残余胆固醇对急性冠脉综合征患者冠状动脉内薄纤维帽粥样硬化斑块的预测价值及其与斑块易损特征的相关性

doi:10.3969/j.issn.1006-5725.2026.14.003

Abstract

Abstract:

Objective To investigate the predictive value of remnant cholesterol （RC） for intracoronary thin-cap fibroatheroma （TCFA） in patients with acute coronary syndrome （ACS） and analyze its relationship with plaque vulnerability features. Methods A total of 186 patients who were hospitalized for chest pain or suspected myocardial ischemia and underwent coronary angiography at Heze Hospital Affiliated to Shandong First Medical University from January 2024 to December 2025 were retrospectively enrolled. These patients were divided into an ACS group （n = 117） and a non-ACS group （n = 69） based on clinical and angiographic findings. All ACS patients underwent optical coherence tomography （OCT） and were further classified into a TCFA group （n = 49） and a non-TCFA group （n = 68）. Clinical data and lipid profiles were compared among the groups. Multivariable logistic regression was employed to identify independent factors for intracoronary TCFA， ROC curve analysis was used to evaluate the predictive value of RC， and Spearman rank correlation was utilized to assess the associations between RC and OCT-derived plaque features. Results Total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， remnant cholesterol （RC）， and high-density lipoprotein cholesterol （HDL-C） exhibited significant differences between the ACS and non-ACS groups （P < 0.05）. Among ACS patients， the TCFA group significantly differed from the non-TCFA group in terms of the proportions of patients with a history of smoking and diabetes mellitus， as well as the levels of TC， LDL-C， and RC （P < 0.05）. Multivariable analysis revealed that diabetes， smoking， elevated LDL-C， and elevated RC （odds ratio ［OR］ = 2.917， 95% confidence interval ［CI］： 1.407 - 6.048） were independent risk factors for intracoronary TCFA （P < 0.05）. Receiver operating characteristic （ROC） curve analysis demonstrated that the area under the curve （AUC） of RC for predicting intracoronary TCFA was 0.702 （95%CI： 0.600 ? 0.803）， with an optimal cutoff value of 0.975 mmol/L， a sensitivity of 0.653， and a specificity of 0.794. Spearman rank correlation analysis indicated that RC was positively correlated with the maximum lipid arc and macrophage infiltration （r_s = 0.438 and 0.248， respectively； P < 0.05）， and negatively correlated with the thinnest fibrous cap thickness and minimum lumen area （MLA）（r_s = -0.369 and -0.342， respectively； P < 0.05）. Conclusions Elevated RC is an independent factor associated with intracoronary TCFA in patients with ACS and possesses a certain predictive value for TCFA. It is also correlated with features of plaque vulnerability， such as a thinner fibrous cap， a larger lipid arc， a smaller MLA， and increased macrophage infiltration. RC can serve as a reference for the risk stratification of high-risk coronary plaques in patients with ACS.

Key words: acute coronary syndrome, remnant cholesterol, thin-cap fibroatheroma, optical coherence tomography, plaque vulnerability features

CLC Number:

R541.4

Wenqian DONG,Beijian CHEN,Guoqing LI,Huaipeng ZHANG,Yuqing JIA,Guili GAO,Hong YANG,Jing LIU,Hua WANG,Xiangbing WANG,Xianghao YU,Qiuyu HOU,Xiaoyu XU. Predictive value of remnant cholesterol for intracoronary thin-cap fibroatheroma and its correlation with plaque vulnerability features in patients with acute coronary syndrome[J]. The Journal of Practical Medicine, 2026, 42(14): 2505-2512.

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References 39

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指标	非ACS组（n = 69）	ACS组（n = 117）	t/χ2/Z值	P值
性别（男/女）/例	40/29	74/43	0.509	0.475
年龄/岁	62.6 ± 8.5	64.5 ± 9.4	-1.388	0.167
吸烟史/［例（%）］	15（21.7）	42（35.9）	4.094	0.043
家族史/［例（%）］	13（18.8）	27（23.1）	0.461	0.497
高血压史/［例（%）］	29（42.0）	73（62.4）	7.268	0.007
糖尿病史/［例（%）］	17（24.6）	46（39.3）	4.175	0.041
TC/（mmol/L）	4.08 ± 0.96	4.62 ± 1.15	-3.302	0.001
HDL-C/（mmol/L）	1.18 ± 0.31	1.07 ± 0.26	2.574	0.011
LDL-C/（mmol/L）	2.17 ± 0.80	2.52 ± 0.93	-2.571	0.011
RC［M（P₂₅，P₇₅））/（mmol/L）	0.56（0.21，0.92）	0.83（0.52，1.36）	-3.627	< 0.001
TG［M（P₂₅，P₇₅））/（mmol/L）	1.93（1.57，2.38）	1.97（1.69，2.54）	-0.950	0.342

