	1.97(1.65, 2.47)	–2.547	0.011
α₁-MG[mg/L, M(Q₁, Q₃)]	27.0(23.0,30.0)	28.0(24.0, 33.0)	–2.652	0.008
CAR×100	3.061(1.828,5.959)	5.495(2.566, 17.125)	–6.768	<0.001
HCY/HDL-C	9.158(6.812,12.261)	11.267(8.976, 14.862)	–6.568	<0.001

临床指标	冠状动脉轻度病变组(n=183)	冠状动脉重度病变组(n=149)	χ²/t/Z	P
男性[例(%)]	129(70.5)	122(81.9)	5.774	0.016
高血压[例(%)]	95(51.9)	102(68.5)	9.316	0.002
糖尿病[例(%)]	44(24.0)	57(38.3)	7.836	0.005
吸烟[例(%)]	93(50.8)	98(65.8)	7.515	0.006
心力衰竭[例(%)]	5(2.7)	23(15.4)	17.164	<0.001
房颤[例(%)]	9(4.9)	11(7.4)	0.881	0.348
年龄(岁，$\bar{x}±s$)	62.2±8.2	68.6±8.9	–6.831	<0.001
LVEF[%, M(Q₁, Q₃)]	60.0(60.0, 62.0)	60.0(58.0, 62.0)	–2.984	0.003
HGB[g/L, M(Q₁, Q₃)]	142.0(130.0, 154.0)	139.0(127.0, 151.0)	–1.569	0.117
PLT[×10⁹/L, M(Q₁, Q₃)]	193.0(160.0, 234.0)	202.0(172.0, 245.0)	–1.801	0.072
WBC[×10⁹/L, M(Q₁, Q₃)]	6.270(5.230, 7.340)	7.060(5.980, 9.245)	–5.153	<0.001
NE[×10⁹/L, M(Q₁, Q₃)]	3.660(2.920, 4.640)	4.470(3.540, 6.460)	–5.157	<0.001
LY[×10⁹/L, M(Q₁, Q₃)]	1.680(1.300, 2.100)	1.750(1.350, 2.170)	–0.639	0.523
TC[mmol/L, M(Q₁, Q₃)]	4.290(3.630, 4.880)	4.320(3.590, 5.035)	–0.933	0.351
TG[mmol/L, M(Q₁, Q₃)]	1.390(0.900, 2.190)	1.470(0.995, 2.055)	–0.360	0.719
LDL-C[mmol/L, M(Q₁, Q₃)]	2.300(1.720, 2.800)	2.480(1.835, 3.045)	–2.202	0.028
HDL-C[mmol/L, M(Q₁, Q₃)]	1.100(0.960, 1.290)	1.060(0.920, 1.175)	–2.592	0.010
ApoA-1[g/L, M(Q₁, Q₃)]	1.010(0.900, 1.130)	0.960(0.820, 1.040)	–3.740	<0.001
ApoB[g/L, M(Q₁, Q₃)]	0.750(0.600, 0.880)	0.820(0.640, 0.995)	–3.045	0.002
HCY[μmol/L, M(Q₁, Q₃)]	11.40(9.40, 13.60)	12.50(11.00, 16.10)	–3.966	<0.001
CysC[mg/L, M(Q₁, Q₃)]	0.900(0.810, 1.060)	0.950(0.810, 1.100)	–1.242	0.214
CRP[mg/dl, M(Q₁, Q₃)]	1.60(0.90, 2.80)	5.20(2.05, 12.15)	–8.113	<0.001
ALB[mg/dl, M(Q₁, Q₃)]	39.30(36.70, 41.40)	37.70(35.60, 40.60)	–3.438	0.001
Scr[mg/dl, M(Q₁, Q₃)]	72.0(62.0, 81.0)	73.0(64.0, 84.0)	–0.864	0.388
UA[μmol/L, M(Q₁, Q₃)]	362.0(307. 0,429.0)	374.0(303.0, 446.0)	–0.713	0.476
β₂-MG[mg/L, M(Q₁, Q₃)]	1.94(1.57, 2.39)	2.05(1.66, 2.70)	–2.104	0.035
α₁-MG[mg/L, M(Q₁, Q₃)]	27.0(24.0, 32.0)	28.0(25.0, 34.0)	–1.741	0.082
CAR×100	4.167(2.198, 7.108)	14.154(5.460, 32.105)	–8.313	<0.001
HCY/HDL-C1	0.171(8.053, 13.407)	12.360(10.000, 16.037)	–4.780	<0.001

临床指标	冠状动脉轻度病变组(n=183)	冠状动脉重度病变组(n=149)	χ²/t/Z	P
男性[例(%)]	129(70.5)	122(81.9)	5.774	0.016
高血压[例(%)]	95(51.9)	102(68.5)	9.316	0.002
糖尿病[例(%)]	44(24.0)	57(38.3)	7.836	0.005
吸烟[例(%)]	93(50.8)	98(65.8)	7.515	0.006
心力衰竭[例(%)]	5(2.7)	23(15.4)	17.164	<0.001
房颤[例(%)]	9(4.9)	11(7.4)	0.881	0.348
年龄(岁，$\bar{x}±s$)	62.2±8.2	68.6±8.9	–6.831	<0.001
LVEF[%, M(Q₁, Q₃)]	60.0(60.0, 62.0)	60.0(58.0, 62.0)	–2.984	0.003
HGB[g/L, M(Q₁, Q₃)]	142.0(130.0, 154.0)	139.0(127.0, 151.0)	–1.569	0.117
PLT[×10⁹/L, M(Q₁, Q₃)]	193.0(160.0, 234.0)	202.0(172.0, 245.0)	–1.801	0.072
WBC[×10⁹/L, M(Q₁, Q₃)]	6.270(5.230, 7.340)	7.060(5.980, 9.245)	–5.153	<0.001
NE[×10⁹/L, M(Q₁, Q₃)]	3.660(2.920, 4.640)	4.470(3.540, 6.460)	–5.157	<0.001
LY[×10⁹/L, M(Q₁, Q₃)]	1.680(1.300, 2.100)	1.750(1.350, 2.170)	–0.639	0.523
TC[mmol/L, M(Q₁, Q₃)]	4.290(3.630, 4.880)	4.320(3.590, 5.035)	–0.933	0.351
TG[mmol/L, M(Q₁, Q₃)]	1.390(0.900, 2.190)	1.470(0.995, 2.055)	–0.360	0.719
LDL-C[mmol/L, M(Q₁, Q₃)]	2.300(1.720, 2.800)	2.480(1.835, 3.045)	–2.202	0.028
HDL-C[mmol/L, M(Q₁, Q₃)]	1.100(0.960, 1.290)	1.060(0.920, 1.175)	–2.592	0.010
ApoA-1[g/L, M(Q₁, Q₃)]	1.010(0.900, 1.130)	0.960(0.820, 1.040)	–3.740	<0.001
ApoB[g/L, M(Q₁, Q₃)]	0.750(0.600, 0.880)	0.820(0.640, 0.995)	–3.045	0.002
HCY[μmol/L, M(Q₁, Q₃)]	11.40(9.40, 13.60)	12.50(11.00, 16.10)	–3.966	<0.001
CysC[mg/L, M(Q₁, Q₃)]	0.900(0.810, 1.060)	0.950(0.810, 1.100)	–1.242	0.214
CRP[mg/dl, M(Q₁, Q₃)]	1.60(0.90, 2.80)	5.20(2.05, 12.15)	–8.113	<0.001
ALB[mg/dl, M(Q₁, Q₃)]	39.30(36.70, 41.40)	37.70(35.60, 40.60)	–3.438	0.001
Scr[mg/dl, M(Q₁, Q₃)]	72.0(62.0, 81.0)	73.0(64.0, 84.0)	–0.864	0.388
UA[μmol/L, M(Q₁, Q₃)]	362.0(307. 0,429.0)	374.0(303.0, 446.0)	–0.713	0.476
β₂-MG[mg/L, M(Q₁, Q₃)]	1.94(1.57, 2.39)	2.05(1.66, 2.70)	–2.104	0.035
α₁-MG[mg/L, M(Q₁, Q₃)]	27.0(24.0, 32.0)	28.0(25.0, 34.0)	–1.741	0.082
CAR×100	4.167(2.198, 7.108)	14.154(5.460, 32.105)	–8.313	<0.001
HCY/HDL-C1	0.171(8.053, 13.407)	12.360(10.000, 16.037)	–4.780	<0.001

