摘要目的:探讨糖化血红蛋白A1c（HbA1c）与载脂蛋白A-1（ApoA-1）比值（HbA1c/ApoA-1）对急性冠状动脉综合征（ACS）患者随访期间主要不良心血管事件（MACEs）的预测价值。方法:本研究为回顾性队列研究，连续入选2017年3月至2019年3月于北京医院住院并接受冠状动脉造影的ACS患者，收集性别、年龄、既往史、Gensini评分、HbA1c和ApoA-1等基线资料。依据随访期间有无MACEs发生分为MACEs组和无MACEs组，分析2组间HbA1c/ApoA-1的差异。按HbA1c/ApoA-1水平的三分位数将患者分为高、中、低HbA1c/ApoA-1组，使用Cox比例风险模型评估3组间MACEs、全因死亡率等终点事件的差异。使用Kaplan-Meier生存分析比较各HbA1c/ApoA-l组间无MACEs生存率差异。使用Spearman秩相关分析评价HbA1c/ApoA-1与Gensini评分的相关性。结果:共纳入ACS患者366例，59例发生MACEs，10例发生全因死亡。所有患者平均年龄为（65.9±10.3）岁，随访（22.3±4.4）个月，校正年龄、收缩压、糖尿病病史、冠状动脉病变严重程度后，高HbA1c/ApoA-1组患者MACEs发生率是低HbA1c/ApoA-1组患者的2.45倍（95% CI：1.16~5.18， P=0.019），但2组全因死亡率差异无统计学意义（ P=1.000）。Kaplan-Meier生存分析显示高HbA1c/ApoA-l组MACEs风险最高，低HbA1c/ApoA-l组风险最低，差异有统计学意义（ P<0.01）。Spearman秩相关分析结果显示，HbA1c/ApoA-1比值高低与ACS患者Gensini评分呈正相关（ r=0.274， P<0.01）。 结论:HbA1c/ApoA-1是ACS患者MACEs的独立危险因素。高HbA1c/ApoA-1患者冠状动脉病变程度更重。HbA1c/ApoA-1水平可能作为评估ACS患者心血管风险的潜在指标，用于早期识别高危人群，预测MACEs的发生。

abstractsObjective:To investigate the predictive value of glycosylated hemoglobin A1c/apolipoprotein A-1 (HbA1c/ApoA-1) ratio for major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS).Methods:The present study is a retrospective cohort study. ACS patients who were hospitalized and underwent coronary angiography at Beijing Hospital from March 2017 to March 2019 were enrolled. Baseline information such as sex, age, previous history, Gensini score, HbA1c and ApoA-1 were analyzed. Patients were divided into two groups according to presence or absence of MACEs and the difference on HbA1c/ApoA-1 ratio was compared between the two groups. According to the tertiles of HbA1c/ApoA-1 levels, patients were divided into high (5.87-16.12), medium (4.50-5.83) and low (2.11-4.48) HbA1c/ApoA-1 groups. Cox proportional risk model was used to evaluate the differences in MACEs and all-cause mortality among the three groups. Kaplan-Meier survival analysis was used to compare the differences of MACEs between the various HbA1c/ApoA-1 groups.Results:A total of 366 ACS patients were included in this study. The mean age of the patients was (65.9±10.3) years. There were 59 MACEs and 10 all-cause deaths during the mean of (22.3±4.4) months follow-up. After adjusting for age, systolic blood pressure, history of diabetes and Gensini score, the incidence of MACEs was 2.45 times higher in the high HbA1c/ApoA-1 group than in the low HbA1c/ApoA-1 group (95% CI 1.16-5.18, P=0.019). There was no significant difference in all-cause mortality between the high and low HbA1c/ApoA-1 groups ( P=1.000). Kaplan-Meier survival analysis showed that patients in the high HbA1c/ApoA-1 group had the highest risk of MACEs, while patients in the low HbA1c/ApoA-1 group had the lowest risk of MACEs ( P<0.01). Spearman rank correlation analysis showed that HbA1/ApoA-1 ratio was positively correlated with Gensini score in ACS patients ( r=0.274, P<0.01). Conclusion:High HbA1c/ApoA-1 ratio was an independent risk factor for MACEs in ACS patients. Patients with high HbA1c/ApoA-1 ratio had more severe coronary artery disease lesions. HbA1c/ApoA-1 ratio may be used as a potential risk stratification biomarker for ACS patients, it might be useful for the early identification of high-risk population and for predicting the incidence of MACEs among ACS patients.