| Objective:This subject aims to explore the correlation of apolipoprotein B/apolipoprotein AI(ApoB/AI)ratio and coronary artery lesions,left ventricular ejection fraction(LVEF),left ventricular size,age,body mass index (BMI),etc,to preliminary clarify the prognostic value in patients with myocardial infarction,by analysis of the ApoB/AI ratio changes in acute stage of myocardial infarction.Methods:The subject was 120 hospitalized patients in Cardiology of the First Hospital of Shanxi Medical University from January 2008 to June 2009,who were first acute myocardial infarction(AMI), and 93 males,27 females,31-91 (59.6±11.96) years of age. The selected patients were admitted to hospital within 24 hours of onset.Collected and observed the lipids values on admission and 4,8 weeks after discharge and major cardiovascular events. Blood lipids include serum total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol (LDL-C), apolipoprotein AI(ApoAI), apolipoprotein B(ApoB), lipoprotein a (Lp(a)). This study, one or more of the following event was defined as the major cardiovascular events:death, recurrent myocardial infarction, re-admitted for unstable angina pectoris or angina pectoris need to be eased by sublingual nitrates. In accordance with the use of lipid lowering medication, the subject was divided into Atorvastatin group and Simvastatin group,to analyze the ApoB/AI and LDL-C/HDL-C ratio changes in acute stage of myocardial infarction,to evaluate the impact of the two drugs on the ratios and the difference between the drugs,as well as the correlation of the ApoB/AI ratio with other prognostic factors, in order to preliminary clarify the effect of ApoB/AI ratio to the prognosis of AMI patients. All data were analyzed using SPSS16.0. Continuous variables were summarised with x±s, univariate association were explored withχ2 test. Analysis statistically by repeated measures analysis of variance, the area under the receiver-operator-characteristic curve(AUC)and partial correlation. P <0.05 was statistically significant.Results:1.Follow-up cases:120 cases of AMI, no(0/120) death and recurrent myocardial infarction, 4 cases(4/120,3.33%)re-admitted for unstable angina pectoris,43 cases(43/120,35.83%)needed to use sublingual nitrates to ease angina pectoris.65 cases(65/120,54.17%)were followed up with complete data,54 males and 11 females,36-87(60.34±10.93) years of age.55 cases(55/120, 45.83%)did not have complete follow-up data,39 males and 16 females,31-91(58.75±13.12)years of age,no groups for lipid analysis,because of not insisting on taking medicine (4 cases,4/55, 7.27%),blood lipids late in reviewed (49 cases,49/55,89.09%) and lost (2 cases,2/55,3.64%).2.The ApoB/AI ratio changes and the effects of selected drugs in acute stage of myocardial infarction:the ApoB/AI ratio on admission and 4,8 weeks after discharge were 0.67±0.19,0.46±0.14,0.3±0.95,any two time compared P<0.001,and the ApoB/AI ratio in line with a linear function, indicating the ApoB/AI ratio in acute stage of MI decreased linearly. In addition, the ApoB/AI ratio of the Atorvastatin group on admission and 4,8 weeks after discharge were 0.66±0.18,0.45±0.12,0.3±0.09, the Simvastatin group was 0.68±0.21,0.47±0.15,0.31±0.1, at any one time the two groups compared P>0.05.It prompted Atorvastatin and Simvastatin on the ApoB/AI ratio of no difference.3. LDL-C/HDL-C ratio changes and the effects of selected drugs in acute stage of myocardial infarction:the LDL-C/HDL-C ratio on admission and 4,8 weeks after discharge were 2.38±0.95,1.55±0.61,1.15±0.49,any two time compared P<0.001,and the LDL-C/HDL-C ratio in line with a linear function, indicating the LDL-C/HDL-C ratio in acute