临床指标	单因素logistic回归分析	多因素logistic回归分析
年龄	0.918	18.597	2.505(1.650~3.802)	<0.001	0.658	10.863	1.931(1.306~2.857)	0.001
性别	0.977	20.182	2.656(1.734~4.068)	<0.001	0.472	3.873	1.603(1.002~2.566)	0.049
高血压	0.816	14.863	2.260(1.493~3.422)	<0.001	0.503	6.683	1.654(1.129~2.422)	0.010
糖尿病	1.067	13.897	2.906(1.659~5.093)	<0.001	0.544	5.286	1.723(1.084~2.740)	0.021
吸烟	1.008	21.592	2.741(1.791~4.193)	<0.001	0.760	11.193	2.138(1.370~3.337)	0.001
LVEF	–0.666	6.448	0.514(0.307~0.859)	0.011
WBC	0.558	7.123	1.747(1.160~2.630)	0.008
NE	0.391	3.532	1.478(0.983~2.221)	0.060
HDL-C	–0.692	10.620	0.500(0.330~0.759)	0.001
ApoA-1	–0.836	14.796	0.433(0.283~0.664)	<0.001
Scr	0.608	8.423	1.837(1.218~2.771)	0.004
α₁-MG	0.528	6.376	1.695(1.125~2.554)	0.012
CAR×100	0.916	18.656	2.500(1.650~3.790)	<0.001	0.800	16.605	2.226(1.515~3.271)	<0.001
HCY/HDL-C	1.026	22.656	2.791(1.829~4.259)	<0.001	0.469	5.352	1.599(1.074~2.379)	0.021

临床指标	单因素logistic回归分析	多因素logistic回归分析
年龄	0.918	18.597	2.505(1.650~3.802)	<0.001	0.658	10.863	1.931(1.306~2.857)	0.001
性别	0.977	20.182	2.656(1.734~4.068)	<0.001	0.472	3.873	1.603(1.002~2.566)	0.049
高血压	0.816	14.863	2.260(1.493~3.422)	<0.001	0.503	6.683	1.654(1.129~2.422)	0.010
糖尿病	1.067	13.897	2.906(1.659~5.093)	<0.001	0.544	5.286	1.723(1.084~2.740)	0.021
吸烟	1.008	21.592	2.741(1.791~4.193)	<0.001	0.760	11.193	2.138(1.370~3.337)	0.001
LVEF	–0.666	6.448	0.514(0.307~0.859)	0.011
WBC	0.558	7.123	1.747(1.160~2.630)	0.008
NE	0.391	3.532	1.478(0.983~2.221)	0.060
HDL-C	–0.692	10.620	0.500(0.330~0.759)	0.001
ApoA-1	–0.836	14.796	0.433(0.283~0.664)	<0.001
Scr	0.608	8.423	1.837(1.218~2.771)	0.004
α₁-MG	0.528	6.376	1.695(1.125~2.554)	0.012
CAR×100	0.916	18.656	2.500(1.650~3.790)	<0.001	0.800	16.605	2.226(1.515~3.271)	<0.001
HCY/HDL-C	1.026	22.656	2.791(1.829~4.259)	<0.001	0.469	5.352	1.599(1.074~2.379)	0.021

变量	单因素logistic回归分析	多因素logistic回归分析
年龄	0.946	17.339	2.575(1.650~4.020)	<0.001	0.859	9.219	2.360(1.356~4.107)	0.002
性别	0.637	5.681	1.891(1.120~3.195)	0.017	0.714	4.740	2.042(1.074~3.883)	0.029
高血压	0.698	9.205	2.010(1.280~3.156)	0.002	0.645	5.321	1.906(1.102~3.296)	0.021
糖尿病	0.672	7.731	1.957(1.219~3.142)	0.005
心衰	1.872	13.628	6.498(2.406~17.553)	<0.001
吸烟	0.620	7.447	1.753(1.191~2.903)	0.006
LVEF	–0.957	14.602	0.384(0.235~0.627)	<0.001	–0.795	7.222	0.452(0.253~0.806)	0.007
WBC	0.866	14.677	2.377(1.526~3.703)	<0.001
NE	0.866	14.677	2.377(1.526~3.703)	<0.001	0.645	5.308	1.906(1.101~3.299)	0.021
ApoA-1	–0.513	5.298	0.599(0.387~0.927)	0.021
ApoB	0.443	3.973	1.557(1.007~2.406)	0.046
ALB	–0.709	9.989	0.492(0.317~0.764)	0.002
α₁-MG	0.518	5.320	1.679(1.081~2.608)	0.021
CAR	1.917	59.908	6.798(4.184~11.045)	<0.001	1.376	22.730	3.958(2.248~6.969)	<0.001
HCY/HDL-C	0.895	15.599	2.446(1.569~3.813)	<0.001	0.634	5.090	1.884(1.087~3.267)	0.024

变量	单因素logistic回归分析	多因素logistic回归分析
年龄	0.946	17.339	2.575(1.650~4.020)	<0.001	0.859	9.219	2.360(1.356~4.107)	0.002
性别	0.637	5.681	1.891(1.120~3.195)	0.017	0.714	4.740	2.042(1.074~3.883)	0.029
高血压	0.698	9.205	2.010(1.280~3.156)	0.002	0.645	5.321	1.906(1.102~3.296)	0.021
糖尿病	0.672	7.731	1.957(1.219~3.142)	0.005
心衰	1.872	13.628	6.498(2.406~17.553)	<0.001
吸烟	0.620	7.447	1.753(1.191~2.903)	0.006
LVEF	–0.957	14.602	0.384(0.235~0.627)	<0.001	–0.795	7.222	0.452(0.253~0.806)	0.007
WBC	0.866	14.677	2.377(1.526~3.703)	<0.001
NE	0.866	14.677	2.377(1.526~3.703)	<0.001	0.645	5.308	1.906(1.101~3.299)	0.021
ApoA-1	–0.513	5.298	0.599(0.387~0.927)	0.021
ApoB	0.443	3.973	1.557(1.007~2.406)	0.046
ALB	–0.709	9.989	0.492(0.317~0.764)	0.002
α₁-MG	0.518	5.320	1.679(1.081~2.608)	0.021
CAR	1.917	59.908	6.798(4.184~11.045)	<0.001	1.376	22.730	3.958(2.248~6.969)	<0.001
HCY/HDL-C	0.895	15.599	2.446(1.569~3.813)	<0.001	0.634	5.090	1.884(1.087~3.267)	0.024

参数	面积差异	标准误差	95%CI	Z	P
CAR vs HCY/HDL-C	0.071	0.0327	0.0069~0.1350	2.172	0.030
CAR vs CAR+HCY/HDL-C	0.038	0.0185	0.0015~0.0741	2.041	0.041
HCY/HDL-C vs CAR+HCY/HDL-C	0.109	0.0196	0.0704~0.1470	5.553	<0.001

参数	面积差异	标准误差	95%CI	Z	P
CAR vs HCY/HDL-C	0.071	0.0327	0.0069~0.1350	2.172	0.030
CAR vs CAR+HCY/HDL-C	0.038	0.0185	0.0015~0.0741	2.041	0.041
HCY/HDL-C vs CAR+HCY/HDL-C	0.109	0.0196	0.0704~0.1470	5.553	<0.001

血清CRP/白蛋白、HCY/HDL-C与冠状动脉病变程度的相关性分析

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吴祖飞 ¹ , 陈诗 ¹ , 刘叶红 ¹ , 苏文韬 ¹ , 宣诗怡 ¹ , 宗刚军 ¹^,² , 吴刚勇 ¹^,²^,^*

解放军医学杂志 | 临床研究 2021,46(7): 678-686

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解放军医学杂志 | 临床研究 2021, 46(7): 678-686

