TC/HDL-C、TyG、CysC、LAD对冠心病并发缺血性脑卒中的预测价值

doi:10.11958/20253309

摘要/Abstract

摘要：

目的探讨血清总胆固醇/高密度脂蛋白胆固醇比值（TC/HDL-C）、甘油三酯葡萄糖指数（TyG）、胱抑素C（CysC）及左心房内径（LAD）对冠心病患者并发缺血性脑卒中的预测价值。方法选取冠心病并发缺血性脑卒中患者100例作为合并症组，另择100例未发生脑卒中的冠心病患者作为冠心病组。回顾性收集2组基线资料及实验室指标，行超声心动图检查，测量左心室舒张末期内径（LVEDd）、LAD及左心室射血分数（LVEF）。采用二元Logistic回归分析冠心病并发缺血性脑卒中的影响因素，并基于影响因素构建列线图预测模型。通过受试者工作特征（ROC）曲线及决策曲线分析列线图预测模型的预测价值。结果合并症组高血压占比、TC/HDL-C、TyG、CysC和LAD水平高于冠心病组（P<0.05）。Logistic回归分析结果显示，TC/HDL-C、TyG、CysC、LAD水平升高是冠心病患者并发缺血性脑卒中的独立危险因素。基于TC/HDL-C、TyG、CysC、LAD构建冠心病患者并发缺血性脑卒中的列线图预测模型，该模型具有良好区分度，C-index为0.880；ROC曲线分析结果显示，该模型预测冠心病患者并发缺血性脑卒中的曲线下面积为0.880（95%CI：0.834~0.927），最佳截断值为51.80分，特异度为0.760，敏感度为0.880，约登指数为0.640。决策曲线分析显示，当预测阈值为10%~30%时，该模型的净收益高于单一指标。结论 TC/HDL-C、TyG、CysC及LAD是冠心病患者并发缺血性脑卒中的影响因素，基于上述4个指标构建的列线图模型对预测冠心病患者并发缺血性脑卒中具有一定价值。

关键词: 冠心病, 缺血性卒中, 胆固醇，HDL, 甘油三酯类, 甘油三酯葡萄糖指数, 胱抑素C, 左心房内径

Abstract:

Objective To evaluate the predictive value of serum total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C), triglyceride-glucose index (TyG), cystatin C (CysC) and left atrial diameter (LAD) in patients with coronary heart disease (CHD) complicated with ischemic stroke. Methods One hundred patients with CHD complicated with ischemic stroke were enrolled as the comorbidity group, while another 100 CHD patients without a history of ischemic stroke were selected as the control group. Baseline characteristics and laboratory parameters were retrospectively collected in both groups. Echocardiography was performed to measure left ventricular end-diastolic diameter (LVEDd), LAD and left ventricular ejection fraction (LVEF). Binary Logistic regression analysis was performed to identify factors influencing ischemic stroke in CHD patients. Based on the identified factors, a nomogram prediction model was constructed. The predictive value of the nomogram model was then assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis. Results The proportion of hypertension, TC/HDL-C ratio, TyG, CysC and LAD were higher in the comorbidity group compared to those of the control group (P<0.05). Logistic regression analysis identified that elevated TC/HDL-C, TyG, CysC and LAD were independent risk factors for ischemic stroke in patients with CHD. A nomogram prediction model was subsequently constructed based on these four indicators. The model exhibited good discriminative ability, with a concordance index of 0.880. ROC curve analysis showed an area under the curve of 0.880 (95% CI: 0.834-0.927) for predicting ischemic stroke. The optimal cut-off value was 51.80 points, with a specificity of 0.760, sensitivity of 0.880 and the Youden's index of 0.640. Decision curve analysis revealed that the nomogram model provided a higher net benefit than any single indicator when the prediction probability threshold was set between 10% and 30%. Conclusion TC/HDL-C, the TyG, CysC and LAD are significant factors influencing ischemic stroke in patients with CHD. The nomogram model constructed based on these factors demonstrates potential utility for predicting this risk.

Key words: coronary disease, ischemic stroke, cholesterol, HDL, triglycerides, triglyceride-glucose index, cystatin C, left atrial diameter

中图分类号:

