Objective: Previous cross-sectional studies suggested that elevated levels of total cholesterol content of erythrocyte membrane (CEM) could significantly increase the risk of acute coronary syndrome (ACS). The purpose of the present study was to assess the predictive value of baseline CEM levels for the risk of clinical endpoint events in patients with ACS through prospective follow-up studies. Methods: This study is a prospective follow-up study, which consisted of 859 patients with first ACS (698 patients with unstable angina pectoris and 161 patients with acute myocardial infarction), diagnosed and hospitalized in the First and Second Affiliated Hospital of Anhui Medical University. The routine blood lipid levels and CEM were measured. Patients were divided into two groups according to the median of baseline CEM: CEM≤131.56 μg/mg group (n=430) and CEM>131.56 μg/mg group (n=429). Patients were followed up at 6 months interval. The clinical endpoints were nonfatal myocardial infarction, nonfatal stroke, all-cause mortality, all-cause mortality, heart failure requiring hospitalization, and coronary artery revascularization. Kaplan-Meier curve analysis and Cox proportional hazard model were used to analyze the impact of elevated CEM on the occurrence of clinical end-point events. HR values and 95%CI of each variable were obtained. Cox regression analysis of all-cause mortality was performed according to whether patients had risk factors for coronary heart disease (hypertension, diabetes, smoking and elevated LDL-C) and whether they were treated with PCI. Results: The follow-up time was 1 640 (1 380, 2 189) days. Cox analysis after adjustment showed that an elevated baseline of CEM (>131.56 μg/mg) was associated with an increased risk of all-cause mortality (HR=1.690, 95%CI 1.041-2.742, P=0.034), but had no significant predictive effect on the other clinical endpoints. Subgroup analysis showed that elevated baseline CEM levels in ACS patients with LDL-C>1.8 mmol/L (HR=1.687, 95%CI 1.026-2.774, P=0.039), receiving in-hospital PCI (HR=2.365, 95%CI 1.054-5.307, P=0.037), or male (HR=1.794, 95%CI 1.010-3.186, P=0.046) were associated with an increased risk of all-cause mortality. Conclusion: The results showed that elevated CEM levels can increase the risk of all-cause mortality in ACS patients.
目的：研究红细胞膜总胆固醇（CEM）水平与急性冠状动脉综合征（ACS）患者预后的相关性。 方法：本研究为前瞻性研究。续贯纳入2010年1月至2012年12月，在安徽医科大学第一附属医院和第二附属医院，首次诊断为ACS患者859例，其中不稳定性心绞痛698例，急性心肌梗死161例。检测患者常规血脂水平和CEM。根据患者基线CEM的中位数值将患者分为CEM≤131.56 μg/mg组（430例）和CEM>131.56 μg/mg组（429例）。对出院后的ACS患者每半年随访1次。临床终点事件包括全因死亡、非致死性心肌梗死、非致死性卒中、心功能衰竭和再血管化治疗。采用Kaplan-Meier曲线及Cox比例风险模型，分析CEM水平升高对临床终点事件发生的影响。根据患者是否具有冠心病的危险因素[高血压、糖尿病、吸烟和低密度脂蛋白胆固醇（LDL-C）升高]和是否行PCI治疗，对患者进行相关亚组全因死亡发生风险的Cox回归分析。 结果：随访时间1 640（1 380，2 189）d。CEM>131.56 μg/mg组患者全因死亡的发生率高于CEM≤131.56 μg/mg组[11.7%（50/429）比7.2%（31/430），P=0.026]。Cox回归分析显示，在校正了相关风险因子后，基线CEM水平升高（>131.56 μg/mg）仅增加全因死亡的发生风险（HR=1.690，95%CI 1.041~2.742，P=0.034）。亚组分析结果显示，在男性（HR=1.794，95%CI 1.010~3.186，P=0.046）、PCI治疗（HR=2.365，95%CI 1.054~5.307，P=0.037）或LDL-C>1.8 mmol/L（HR=1.687，95%CI 1.026~2.774，P=0.039）的ACS患者中，基线CEM水平升高增加全因死亡的发生风险。 结论：提示CEM水平的升高可增加ACS患者的全因死亡风险。.
Keywords: Acute coronary syndrome; Prognosis; Total cholesterol of erythrocyte membrane.