血清CRP/白蛋白、HCY/HDL-C与冠状动脉病变程度的相关性分析

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吴祖飞¹, 陈诗¹, 刘叶红¹, 苏文韬¹, 宣诗怡¹, 宗刚军¹^,², 吴刚勇¹^,²^,^*

作者信息

¹安徽医科大学无锡临床学院心内科，江苏无锡 214044

²解放军联勤保障部队第904医院心血管内科，江苏无锡 214044

吴祖飞，硕士研究生，主要从事心血管疾病方面的研究

通讯作者:

吴刚勇，E-mail：wuwangyi520@sina.com

Relationship between CRP/albumin, HCY/HDL-C and the severity of coronary artery disease

Zu-Fei Wu¹, Shi Chen¹, Ye-Hong Liu¹, Wen-Tao Su¹, Shi-Yi Xuan¹, Gang-Jun Zong¹^,², Gang-Yong Wu¹^,²^,^*

Affiliations

¹Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu 214044, China

²Department of Cardiology, the 904th Hospital of PLA Joint Logistics Support Force, Wuxi, Jiangsu 214044, China

出版时间: 2021-07-28 doi: 10.11855/j.issn.0577-7402.2021.07.07

文章导航

摘要

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目的探讨血清C反应蛋白/白蛋白比值(CRP/ALB，CAR)、同型半胱氨酸/高密度脂蛋白胆固醇比值(HCY/HDL-C)与冠状动脉病变程度的相关性。方法纳入2018年1月—2019年12月因胸痛症状在解放军联勤保障部队第904医院心内科行冠状动脉造影检查的患者577例，根据造影结果分为非冠心病组(n=245)与冠状动脉粥样硬化性心脏病组(冠心病组，n=332)；进一步将冠心病组分为两个亚组：冠状动脉轻度病变亚组(Gensini评分<30，n=183)、冠状动脉重度病变亚组(Gensini评分≥30，n=149)。检测各组患者的血清CRP、ALB、HCY、HDL-C等指标，计算CAR、HCY/HDL-C，并采用logistic回归分析、Pearson相关性分析及受试工作者特征曲线(ROC)分析冠心病及冠状动脉重度病变的独立危险因素。结果冠心病组患者的CAR、HCY/HDL-C明显高于非冠心病组，差异有统计学意义(P<0.05)。多因素logistic回归分析结果提示CAR、HCY/HDL-C、年龄、高血压、性别均是冠心病及冠状动脉重度病变的独立危险因素。Pearson相关性分析结果表明，CAR、HCY/HDL-C均与Gensini积分呈正相关(r=0.427，P<0.01；r=0.247，P<0.01)。ROC分析结果显示，CAR、HCY/HDL-C及两者联合均对冠状动脉重度病变有预测价值，且两因素联合预测冠状动脉重度病变的曲线下面积(AUC)高于任一单项指标，差异有统计学意义(P<0.05)。结论 CAR及HCY/HDL-C升高可预测冠状动脉重度病变，两者联合的诊断价值优于单项指标，可用于冠心病的诊断及病情评估。

关键词

同型半胱氨酸 / 高密度脂蛋白胆固醇 / C反应蛋白 / 白蛋白 / Gensini积分 / 冠心病

Abstract

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Objective To explore the correlation of the serum C-reactive protein/albumin ratio (CRP/ALB, CAR) and homocysteine/high-density lipoprotein cholesterol (HCY/HDL-C) to the morbid change of coronary artery disease. Methods A total of 577 patients who underwent coronary angiography in the Department of Cardiology of the 904th Hospital of PLA Joint Logistics Support Force from January 2018 to December 2019 were divided into two groups according to the results of coronary angiography: non-coronary heart group (n=245) and coronary atherosclerotic heart disease group (coronary heart disease group,n=332). The coronary heart disease group was further divided into two subgroups: mild coronary artery disease subgroup (Gensini score <30, n=183) and severe coronary artery disease subgroup (Gensini score ≥30, n=149). The serum levels of CRP, ALB, HCY,HDL-C and other indicators of patients in each group were detected, and CAR and HCY/HDL-C were calculated, and then the logistic regression analysis, Pearson correlation analysis and receiver operating characteristic (ROC) curve analysis were carried out to analyze the independent risk factors for coronary heart disease and severe coronary artery lesion. Results The levels of CAR and HCY/HDL-C were significantly higher in coronary heart disease group than those in non-coronary heart disease group with statistically significant difference (P<0.05). Multivariate logistic regression analysis showed that CAR, HCY/HDL-C, age, hypertension, and gender were the independent risk factors for coronary heart disease and severe coronary artery disease. Pearson correlation analysis showed that CAR and HCY/HDL-C were positively correlated with Gensini score (r=0.427, P<0.01; r=0.247,P<0.01). The results of ROC curve analysis showed that CAR, HCY/HDL-C and both their combination had predictive values for severe coronary heart disease, and the AUC of combined the both factors was statistically higher than that of any single factor alone(P<0.05). Conclusions Elevated levels of CAR and HCY/HDL-C may predict the severe coronary artery disease. The diagnostic value of combined the two factors is better than a single factor alone, so can be used for the diagnosis and condition evaluation of coronary artery disease.

Key words

homocysteine / high density lipoprotein cholesterol / C-reactive protein / albumin / Gensini score / coronary artery disease

引用本文

吴祖飞, 陈诗, 刘叶红, 苏文韬, 宣诗怡, 宗刚军, 吴刚勇. 血清CRP/白蛋白、HCY/HDL-C与冠状动脉病变程度的相关性分析. 解放军医学杂志, 2021 , 46 (7) : 678 -686 . DOI: 10.11855/j.issn.0577-7402.2021.07.07

Zu-Fei Wu, Shi Chen, Ye-Hong Liu, Wen-Tao Su, Shi-Yi Xuan, Gang-Jun Zong, Gang-Yong Wu. Relationship between CRP/albumin, HCY/HDL-C and the severity of coronary artery disease[J]. Medical Journal of Chinese People’s Liberation Army, 2021 , 46 (7) : 678 -686 . DOI: 10.11855/j.issn.0577-7402.2021.07.07

正文

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冠状动脉粥样硬化性心脏病(简称冠心病，CHD)是一种常见的心血管疾病，发病率及病死率均逐年增高，已成为全世界的首要死亡原因及最大的疾病负担。因此，早期识别冠心病并及早干预具有重要的社会价值。大量研究发现，冠状动脉粥样硬化是氧化应激、脂质沉积及炎症反应等相互作用的结果^[1-3]。大部分观点认为低密度脂蛋白胆固醇(LDL-C)及氧化型低密度脂蛋白(ox-LDL)可能在动脉内膜中积聚并激活主动免疫-炎症反应^[4]，从而导致动脉粥样硬化^[5]；然而也有很多临床研究结论相反，甚至指出LDL-C不是冠状动脉粥样硬化的独立危险因素^[6-7]。目前已经明确LDL-C对血管内皮的损伤作用，但临床上血清LDL-C水平与冠状动脉粥样硬化的病变程度并不平行，可能与LDL-C还受到同型半胱氨酸(HCY)及高密度脂蛋白胆固醇(HDL-C)的影响有关。高HCY血症在动脉粥样硬化形成的每个阶段如内皮损伤、ox-LDL形成、泡沫细胞形成及斑块形成中均起着重要作用^[8]，HCY可增强金属氧化酶催化的LDL-C的氧化^[9-11]，使诱导型一氧化氮合酶(iNOS)和髓过氧化物酶(MPO)的产生增加，间接导致ox-LDL增加^[12]，因此HCY在一定程度上可促进LDL-C对血管内皮细胞的损伤作用。HDL-C具有抗炎、抗血栓和抗氧化的特性，可直接拮抗ox-LDL对内皮细胞和血管平滑肌细胞的影响，并通过对氧磷酶1(PON1)发挥抗氧化作用^[13]。而HCY能够抑制PON1，从而拮抗HDL-C的血管保护作用^[14]。因此，从理论上说，HCY/HDL-C可在一定程度上反映体内氧化应激、脂质代谢紊乱对血管内皮的损伤情况。C反应蛋白(CRP)作为一种炎症标记物，与冠心病的发生发展密切相关^[15-16]；体内炎症反应可消耗白蛋白，而血清白蛋白水平与冠状动脉病变程度及初发急性心肌梗死的风险呈负相关^[17]。故CRP与白蛋白的比值(CRP/ALB，CAR)能更好地反映CHD病程中的炎症因素作用^[7]。然而，目前国内外对于CAR、HCY/HDL-C与冠状动脉病变程度相关性的研究较少，尤其两者联合应用对冠状动脉重度狭窄的诊断效能如何尚未见相关报道。因此，本研究以Gensini积分为冠状动脉病变程度的评估标准，通过分析CAR、HCY/HDL-C与Gensini积分的相关性，探讨CAR、HCY/HDL-C以及两者联合应用对冠状动脉病变程度的评估价值。