R541.4

图/表 7

参考文献 25

[1]	Alpert J S. New coronary heart disease risk factors[J]. Am J Med, 2023, 136(4):331-332. doi:10.1016/j.amjmed.2022.08.002.
[2]	Wang R, Wang H, Liu S, et al. Coronary heart disease increases the risk of perioperative ischemic stroke after noncardiac surgery:A retrospective cohort study[J]. CNS Neurosci Ther, 2024, 30(8):e14912. doi:10.1111/cns.14912.
[3]	Hurskainen M, Tynkkynen J, Eskola M, et al. Incidence of stroke and mortality due to stroke after acute coronary syndrome[J]. J Stroke Cerebrovasc Dis, 2022, 31(12):106842. doi:10.1016/j.jstrokecerebrovasdis.2022.106842.
[4]	孙亚召, 孟杰杰, 吴英杰, 等. 低密度脂蛋白亚型和其他血脂残余风险指标与老年缺血性心脑血管病终点事件的关系[J]. 中华老年心脑血管病杂志, 2023, 25(5):485-488.
	Sun Y Z, Meng J J, Wu Y J, et al. Relationship of low-density lipoprotein subtypes and other residual lipid risk indicators with endpoint events of ICCVD in elderly[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2023, 25(5):485-488. doi:10.3969/j.issn.1009-0126.2023.05.010.
[5]	Vishnu Chander S, Sarumathy S, Nanda Kumar R, et al. Association of serum cystatin c level with carotid arterial wall elastic resistance as a potential marker for detection of early stage atherosclerosis[J]. Cureus, 2023, 15(5):e38543. doi:10.7759/cureus.38543.
[6]	北京高血压防治协会, 中国脑卒中学会高血压预防与管理分会, 中国老年保健协会养老与健康专业委员会, 等. 基层冠心病与缺血性脑卒中共患管理专家共识2022[J]. 心脑血管病防治, 2022, 22(4):1-19.
	Beijing Hypertension Association, Hypertension Prevention and Management Branch of Chinese Stroke Association, Elderly Care and Health Professional Committee of China Aging Well Association, et al. 2022 expert consensus on the management of coronary heart disease with ischemic stroke in community[J]. Cardio-cerebrovasc Dis Prev Treat, 2022, 22(4):1-19. doi:10.3969/j.issn.1009-816x.2022.04.001.
[7]	符雨思, 赵振强. 急性冠状动脉综合征和急性缺血性脑卒中院内连续发生的机制及治疗研究新进展[J]. 中华老年心脑血管病杂志, 2024, 26(4):478-480.
	Fu Y S, Zhao Z Q. New advances in research on mechanisms and treatment of in-hospital sequential occurrence of acute coronary syndrome and acute ischemic stroke[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2024, 26(4):478-480. doi:10.3969/j.issn.1009-0126.2024.04.029.
[8]	Ohlow M A, Winterhalter M. Coronary heart disease-a protracted treatment course[J]. Dtsch Arztebl Int, 2023, 120(6):98. doi:10.3238/arztebl.m2022.0392.
[9]	李琦, 李娇, 陈雅芳, 等. TyG和TyG-BMI与冠心病患者颈动脉粥样硬化的相关性[J]. 心脏杂志, 2024, 36(3):277-282.
	Li Q, Li J, Chen Y F, et al. Correlation between TyG,TyG-BMI and carotid atherosclerosis in patients with coronary artery disease[J]. Chinese Heart Journal, 2024, 36(3):277-282. doi:10.12125/j.chj.202307037.
[10]	陈丽娟, 周宇生, 栾颖, 等. TC/HDL-C联合HNP1-3、脂蛋白a检测在冠心病临床诊断中的应用[J]. 分子诊断与治疗杂志, 2023, 15(2):261-264.
	Chen L J, Zhou Y S, Luan Y, et al. Application analysis of TC/HDL-C combined with HNP1-3 and lipoprotein A detection in clinical diagnosis of coronary heart disease[J]. Journal of Molecular Diagnosis and Therapy, 2023, 15(2):261-264. doi:10.3969/j.issn.1674-6929.2023.02.021.
[11]	张青云, 孙丹丹, 王芬, 等. 胆固醇与高密度脂蛋白比值对冠心病患者发生缺血性脑卒中的预测价值[J]. 中华现代护理杂志, 2021, 27(19):2596-2599.
	Zhang Q Y, Sun D D, Wang F, et al. Study on the predictive value of total cholesterol / high density lipoprotein cholesterol ratio for new-onset ischemic stroke in patients with coronary heart disease[J]. Chinese Journal of Modern Nursing, 2021, 27(19):2596-2599. doi:10.3760/cma.j.cn115682-20201127-06426.
[12]	李友凤, 王春慧, 孙文先, 等. 总胆固醇/高密度脂蛋白胆固醇比值对脑卒中复发的预测价值[J]. 中国实用神经疾病杂志, 2020, 23(9):771-775.
	Li Y F, Wang C H, Sun W X, et al. Association of total cholesterol/high density lipoprotein cholesterol ratio and stroke recurrence[J]. Chinese Journal of Practical Nervous Diseases, 2020, 23(9):771-775. doi:10.12083/SYSJ.2020.09.121.
[13]	Cui C, Liu L, Qi Y, et al. Joint association of TyG and high sensitivity C-reactive protein with cardiovascular disease:a national cohort study[J]. Cardiovasc Diabetol, 2024, 23(1):156. doi:10.1186/s12933-024-02244-9.
[14]	汪宇, 缪莹, 林强, 等. 甘油三酯葡萄糖指数联合腰围对泸州地区中老年人群10年新发冠心病的前瞻性队列研究[J]. 实用医学杂志, 2024, 40(12):1731-1736.