指标	非TCFA组（n = 68）	TCFA组（n = 49）	t/χ2/Z值	P值
性别（男/女）/例	42/26	32/17	0.154	0.695
年龄/岁	64.3 ± 8.8	64.8 ± 10.2	-0.344	0.778
吸烟史/［例（%）］	19（27.9）	23（46.9）	4.467	0.035
家族史/［例（%）］	14（20.6）	13（26.5）	0.567	0.452
高血压史/［例（%）］	42（61.8）	31（63.3）	0.027	0.869
糖尿病史/［例（%）］	20（29.4）	26（53.1）	6.676	0.010
TC/（mmol/L）	4.32 ± 1.10	5.05 ± 1.08	-3.595	< 0.001
HDL-C/（mmol/L）	1.10 ± 0.25	1.03 ± 0.27	1.490	0.139
LDL-C/（mmol/L）	2.34 ± 0.85	2.76 ± 0.98	-2.458	0.015
RC［M（P₂₅，P₇₅））/（mmol/L）	0.67（0.43，0.92）	1.21（0.76，1.56）	-3.710	< 0.001
TG［M（P₂₅，P₇₅））/（mmol/L）	1.95（1.66，2.54）	1.98（1.74，2.52）	-0.238	0.810

变量	B	SE	Waldχ²	OR	95%CI	P值
性别	-0.227	0.499	0.206	0.797	0.299 ~ 2.122	0.650
年龄	0.003	0.023	0.021	1.003	0.959 ~ 1.050	0.884
糖尿病史	1.156	0.460	6.316	3.176	1.290 ~ 7.822	0.012
家族史	0.734	0.520	1.997	2.086	0.752 ~ 5.784	0.158
高血压史	-0.009	0.463	0.000	0.991	0.400 ~2.457	0.985
吸烟史	1.045	0.488	4.583	2.842	1.092 ~ 7.397	0.032
TG	0.374	0.371	1.019	1.454	0.703 ~ 3.005	0.313
HDL-C	-0.957	0.897	1.136	0.384	0.066 ~2.231	0.286
LDL-C	0.571	0.255	5.021	1.770	1.074 ~ 2.918	0.025
RC	1.071	0.372	8.281	2.917	1.407 ~ 6.048	0.004

指标	最佳截断值	AUC（95%CI）	P值	敏感度/%	特异度/%	约登指数
糖尿病史	1	0.618（0.514 ~ 0.722）	0.030	53.1	70.6	0.237
吸烟史	1	0.530（0.490 ~ 0.700）	0.080	46.9	72.1	0.190
LDL-C	2.985	0.630（0.526 ~ 0.734）	0.017	44.9	79.4	0.243
RC	0.975	0.702（0.600 ~ 0.803）	< 0.001	65.3	79.4	0.467

指标	非TCFA组（n = 68）	TCFA组（n = 49）	t/χ2/Z值	P值
最薄纤维帽厚度/μm	91.41 ± 14.11	55.85 ± 5.51	18.870^*	<0.001
最大脂质弧度/°	94.72 ± 32.29	217.02 ± 20.96	-24.826^*	<0.001
MLA/mm²	4.09 ± 0.37	2.85 ± 0.39	17.420	<0.001
巨噬细胞浸润/［例（%）］	10（14.7）	16（32.7）	5.307	0.021
微血管/［例（%）］	9（13.2）	8（16.3）	0.219	0.640
胆固醇结晶/［例（%）］	18（26.5）	19（38.8）	1.994	0.158

Predictive value of remnant cholesterol for intracoronary thin-cap fibroatheroma and its correlation with plaque vulnerability features in patients with acute coronary syndrome

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斑块特征	r_s 值	P值
最薄纤维帽厚度	-0.369	<0.001
最大脂质弧度	0.438	<0.001
MLA	-0.342	<0.001
巨噬细胞浸润	0.248	0.007

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