1 资料与方法

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1.1 一般资料

纳入2018年1月—2019年12月因胸痛在解放军联勤保障部队第904医院心内科住院的共1101例进行回顾性分析。本研究经解放军联勤保障部队第904医院伦理委员会批准。诊断标准：不稳定性心绞痛的诊断参照《不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南》^[18]，房颤的诊断依据2010年欧洲ESC诊疗指南^[19]，心力衰竭的诊断符合2018年中国心力衰竭诊断和治疗指南的标准^[20]。根据WHO冠心病诊断指南，以任一主要冠状动脉如左主干、左前降支、左回旋支、右冠状动脉或其主要分支(对角支、钝缘支、左室后支、后降支)狭窄≥50%作为冠心病的诊断标准。纳入标准：(1)年龄37~85岁，因胸痛入院行冠状动脉造影检查；(2)神智清楚，能自然交流沟通，无严重神经及精神类疾病。所有受试者入院后均规范服用阿司匹林、替格瑞洛/氯吡格雷双抗治疗。排除标准：(1)ST段抬高型心肌梗死，既往有陈旧性心肌梗死、冠状动脉介入治疗、冠状动脉旁路移植术病史的患者；(2)半年内存在急性脑梗死的患者；(3)伴有肺梗死、主动脉夹层、急慢性肾炎及其他系统病变者；(4)合并血液系统疾病、恶性肿瘤或自身免疫性疾病；(5)合并急慢性感染性疾病。最终纳入577例，其中男404例，女173例，年龄(63.1±9.6)岁。

1.2 方法

1.2.1 资料收集

收集所有患者入院时的临床资料，包括年龄、性别、高血压、糖尿病、吸烟及饮酒情况等。所有患者入院后清晨空腹时采集肘静脉血检测血常规，包括血红蛋白(HGB)、血小板计数(PLT)、白细胞计数(WBC)、中性粒细胞计数(NE)、淋巴细胞计数(LY)等，采用全自动生化仪(美国Beckman公司)检测总胆固醇(TC)、三酰甘油(TG)、LDL-C、HDL-C、ApoA-1、ApoB、HCY、胱抑素C(CysC)、CRP、白蛋白(ALB)、血肌酐(Scr)、尿酸(UA)、β₂微球蛋白(β₂-MG)、α₁微球蛋白(α₁-MG)等，并计算CAR、HCY/HDL-C。采用西门子彩色多普勒超声(G603，探头频率3~4 MHz)测定所有患者的左室射血分数(LVEF)。

1.2.2 Gensini积分评定

冠状动脉造影检查均于入院3 d内完成，并由至少两名经验丰富的高级职称医师评估冠状动脉病变情况。Gensini积分评定标准：(1)将病变血管分为左主干、左前降支、回旋支和右冠状动脉，对每支血管病变程度进行定量评定，无任何异常计为0分，狭窄≤25%计1分，26%~50%计2分，51%~75%计4分，76%~90%计8分，91%~99%计16分，100%计32分；(2)不同节段冠状动脉得分乘以相应系数：左主干病变得分×5；左前降支近段×2.5，中段得分×1.5，远段得分×1；第1对角支×1；第2对角支×0.5；左回旋支近段×2.5，远段、钝圆支及后降支均×1，左室后侧支×0.5；右冠近、中、远段和后降支均×1；(3)取各支积分之和即为每例患者冠状动脉病变程度的最终积分^[21]。

1.2.3 患者分组

依据冠脉造影结果，将所有患者分为非冠心病组(n=245)与冠心病组(n=332)；按照冠状动脉病变程度进一步将冠心病组分为两个亚组：冠状动脉轻度病变组(Gensini评分<30，n=183)、冠状动脉重度病变组(Gensini评分≥30，n=149)。

1.3 统计学处理

采用SPSS 20.0软件进行统计分析。计量资料符合正态分布的以$\bar{x}±s$表示，不符合正态分布的以[M(Q₁，Q₃)]表示，正态分布的样本两组间比较采用完全随机设计独立样本t检验或单因素方差分析，非正态分布的样本两组间比较采用两样本Mann-Whitney U检验。计数资料以例(%)表示，两组间比较采用χ²检验。将一般资料中连续性变量进行二分类后纳入单因素logistic回归分析，以P<0.05为标准筛选出相关影响因素后纳入多因素logistic二元回归分析以筛选冠状动脉病变及冠状动脉重度病变的独立危险因素。采用Pearson相关分析检验评估CAR、HCY/HDL-C与Gensini积分的相关性。根据患者的CAR和HCY/HDL-C，应用MedCalc 15.2.2统计软件生成受试者工作特征(ROC)曲线，采用DeLong-DeLong非参数法比较各自的ROC曲线下面积(AUC)，分析CAR及HCY/HDL-C对冠状动脉重度病变的预测价值，并采用Z检验比较AUC是否有统计学差异。P<0.05为差异有统计学意义。

2 结果

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2.1

一般资料比较，与非冠心病组比较，冠心病组男性患者多，年龄大，吸烟人数多，合并高血压、糖尿病比例高，LVEF、血清HDL-C、ApoA-1、ALB水平明显降低(P<0.05)，白细胞(WBC)、中性粒细胞计数(NE)、HCY、胱抑素C、CRP、Scr、β₂-MG、α₁-MG、CAR、HCY/HDL-C均明显升高(P<0.05)(表1)。与冠状动脉轻度病变组比较，冠状动脉重度病变组中男性及高龄患者多，合并高血压、糖尿病、心力衰竭比例高，吸烟的人数多，LVEF、血清HDL-C、ApoA-1、ALB水平低(P<0.05)，WBC、NE、LDL-C、ApoB、HCY、CRP、β₂-MG、CAR、HCY/HDL-C明显升高(P<0.05)(表2)。

2.2 冠心病的影响因素

2.2.1 单因素logistic回归分析冠心病的影响因素

将冠心病组与非冠心病组间一般资料差异有统计学意义(P<0.2)的因素纳入单因素logistic回归分析，结果显示，年龄、性别、高血压、糖尿病、吸烟、LVEF、WBC、NE、HDL-C、ApoA-1、Scr、α₁-MG、CRP、HCY、CAR、HCY/HDL-C是冠状动脉病变的预测因素(P<0.05，表3)。

2.2.2 多因素logistic回归分析影响冠状动脉病变的独立相关因素

将单因素logistic回归分析中差异有统计学意义(P<0.05)的因素两两进行Pearson相关性分析后纳入多因素logistic回归分析。因CRP与CAR存在高度线性相关(r=0.996，P<0.01)、HCY与HCY/HDL-C存在高度线性相关(r=0.884，P<0.01)，且本文主要研究CAR、HCY/HDL-C，故剔除CRP、HCY后行共线性分析，提示WBC、NE、HDL-C、APoA-1、Scr、α₁-MG、CAR、HCY/HDL-C等因素方差膨胀因子均<10，容忍度>0.1，故将其纳入多因素logistic回归分析，结果显示，年龄、性别、高血压、糖尿病、吸烟、CAR(OR=2.226，95%CI 1.515~3.271，P<0.01)、HCY/HDL-C(OR=1.599，95%CI 1.074~2.379，P=0.021)为冠心病的独立预测因素(表3)。