	Wang Y, Miao Y, Lin Q, et al. Association between TyG-WC and risk of coronary heart disease in middle-aged and elderly population:a prospective cohort study with 10-year follow-up[J]. The Journal of Practical Medicine, 2024, 40(12):1731-1736. doi:10.3969/j.issn.1006-5725.2024.12.020.
[15]	李阳, 郝修宏. 三酰甘油葡萄糖指数联合内皮细胞特异分子1对冠心病伴高血压患者术后缺血的预测价值[J]. 中华老年心脑血管病杂志, 2025, 27(9):1158-1163.
	Li Y, Hao X H. Predictive value of TyG combined with ESM-1 for postoperative ischemia in hypertension patients with concomitant CHD[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2025, 27(9):1158-1163. doi:10.3969/j.issn.1009-0126.2025.09.006.
[16]	赵桂梅, 杨毅, 洪小兰, 等. 甘油三酯葡萄糖乘积指数、红细胞分布宽度、血清尿酸、降钙素原与冠心病患者冠状动脉狭窄程度和短期预后的关系分析[J]. 现代生物医学进展, 2022, 22(22):4341-4346.
	Zhao G M, Yang Y, Hong X L, et al. Relationship analysis between triglyceride-glucose product index,red blood cell distribution width,serum uric acid,procalcitonin and the degree of coronary artery stenosis and short-term prognosis in patients with coronary heart disease[J]. Progress in Modern Biomedicine, 2022, 22(22):4341-4346. doi:10.13241/j.cnki.pmb.2022.22.027.
[17]	Cai W, Xu J, Wu X, et al. Association between triglyceride-glucose index and all-cause mortality in critically ill patients with ischemic stroke:analysis of the MIMIC-IV database[J]. Cardiovasc Diabetol, 2023, 22(1):138. doi:10.1186/s12933-023-01864-x.
[18]	王玮玮, 刘月荷, 潘慧, 等. 三酰甘油-葡萄糖指数对急性冠脉综合征患者主要心脑血管不良事件的预测效能[J]. 中国临床研究, 2025, 38(2):275-279.
	Wang W W, Liu Y H, Pan H, et al. Evaluation of the predictive efficacy of triglyceride-glucose index in predicting major adverse cardiovascular and cerebrovascular events in patients with acute coronary syndrome[J]. Chinese Journal of Clinical Research, 2025, 38(2):275-279. doi:10.13429/j.cnki.cjcr.2025.02.023.
[19]	Dang K, Wang X, Hu J, et al. The association between triglyceride-glucose index and its combination with obesity indicators and cardiovascular disease:NHANES 2003-2018[J]. Cardiovasc Diabetol, 2024, 23(1):8. doi:10.1186/s12933-023-02115-9.
[20]	Pruc M, Swieczkowski D, Cander B, et al. Diagnostic and prognostic value of cystatin C in acute coronary syndrome:An up-to-date meta-analysis[J]. Cardiol J, 2025, 32(2):142-152. doi:10.5603/cj.102453.
[21]	向乾才, 罗廷福, 张娟, 等. 血清H-FABP、CysC及LVEF联合检测对老年冠心病病人预后评估的临床价值[J]. 中西医结合心脑血管病杂志, 2020, 18(21):3659-3662.
	Xiang Q C, Luo T F, Zhang J, et al. Value of serum H-FABP,CysC and LVEF on prognosis assessment in elderly patients with coronary heart Disease[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2020, 18(21):3659-3662. doi:10.12102/j.issn.1672-1349.2020.21.038.
[22]	张舒贤, 王红雷. 早发冠心病患者发生院外主要不良心血管事件的影响因素分析[J]. 实用心脑肺血管病杂志, 2025, 33(6):6-10,17.
	Zhang S X, Wang H L. Influencing factors of out-of-hospital major adverse cardiovascular events in patients with premature coronary artery disease[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2025, 33(6):6-10,17. doi:10.12114/j.issn.1008-5971.2025.00.112.
[23]	俞江, 郑甲, 陈建州, 等. 血清CysC、CT-1联合FFR值预测冠状动脉中度狭窄冠心病患者PCI术后主要心脏不良事件发生风险的临床研究[J]. 现代生物医学进展, 2024, 24(7):1306-1311.
	Yu J, Zheng J, Chen J Z, et al. Clinical study on serum CysC,CT-1 combined with FFR value in predicting the risk of major adverse cardiac events after PCI in patients with coronary heart disease with moderate coronary artery stenosis[J]. Progress in Modern Biomedicine, 2024, 24(7):1306-1311. doi:10.13241/j.cnki.pmb.2024.07.020.
[24]	赵甲彧, 刘雅婷, 张芳, 等. 左心室压力-应变环参数在冠心病经皮冠状动脉介入围手术期心肌做功评估中的价值[J]. 中国急救复苏与灾害医学杂志, 2025, 20(2):150-154.
	Zhao J Y, Liu Y T, Zhang F, et al. The value of left ventricular pressure-strain loop parameters in perioperative myocardial work assessment of coronary heart disease after percutaneous coronary intervention[J]. China Journal of Emergency Resuscitation and Disaster Medicine, 2025, 20(2):150-154. doi:10.3969/j.issn.1673-6966.2025.02.003.
[25]	Shen Z, Chen D, Cheng H, et al. N-terminal pro-B-type natriuretic peptide and D-dimer combined with left atrial diameter to predict the risk of ischemic stroke in nonvalvular atrial fibrillation[J]. Clin Cardiol, 2023, 46(1):41-48. doi:10.1002/clc.23933.