stage of MI decreased in a linear trend. In addition, the LDL-C/HDL-C ratio of the Atorvastatin group on admission and 4,8 weeks after discharge were 2.38±0.95,1.55±0.58,1.17±0.48,the Simvastatin group was 2.37±0.96,1.55±0.66,1.13±0.5,at any one time the two groups compared P>0.05.It prompted Atorvastatin and Simvastatin on the LDL-C/HDL-C ratio of no difference.4. The correlation analysis of the ApoB/AI ratio on admission with other prognostic factors: the ApoB/AI ratio had a positive correlation with coronary artery score (Gensini points) (0.8±0.29 vs 7.26±3.67,r=0.593,P<0.001),left ventricular end-diastolic volume(LVDD)(0.8±0.29 vs 53.35±6.2, r=0.309, P=0.001)and BMI (0.8±0.29 vs 24.18±2.78, r=0.299, P=0.001),a negative correlation with LVEF(0.8±0.29 vs 49.36±11.51, r=-0.468, P<0.001)and age (0.8±0.29 vs 59.87±11.87,r=-0.095,P=0.31).It promoted the larger the ApoB/AI ratio was, the worse the prognosis of AMI patient was.5. The correlation analysis of serum lipids on admission with Gensini points:the ApoB/AI ratio(0.8±0.29 vs 7.26±3.67,r=0.593,P<0.001), ApoB(0.9±0.27 vs 7.26±3.67,r=0.554,P<0.001), the LDL-C/HDL-C ratio(2.5±0.92 vs 7.26±3.67, r=0.249, P=0.01),LDL-C(2.35±0.91 vs 7.26±3.67, r=0.356,P=0.002),TC(4.14±1.11 vs 7.26±3.67, r= 0.206, P=0.03)are positively related with Gensini points,HDL-C(0.97±0.27 vs 7.26±3.67, r=-0.227,P=0.02)and ApoAI(1.17±0.26 vs 7.26±3.67,r=-0.198,P=0.04) had a negative correlation with Gensini points,the ApoB/AI ratio and Gensini points had the best correlation.It suggested that ApoB/AI ratio was the best on judging the prognosis of patients among serum lipids.6.The analysis of serum lipids at different time on judging the prognosis of AMI patients:1) the AUC for TC,TG,HDL-C,LDL-C,ApoAI,ApoB,Lpa,the ApoB/AI and LDL-C/HDL-C ratio on admission were 0.654,0.604,0.364,0.678,0.397,0.837,0.527,0.862,0.776,P<0.001,the AUC for the ApoB/AI ratio was the greatest. It promoted that within 24 hours after AMI,the ApoB/AI ratio has the maximum value in serum lipids on judging the prognosis of AMI patients;2) 4 weeks after discharge, the AUC for TC,TG,HDL-C,LDL-C,ApoAI,ApoB,Lpa,the ApoB/AI and LDL-C/HDL-C ratio were 0.502,0.455,0.514,0.522,0.453,0.537,0.479,0.662,0.509,P>0.05.It promoted that about one month after AMI, the ApoB/AI ratio and other serum lipids had little value on judging the prognosis of AMI patients;But the AUC for the ApoB/AI ratio was the greatest,and P was the closest to 0.05.It promoted that the ApoB/AI ratio had a certain value in predicting the prognosis of patients compared with other serum lipids;3) 8 weeks after discharge, the AUC for TC,TQHDL-C,LDL-C,ApoAI,ApoB,Lpa,the ApoB/AI and LDL-C/HDL-C ratio were 0.496,0.446,0.535,0.521,0.455,0.584,0.465,0.647,0.510,only the ApoB/AI ratio P>0.05. It promoted that about two months after AMI, only the ApoB/AI ratio had certain value on judging the prognosis of AMI patients.So among the serum lipids, the ApoB/AI ratio was the best in predicting the prognostic value of patients,and the larger the ApoB/AI ratio was,the worse the prognosis of AMI patients was.Conclusion:1. In acute stage of myocardial infarction, the ApoB/AI ratio was in linearly decreased trend, suggesting that AMI patients have good prognosis.It is related with insisting on taking statins and the bodies are still in a certain state of stress.2. In acute stage of myocardial infarction, particularly two months after AMI, the ApoB/AI ratio was the best in predicting the prognosis of patients among serum lipids.The larger the ApoB/AI ratio was, the worse the prognosis of patients were. It suggested that we should pay attention to the monitoring of ApoB/AI ratio in work. |
PDF Full Text Request