2.3 冠心病病变程度的影响因素

2.3.1 单因素logistic回归分析冠心病病变程度的影响因素

将冠状动脉轻度病变亚组与冠状动脉重度病变亚组间一般资料差异有统计学意义(P<0.2)的因素纳入单因素logistic回归分析，结果显示，年龄、性别、高血压、糖尿病、心力衰竭、吸烟、LVEF、WBC、NE、ApoA-1、ApoB、ALB、CRP、HCY、α₁-MG、CAR、HCY/HDL-C是冠状动脉病变程度的预测因素(P<0.05，表4)。

2.3.2 多因素logistic回归分析影响冠心病病变程度的相关因素

将单因素logistic回归分析结果有意义的因素两两进行Pearson相关性分析后纳入多因素logistic回归分析模型。因CRP与CAR存在高度线性相关、HCY与HCY/HDL存在高度线性相关，且ROC曲线面积显示CAR、HCY/HDL-C对冠状动脉重度病变诊断效能分别优于CRP、HCY，剔除CRP、HCY后行共线性诊断提示LVEF、WBC、NE、ApoA-1、ApoB、ALB、α₁-MG、CAR、HCY/HDL-C等参数方差膨胀因子均小于10，容忍度大于0.1，故将其纳入多因素logistic回归分析，结果显示，年龄、性别、高血压、LVEF、NE、CAR(OR=3.958，95%CI 2.248~6.969，P<0.01)、HCY/HDL-C(OR=1.884，95%CI 1.087~3.267，P<0.01)为冠心病病变程度的独立预测因素(表4)。

2.4 CAR、HCY/HDL-C与Gensini积分的相关性

Person相关性分析结果显示，CAR、HCY/HDL-C与Gensini积分呈正相关(r=0.427、r=0.247，P<0.01)。CAR、HCY/HDL-C越大，Gensini积分越高，则患者的冠状动脉病变程度越重(图1)。

2.5 ROC曲线分析CAR、HCY/HDL-C及两者联合对冠状动脉病变程度的预测价值

采用ROC曲线评估CAR、HCY/HDL-C及两者联合对冠状动脉重度病变的预测价值，并对曲线下面积(AUC)进行比较。结果显示，CAR×100取界值6.5506时，对冠状动脉重度病变的预测效能最高，敏感度为69.9%，特异度为78.8%，AUC=0.783，95%CI为0.737~0.829，P<0.01；HCY/HDL-C取界值9.7253时，敏感度为79.1%，特异度为53.5%，AUC=0.712，95%CI为0.668~0.757，P<0.01；两者联合(AUC=0.821，95%CI 0.787~0.852，P<0.01)能更好地预测冠状动脉重度病变(图2)，且CAR与HCY/HDL-C两者联合对冠状动脉重度病变的判断能力均优于单一指标的预测能力[CAR(Z=2.041，P=0.041)，HCY/HDL-C(Z=5.553，P<0.01)]，且差异有统计学意义(表5)。

3 讨论

收起

冠状动脉粥样硬化的危险因素主要是血脂异常和体内由各种炎性因子介导的炎症反应^[22]。炎症反应在冠状动脉粥样硬化发生发展的各阶段都发挥着重要作用，多种炎症反应标志物与不稳定性心绞痛、非ST段抬高型心肌梗死的发生、发展密切相关^[23-24]。目前国内外越来越多的研究表明，急性时相蛋白CRP对血管内皮细胞具有促炎症作用，在冠状动脉粥样硬化的发生发展中起着重要作用^[25]。Fairclough等^[26]提出CAR评估入院患者预后的准确性高于CRP和白蛋白。Tanriverdi等^[27]在比较了CAR与其他炎性标记物在稳定型心绞痛患者中的诊断价值，发现CAR检测冠心病(有意义病变)的诊断价值最强。本研究以目前常用的客观反映冠状动脉病变程度的Gensini评分为验证标准，进一步证实了CAR能准确地评估冠状动脉病变及其严重程度，是冠状动脉重度病变的独立预测因子，进一步丰富了CAR在冠状动脉病变病情评估中的应用。

HCY水平升高与心血管疾病和动脉粥样硬化的风险增加有关^[28]。HCY的致病作用与其产生超氧离子和过氧化氢的能力有关，后者可促进LDL-C脂质过氧化^[10]及对动脉内皮的损伤^[29]。高HCY血症还可增强巨噬细胞内ox-LDL的清道夫受体CD36的表达，导致泡沫细胞的形成^[30]。HDL-C是冠心病的一个独立的保护因素，能直接拮抗ox-LDL对内皮细胞和血管平滑肌细胞的影响^[31]，其抗氧化能力主要归因于与HDL-C相关的蛋白，如PON1、ApoA-1等。PON1蛋白能预防LDL-C的氧化修饰和随后的动脉粥样硬化病变的形成^[32]。HCY可抑制PON1的活性，使HDL-C失去抗氧化和抗毒性等心血管保护作用，在冠状动脉粥样硬化形成中起促进作用^[24]。Liao等^[33]发现，高HCY血症可通过抑制ApoA-1蛋白的合成和促进HDL-C的清除来减少循环HDL-C，抑制胆固醇的反向转运。很多研究表明，男性冠心病患者血浆HCY浓度升高与HDL-C水平降低有关^[14,34-35]。上述研究结果表明，冠心病患者血浆HCY水平与HDL-C呈负相关，且高HCY血症可以促进HDL-C的清除，降低血浆HDL-C水平，故HCY/HDL-C能够在一定程度上反映冠心病患者体内脂代谢紊乱及LDL-C对血管内皮的损伤情况。

既往Afrasyap等^[36]报道HCY/HDL-C与冠心病的发生呈正相关，与闭塞血管数目相关但差异无统计学意义，但并未就HCY/HDL-C是否为冠状动脉狭窄的独立危险因素做进一步分析。本研究探讨了HCY/HDL-C与冠状动脉病变严重程度的关系，采用Gensini积分量化评估了冠状动脉狭窄程度，发现冠心病组HCY/HDL-C明显高于冠状动脉正常组，且冠状动脉重度病变组HCY/HDL-C明显高于冠状动脉轻度病变组，差异有统计学意义，多因素logistic回归分析及ROC曲线分析结果均支持HCY/HDL-C对冠状动脉病变的判断价值。本研究结论之所以与Afrasyap等^[36]的研究结论不完全一致，不排除与他们的研究样本量过小及缺乏量化指标对比等因素有关。

本研究从冠心病发病机制的角度，联合炎症与脂质代谢紊乱两个冠心病危险因素预测冠状动脉病变程度，相较于大多数研究中单个发病机制多指标联合来说可能更为敏感、准确。多因素logistic回归分析结果表明，CAR、HCY/HDL-C不仅是冠心病的独立预测因素，也是冠状动脉重度病变的独立预测因素，提示CAR、HCY/HDL-C在冠心病的发生、发展中均起着重要作用；ROC曲线分析结果显示CAR与HCY/HDL-C联合应用时较单一指标对冠状动脉重度病变的预测价值更高，同样也说明了联合CAR与HCY/HDL-C，从冠心病发病机制的角度去预测冠状动脉病变程度更具指导意义，可提高临床诊断价值。尤其是对于没有能力行冠状动脉造影检查的基层医院，采用CAR与HCY/HDL-C联合诊断，有助于早期识别冠心病高危患者，强化药物治疗或转上级医院进一步诊治，对于降低冠心病发病率及病死率具有十分重要的意义。

本研究的不足之处包括：(1)主要使用Gensini积分评价冠冠状动脉病变情况，未包括分支病变、扭曲病变及钙化病变等特征，相较于SYNTAX评分系统具有一定的局限性；(2)CRP、ALB、HCY、HDL-C均为术前单次血样检测结果，未进行动态检测，患者进行血运重建如PCI或CABG后，CAR、HCY/HDL-C比值是否会发生相应变化值得进一步关注；(3)病例样本数较少，仍需更多大样本量、多中心研究来进一步探讨CAR、HCY/HDL-C与冠状动脉病变程度之间的关系。

总之，CAR与HCY/HDL-C在一定程度上分别反映了患者体内的炎症反应和血脂代谢异常，能够较好地预测冠状动脉病变及其严重程度，两者联合应用的诊断价值更高，对冠心病的临床诊疗具有一定的指导意义。