组别		年龄≥60岁				性别（男/女）			BMI≥24 kg/m²				糖尿病
冠心病组		70（70.00）				63/37			64（64.00）				25（25.00）
合并症组		73（73.00）				65/35			62（62.00）				28（28.00）
χ²或t		0.221				0.087			0.086				0.231
组别	高血压				病变血管数（单支）					TC/HDL-C				TyG
冠心病组	26（26.00）				45（45.00）					3.89±0.78				8.13±1.01
合并症组	40（40.00）				43（43.00）					4.71±0.85				8.95±1.06
χ²或t	4.432^＊				0.081					6.980^＊				5.602^＊
组别			CysC/（mg/L）				Hcy/（μmol/L）					LVEDd/mm
冠心病组			0.92±0.23				20.58±2.54					46.96±3.36
合并症组			1.09±0.25				21.03±2.55					47.32±3.51
χ²或t			5.218^＊				1.269					0.740
组别				LAD/mm				LVEF/%			ALT/（U/L）
冠心病组				37.19±3.52				60.54±5.98			83.26±6.19
合并症组				39.42±3.48				59.75±5.92			83.52±6.42
χ²或t				4.524^＊				0.950			0.303

组别		年龄≥60岁				性别（男/女）			BMI≥24 kg/m²				糖尿病
冠心病组		70（70.00）				63/37			64（64.00）				25（25.00）
合并症组		73（73.00）				65/35			62（62.00）				28（28.00）
χ²或t		0.221				0.087			0.086				0.231
组别	高血压				病变血管数（单支）					TC/HDL-C				TyG
冠心病组	26（26.00）				45（45.00）					3.89±0.78				8.13±1.01
合并症组	40（40.00）				43（43.00）					4.71±0.85				8.95±1.06
χ²或t	4.432^＊				0.081					6.980^＊				5.602^＊
组别			CysC/（mg/L）				Hcy/（μmol/L）					LVEDd/mm
冠心病组			0.92±0.23				20.58±2.54					46.96±3.36
合并症组			1.09±0.25				21.03±2.55					47.32±3.51
χ²或t			5.218^＊				1.269					0.740
组别				LAD/mm				LVEF/%			ALT/（U/L）
冠心病组				37.19±3.52				60.54±5.98			83.26±6.19
合并症组				39.42±3.48				59.75±5.92			83.52±6.42
χ²或t				4.524^＊				0.950			0.303

变量	β	SE	Wald χ²	P	OR	OR 95%CI
高血压	-0.336	0.440	0.584	0.445	0.714	0.302~1.693
TC/HDL-C	1.309	0.257	25.963	<0.001	3.701	2.237~6.122
TyG	0.727	0.188	14.899	<0.001	2.068	1.430~2.991
CysC	4.129	0.931	19.671	<0.001	62.141	10.020~385.382
LAD	0.212	0.058	13.538	<0.001	1.236	1.104~1.384
常数项	-23.874	3.534	45.631	<0.001	0.000	-

变量	β	SE	Wald χ²	P	OR	OR 95%CI
高血压	-0.336	0.440	0.584	0.445	0.714	0.302~1.693
TC/HDL-C	1.309	0.257	25.963	<0.001	3.701	2.237~6.122
TyG	0.727	0.188	14.899	<0.001	2.068	1.430~2.991
CysC	4.129	0.931	19.671	<0.001	62.141	10.020~385.382
LAD	0.212	0.058	13.538	<0.001	1.236	1.104~1.384
常数项	-23.874	3.534	45.631	<0.001	0.000	-