基金

收起

江苏省自然科学基金面上项目(BK20201139)
无锡市科技局医疗与公众健康技术创新应用项目(N20202035)

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2021年第46卷第7期

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doi: 10.11855/j.issn.0577-7402.2021.07.07

接收时间：2021-04-25
首发时间：2025-12-20
出版时间：2021-07-28

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出版历史

收稿日期：2021-04-25
修回日期：2021-06-26

基金

Natural Science Foundation of Jiangsu Province(BK20201139)

江苏省自然科学基金面上项目(BK20201139)

Medical and Public Health Technology Innovation Application Project of Wuxi Science and Technology Bureau(N20202035)

无锡市科技局医疗与公众健康技术创新应用项目(N20202035)

作者信息

¹安徽医科大学无锡临床学院心内科，江苏无锡 214044

²解放军联勤保障部队第904医院心血管内科，江苏无锡 214044

通讯作者:

吴刚勇，E-mail：wuwangyi520@sina.com

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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临床指标	非冠心病组(n=245)	冠心病组(n=332)	χ²/t/Z	P
男性[例(%)]	130(53.1)	251(75.6)	31.934	<0.001
高血压[例(%)]	102(41.6)	197(59.3)	17.699	<0.001
糖尿病[例(%)]	40(16.3)	101(30.4)	15.168	<0.001
吸烟[例(%)]	84(34.3)	190(57.2)	30.534	<0.001
年龄(岁，$\bar{x}±s$)	60.5±9.7	65.0±9.1	–5.726	<0.001
心力衰竭[例(%)]	14(5.7)	28(8.43)	1.545	0.214
房颤[例(%)]	21(8.6)	20(6.02)	1.386	0.239
LVEF[%, M(Q₁, Q₃)]	61(60,62)	60.0(58.0, 62.0)	–3.147	0.002
HGB[g/L, M(Q₁, Q₃)]	139.0(127.0,151.0)	140.0(129.3, 153.0)	–1.769	0.077
PLT[×10⁹/L, M(Q₁, Q₃)]	192.0(162.0,232.0)	197.0(165.0, 238.0)	–1.682	0.093
WBC[×10⁹/L, M(Q₁, Q₃)]	5.730(4.900,6.960)	6.605(5.499, 8.118)	–5.525	<0.001
NE[×10⁹/L, M(Q₁, Q₃)]	3.530(2.730,4.550)	4.005(3.130, 5.378)	–4.580	<0.001
LY[×10⁹/L, M(Q₁, Q₃)]	1.720(1.350,2.100)	1.710(1.320, 2.133)	–0.111	0.911
TC[mmol/L, M(Q₁, Q₃)]	4.220(3.630,4.920)	4.290(3.605, 4.890)	–0.314	0.753
TG[mmol/L, M(Q₁, Q₃)]	1.460(0.980,2.220)	1.415(0.963, 2.138)	–0.170	0.865
LDL-C[mmol/L, M(Q₁, Q₃)]	2.300(1.690,2.850)	2.355(1.820, 2.850)	–1.307	0.191
HDL-C[mmol/L, M(Q₁, Q₃)]	1.150(1.00,1.380)	1.075(0.950, 1.238)	–4.173	<0.001
ApoA-1[g/L, M(Q₁, Q₃)]	1.030(0.940,1.260)	1.000(0.870, 1.078)	–5.578	<0.001
ApoB[g/L, M(Q₁, Q₃)]	0.750(0.600,0.930)	0.780(0.603, 0.928)	–1.650	0.099
HCY[μmol/L, M(Q₁, Q₃)]	10.60(8.70,12.60)	12.20(9.93, 14.40)	–5.658	<0.001
CysC[mg/L, M(Q₁, Q₃)]	0.890(0.780,0.990)	0.920(0.810, 1.070)	–2.384	0.017
CRP[mg/dl, M(Q₁, Q₃)]	1.20(0.70,2.30)	2.10(1.00, 6.48)	–6.673	<0.001
ALB[mg/dl, M(Q₁, Q₃)]	39.30(37.40,41.50)	38.70(36.10, 41.00)	–2.704	0.007
Scr[mg/dl, M(Q₁, Q₃)]	68.0(58.0,78.0)	72.0(63.0, 83.0)	–3.378	0.001
UA[μmol/L, M(Q₁, Q₃)]	363.0(300.0,433.0)	366.5(305.0, 441.8)	–1.040	0.298
β₂-MG[mg/L, M(Q₁, Q₃)]	1.84(1.49,2.27)	1.97(1.65, 2.47)	–2.547	0.011
α₁-MG[mg/L, M(Q₁, Q₃)]	27.0(23.0,30.0)	28.0(24.0, 33.0)	–2.652	0.008
CAR×100	3.061(1.828,5.959)	5.495(2.566, 17.125)	–6.768	<0.001
HCY/HDL-C	9.158(6.812,12.261)	11.267(8.976, 14.862)	–6.568	<0.001

临床指标

非冠心病组(n=245)

冠心病组(n=332)

χ²/t/Z

男性[例(%)]

130(53.1)

251(75.6)

31.934

<0.001

高血压[例(%)]

102(41.6)

197(59.3)

17.699

<0.001

糖尿病[例(%)]

40(16.3)

101(30.4)

15.168

<0.001

吸烟[例(%)]

84(34.3)

190(57.2)

30.534

<0.001

年龄(岁，$\bar{x}±s$)

60.5±9.7

65.0±9.1

–5.726

<0.001

心力衰竭[例(%)]

14(5.7)

28(8.43)

1.545

0.214

房颤[例(%)]

21(8.6)

20(6.02)

1.386

0.239

LVEF[%, M(Q₁, Q₃)]

61(60,62)

60.0(58.0, 62.0)

–3.147

0.002

HGB[g/L, M(Q₁, Q₃)]

139.0(127.0,151.0)

140.0(129.3, 153.0)

–1.769

0.077

PLT[×10⁹/L, M(Q₁, Q₃)]

192.0(162.0,232.0)

197.0(165.0, 238.0)

–1.682

0.093

WBC[×10⁹/L, M(Q₁, Q₃)]

5.730(4.900,6.960)

6.605(5.499, 8.118)

–5.525

<0.001

NE[×10⁹/L, M(Q₁, Q₃)]

3.530(2.730,4.550)

4.005(3.130, 5.378)

–4.580

<0.001

LY[×10⁹/L, M(Q₁, Q₃)]

1.720(1.350,2.100)

1.710(1.320, 2.133)

–0.111

0.911

TC[mmol/L, M(Q₁, Q₃)]

4.220(3.630,4.920)

4.290(3.605, 4.890)

–0.314

0.753

TG[mmol/L, M(Q₁, Q₃)]

1.460(0.980,2.220)

1.415(0.963, 2.138)

–0.170

0.865

LDL-C[mmol/L, M(Q₁, Q₃)]

2.300(1.690,2.850)

2.355(1.820, 2.850)

–1.307

0.191

HDL-C[mmol/L, M(Q₁, Q₃)]

1.150(1.00,1.380)

1.075(0.950, 1.238)

–4.173

<0.001

ApoA-1[g/L, M(Q₁, Q₃)]

1.030(0.940,1.260)

1.000(0.870, 1.078)

–5.578

<0.001

ApoB[g/L, M(Q₁, Q₃)]

0.750(0.600,0.930)

0.780(0.603, 0.928)

–1.650

0.099

HCY[μmol/L, M(Q₁, Q₃)]

10.60(8.70,12.60)

12.20(9.93, 14.40)

–5.658

<0.001

CysC[mg/L, M(Q₁, Q₃)]

0.890(0.780,0.990)

0.920(0.810, 1.070)

–2.384

0.017

CRP[mg/dl, M(Q₁, Q₃)]

1.20(0.70,2.30)

2.10(1.00, 6.48)

–6.673

<0.001

ALB[mg/dl, M(Q₁, Q₃)]

39.30(37.40,41.50)

38.70(36.10, 41.00)

–2.704

0.007

Scr[mg/dl, M(Q₁, Q₃)]

68.0(58.0,78.0)

72.0(63.0, 83.0)

–3.378

0.001

UA[μmol/L, M(Q₁, Q₃)]

363.0(300.0,433.0)

366.5(305.0, 441.8)

–1.040

0.298

β₂-MG[mg/L, M(Q₁, Q₃)]

1.84(1.49,2.27)

1.97(1.65, 2.47)

–2.547

0.011

α₁-MG[mg/L, M(Q₁, Q₃)]

27.0(23.0,30.0)

28.0(24.0, 33.0)

–2.652

0.008

CAR×100

3.061(1.828,5.959)

5.495(2.566, 17.125)

–6.768

<0.001

HCY/HDL-C

9.158(6.812,12.261)

11.267(8.976, 14.862)

–6.568

<0.001

临床指标	冠状动脉轻度病变组(n=183)	冠状动脉重度病变组(n=149)	χ²/t/Z	P
男性[例(%)]	129(70.5)	122(81.9)	5.774	0.016
高血压[例(%)]	95(51.9)	102(68.5)	9.316	0.002
糖尿病[例(%)]	44(24.0)	57(38.3)	7.836	0.005
吸烟[例(%)]	93(50.8)	98(65.8)	7.515	0.006
心力衰竭[例(%)]	5(2.7)	23(15.4)	17.164	<0.001
房颤[例(%)]	9(4.9)	11(7.4)	0.881	0.348
年龄(岁，$\bar{x}±s$)	62.2±8.2	68.6±8.9	–6.831	<0.001
LVEF[%, M(Q₁, Q₃)]	60.0(60.0, 62.0)	60.0(58.0, 62.0)	–2.984	0.003
HGB[g/L, M(Q₁, Q₃)]	142.0(130.0, 154.0)	139.0(127.0, 151.0)	–1.569	0.117
PLT[×10⁹/L, M(Q₁, Q₃)]	193.0(160.0, 234.0)	202.0(172.0, 245.0)	–1.801	0.072
WBC[×10⁹/L, M(Q₁, Q₃)]	6.270(5.230, 7.340)	7.060(5.980, 9.245)	–5.153	<0.001
NE[×10⁹/L, M(Q₁, Q₃)]	3.660(2.920, 4.640)	4.470(3.540, 6.460)	–5.157	<0.001
LY[×10⁹/L, M(Q₁, Q₃)]	1.680(1.300, 2.100)	1.750(1.350, 2.170)	–0.639	0.523
TC[mmol/L, M(Q₁, Q₃)]	4.290(3.630, 4.880)	4.320(3.590, 5.035)	–0.933	0.351
TG[mmol/L, M(Q₁, Q₃)]	1.390(0.900, 2.190)	1.470(0.995, 2.055)	–0.360	0.719
LDL-C[mmol/L, M(Q₁, Q₃)]	2.300(1.720, 2.800)	2.480(1.835, 3.045)	–2.202	0.028
HDL-C[mmol/L, M(Q₁, Q₃)]	1.100(0.960, 1.290)	1.060(0.920, 1.175)	–2.592	0.010
ApoA-1[g/L, M(Q₁, Q₃)]	1.010(0.900, 1.130)	0.960(0.820, 1.040)	–3.740	<0.001
ApoB[g/L, M(Q₁, Q₃)]	0.750(0.600, 0.880)	0.820(0.640, 0.995)	–3.045	0.002
HCY[μmol/L, M(Q₁, Q₃)]	11.40(9.40, 13.60)	12.50(11.00, 16.10)	–3.966	<0.001
CysC[mg/L, M(Q₁, Q₃)]	0.900(0.810, 1.060)	0.950(0.810, 1.100)	–1.242	0.214
CRP[mg/dl, M(Q₁, Q₃)]	1.60(0.90, 2.80)	5.20(2.05, 12.15)	–8.113	<0.001
ALB[mg/dl, M(Q₁, Q₃)]	39.30(36.70, 41.40)	37.70(35.60, 40.60)	–3.438	0.001
Scr[mg/dl, M(Q₁, Q₃)]	72.0(62.0, 81.0)	73.0(64.0, 84.0)	–0.864	0.388
UA[μmol/L, M(Q₁, Q₃)]	362.0(307. 0,429.0)	374.0(303.0, 446.0)	–0.713	0.476
β₂-MG[mg/L, M(Q₁, Q₃)]	1.94(1.57, 2.39)	2.05(1.66, 2.70)	–2.104	0.035
α₁-MG[mg/L, M(Q₁, Q₃)]	27.0(24.0, 32.0)	28.0(25.0, 34.0)	–1.741	0.082
CAR×100	4.167(2.198, 7.108)	14.154(5.460, 32.105)	–8.313	<0.001
HCY/HDL-C1	0.171(8.053, 13.407)	12.360(10.000, 16.037)	–4.780	<0.001

临床指标

冠状动脉轻度病变组(n=183)

冠状动脉重度病变组(n=149)

χ²/t/Z

男性[例(%)]

129(70.5)

122(81.9)

5.774

0.016

高血压[例(%)]

95(51.9)

102(68.5)

9.316

0.002

糖尿病[例(%)]

44(24.0)

57(38.3)

7.836

0.005

吸烟[例(%)]

93(50.8)

98(65.8)

7.515

0.006

心力衰竭[例(%)]

5(2.7)

23(15.4)

17.164

<0.001

房颤[例(%)]

9(4.9)

11(7.4)

0.881

0.348

年龄(岁，$\bar{x}±s$)

62.2±8.2

68.6±8.9

–6.831

<0.001

LVEF[%, M(Q₁, Q₃)]

60.0(60.0, 62.0)

60.0(58.0, 62.0)

–2.984

0.003

HGB[g/L, M(Q₁, Q₃)]

142.0(130.0, 154.0)

139.0(127.0, 151.0)

–1.569

0.117

PLT[×10⁹/L, M(Q₁, Q₃)]

193.0(160.0, 234.0)

202.0(172.0, 245.0)

–1.801

0.072

WBC[×10⁹/L, M(Q₁, Q₃)]

6.270(5.230, 7.340)

7.060(5.980, 9.245)

–5.153

<0.001

NE[×10⁹/L, M(Q₁, Q₃)]

3.660(2.920, 4.640)

4.470(3.540, 6.460)

–5.157

<0.001

LY[×10⁹/L, M(Q₁, Q₃)]

1.680(1.300, 2.100)

1.750(1.350, 2.170)

–0.639

0.523

TC[mmol/L, M(Q₁, Q₃)]

4.290(3.630, 4.880)

4.320(3.590, 5.035)

–0.933

0.351

TG[mmol/L, M(Q₁, Q₃)]

1.390(0.900, 2.190)

1.470(0.995, 2.055)

–0.360

0.719

LDL-C[mmol/L, M(Q₁, Q₃)]

2.300(1.720, 2.800)

2.480(1.835, 3.045)

–2.202

0.028

HDL-C[mmol/L, M(Q₁, Q₃)]

1.100(0.960, 1.290)

1.060(0.920, 1.175)

–2.592

0.010

ApoA-1[g/L, M(Q₁, Q₃)]

1.010(0.900, 1.130)

0.960(0.820, 1.040)

–3.740

<0.001

ApoB[g/L, M(Q₁, Q₃)]

0.750(0.600, 0.880)

0.820(0.640, 0.995)

–3.045

0.002

HCY[μmol/L, M(Q₁, Q₃)]

11.40(9.40, 13.60)

12.50(11.00, 16.10)

–3.966

<0.001

CysC[mg/L, M(Q₁, Q₃)]

0.900(0.810, 1.060)

0.950(0.810, 1.100)

–1.242

0.214

CRP[mg/dl, M(Q₁, Q₃)]

1.60(0.90, 2.80)

5.20(2.05, 12.15)

–8.113

<0.001

ALB[mg/dl, M(Q₁, Q₃)]

39.30(36.70, 41.40)

37.70(35.60, 40.60)

–3.438

0.001

Scr[mg/dl, M(Q₁, Q₃)]

72.0(62.0, 81.0)

73.0(64.0, 84.0)

–0.864

0.388

UA[μmol/L, M(Q₁, Q₃)]

362.0(307. 0,429.0)

374.0(303.0, 446.0)

–0.713

0.476

β₂-MG[mg/L, M(Q₁, Q₃)]

1.94(1.57, 2.39)

2.05(1.66, 2.70)

–2.104

0.035

α₁-MG[mg/L, M(Q₁, Q₃)]

27.0(24.0, 32.0)

28.0(25.0, 34.0)

–1.741

0.082

CAR×100

4.167(2.198, 7.108)

14.154(5.460, 32.105)

–8.313

<0.001

HCY/HDL-C1

0.171(8.053, 13.407)

12.360(10.000, 16.037)

–4.780

<0.001

临床指标	单因素logistic回归分析	多因素logistic回归分析
年龄	0.918	18.597	2.505(1.650~3.802)	<0.001	0.658	10.863	1.931(1.306~2.857)	0.001
性别	0.977	20.182	2.656(1.734~4.068)	<0.001	0.472	3.873	1.603(1.002~2.566)	0.049
高血压	0.816	14.863	2.260(1.493~3.422)	<0.001	0.503	6.683	1.654(1.129~2.422)	0.010
糖尿病	1.067	13.897	2.906(1.659~5.093)	<0.001	0.544	5.286	1.723(1.084~2.740)	0.021
吸烟	1.008	21.592	2.741(1.791~4.193)	<0.001	0.760	11.193	2.138(1.370~3.337)	0.001
LVEF	–0.666	6.448	0.514(0.307~0.859)	0.011
WBC	0.558	7.123	1.747(1.160~2.630)	0.008
NE	0.391	3.532	1.478(0.983~2.221)	0.060
HDL-C	–0.692	10.620	0.500(0.330~0.759)	0.001
ApoA-1	–0.836	14.796	0.433(0.283~0.664)	<0.001
Scr	0.608	8.423	1.837(1.218~2.771)	0.004
α₁-MG	0.528	6.376	1.695(1.125~2.554)	0.012
CAR×100	0.916	18.656	2.500(1.650~3.790)	<0.001	0.800	16.605	2.226(1.515~3.271)	<0.001
HCY/HDL-C	1.026	22.656	2.791(1.829~4.259)	<0.001	0.469	5.352	1.599(1.074~2.379)	0.021

临床指标

单因素logistic回归分析

多因素logistic回归分析

Wald χ²

OR(95%CI)

Wald χ²

OR(95%CI)

年龄

0.918

18.597

2.505(1.650~3.802)

<0.001

0.658

10.863

1.931(1.306~2.857)

0.001

性别

0.977

20.182

2.656(1.734~4.068)

<0.001

0.472

3.873

1.603(1.002~2.566)

0.049

高血压

0.816

14.863

2.260(1.493~3.422)

<0.001

0.503

6.683

1.654(1.129~2.422)

0.010

糖尿病

1.067

13.897

2.906(1.659~5.093)

<0.001

0.544

5.286

1.723(1.084~2.740)

0.021

吸烟

1.008

21.592

2.741(1.791~4.193)

<0.001

0.760

11.193

2.138(1.370~3.337)

0.001

LVEF

–0.666

6.448

0.514(0.307~0.859)

0.011

WBC

0.558

7.123

1.747(1.160~2.630)

0.008

0.391

3.532

1.478(0.983~2.221)

0.060

HDL-C

–0.692

10.620

0.500(0.330~0.759)

0.001

ApoA-1

–0.836

14.796

0.433(0.283~0.664)

<0.001

Scr

0.608

8.423

1.837(1.218~2.771)

0.004

α₁-MG

0.528

6.376

1.695(1.125~2.554)

0.012

CAR×100

0.916

18.656

2.500(1.650~3.790)

<0.001

0.800

16.605

2.226(1.515~3.271)

<0.001

HCY/HDL-C

1.026

22.656

2.791(1.829~4.259)

<0.001

0.469

5.352

1.599(1.074~2.379)

0.021

变量	单因素logistic回归分析	多因素logistic回归分析
年龄	0.946	17.339	2.575(1.650~4.020)	<0.001	0.859	9.219	2.360(1.356~4.107)	0.002
性别	0.637	5.681	1.891(1.120~3.195)	0.017	0.714	4.740	2.042(1.074~3.883)	0.029
高血压	0.698	9.205	2.010(1.280~3.156)	0.002	0.645	5.321	1.906(1.102~3.296)	0.021
糖尿病	0.672	7.731	1.957(1.219~3.142)	0.005
心衰	1.872	13.628	6.498(2.406~17.553)	<0.001
吸烟	0.620	7.447	1.753(1.191~2.903)	0.006
LVEF	–0.957	14.602	0.384(0.235~0.627)	<0.001	–0.795	7.222	0.452(0.253~0.806)	0.007
WBC	0.866	14.677	2.377(1.526~3.703)	<0.001
NE	0.866	14.677	2.377(1.526~3.703)	<0.001	0.645	5.308	1.906(1.101~3.299)	0.021
ApoA-1	–0.513	5.298	0.599(0.387~0.927)	0.021
ApoB	0.443	3.973	1.557(1.007~2.406)	0.046
ALB	–0.709	9.989	0.492(0.317~0.764)	0.002
α₁-MG	0.518	5.320	1.679(1.081~2.608)	0.021
CAR	1.917	59.908	6.798(4.184~11.045)	<0.001	1.376	22.730	3.958(2.248~6.969)	<0.001
HCY/HDL-C	0.895	15.599	2.446(1.569~3.813)	<0.001	0.634	5.090	1.884(1.087~3.267)	0.024

变量

单因素logistic回归分析

多因素logistic回归分析

Wald χ²

OR(95%CI)

Wald χ²

OR(95%CI)

年龄

0.946

17.339

2.575(1.650~4.020)

<0.001

0.859

9.219

2.360(1.356~4.107)

0.002

性别

0.637

5.681

1.891(1.120~3.195)

0.017

0.714

4.740

2.042(1.074~3.883)

0.029

高血压

0.698

9.205

2.010(1.280~3.156)

0.002

0.645

5.321

1.906(1.102~3.296)

0.021

糖尿病

0.672

7.731

1.957(1.219~3.142)

0.005

心衰

1.872

13.628

6.498(2.406~17.553)

<0.001

吸烟

0.620

7.447

1.753(1.191~2.903)

0.006

LVEF

–0.957

14.602

0.384(0.235~0.627)

<0.001

–0.795

7.222

0.452(0.253~0.806)

0.007

WBC

0.866

14.677

2.377(1.526~3.703)

<0.001

0.866

14.677

2.377(1.526~3.703)

<0.001

0.645

5.308

1.906(1.101~3.299)

0.021

ApoA-1

–0.513

5.298

0.599(0.387~0.927)

0.021

ApoB

0.443

3.973

1.557(1.007~2.406)

0.046

ALB

–0.709

9.989

0.492(0.317~0.764)

0.002

α₁-MG

0.518

5.320

1.679(1.081~2.608)

0.021

CAR

1.917

59.908

6.798(4.184~11.045)

<0.001

1.376

22.730

3.958(2.248~6.969)

<0.001

HCY/HDL-C

0.895

15.599

2.446(1.569~3.813)

<0.001

0.634

5.090

1.884(1.087~3.267)

0.024

参数	面积差异	标准误差	95%CI	Z	P
CAR vs HCY/HDL-C	0.071	0.0327	0.0069~0.1350	2.172	0.030
CAR vs CAR+HCY/HDL-C	0.038	0.0185	0.0015~0.0741	2.041	0.041
HCY/HDL-C vs CAR+HCY/HDL-C	0.109	0.0196	0.0704~0.1470	5.553	<0.001

参数

面积差异

标准误差

95%CI

CAR vs HCY/HDL-C

0.071

0.0327

0.0069~0.1350

2.172

0.030

CAR vs CAR+HCY/HDL-C

0.038

0.0185

0.0015~0.0741

2.041

0.041

HCY/HDL-C vs CAR+HCY/HDL-C

0.109

0.0196

0.0704~0.1470

5.553

<0.001