【摘要】 背景既往发现，糖化血红蛋白和载脂蛋白A-1比值(HbA_1c/ApoA-1)、三酰甘油葡萄糖-体质指数（TyG-BMI）与冠状动脉疾病的发生、发展相关，但与冠状动脉钙化（CAC）严重程度的相关性并不明确。目的探讨HbA_1c/ApoA-1、TyG-BMI及两者联合与CAC严重程度的相关性。方法 纳入2024年于扬州大学附属苏北人民医院行冠状动脉CT血管造影（CTA）的441例患者进行回顾性分析，将入组患者分为无/轻度钙化组[冠状动脉钙化积分（CACS）=0～99分，223例]和中/重度钙化组（CACS≥100分，218例）。收集患者的临床数据，计算HbA_1c/ApoA-1、TyG-BMI。采用单因素和多因素Logistic回归分析探讨中/重度CAC的危险因素，将HbA_1c/ApoA-1、TyG-BMI分别作为连续变量和分类变量进行分析。采用非线性趋势限制性立方样条（RCS）曲线探讨HbA_1c/ApoA-1、TyG-BMI与CACS的关系。绘制受试者工作特征（ROC）曲线评估HbA_1c/ApoA-1、TyG-BMI及联合对中/重度CAC的预测价值。对性别、年龄、高血压、2型糖尿病、吸烟史和酗酒史进行亚组分析，采用似然比检验进行交互检验。结果 患者中位年龄70.0（62.0,75.0）岁，男276例、女165例。多因素Logistic回归分析结果显示，空腹血糖（OR=1.018,95%CI=1.009～1.028）、脂蛋白a（OR=1.001,95%CI=1.001～1.002）、HbA_1c/ApoA-1（OR=1.158,95%CI=1.059～1.267）、TyG-BMI（OR=1.013,95%CI=1.006～1.020）升高为中/重度CAC的危险因素（P<0.05）。分别将HbA_1c/ApoA-1、TyG-BMI作为连续变量和分类变量进行多因素Logistic回归分析，HbA_1c/ApoA-1分组[Q1组111例(HbA_1c/ApoA-1≤182.69),Q2组109例(182.69<HbA_1c/ApoA-1≤207.06),Q3组106例(207.06<HbA_1c/ApoA-1≤231.24)和Q4组115例(HbA_1c/ApoA-1>231.24)]Q2、Q3、Q4组为中/重度CAC的危险因素（P<0.05）。TyGBMI分组[Q1组112例（TyG-BMI≤0.17）,Q2组108例（0.17<TyG-BMI≤4.23）,Q3组110例（4.23<TyG-BMI≤5.36）和Q4组111例（TyG-BMI>5.36）]Q3、Q4组为中/重度CAC的危险因素（P<0.05）。ROC曲线结果显示空腹血糖、脂蛋白a、HbA_1c/ApoA-1和TyG-BMI预测中/重度CAC的ROC曲线下面积（AUC）分别为0.675（95%CI=0.625～0.725）、0.609（95%CI=0.557～0.661）、0.672（95%CI=0.622～0.732）、0.693（95%CI=0.644～0.742）,HbA_1c/ApoA-1与TyGBMI联合预测的AUC为0.728（95%CI=0.682～0.775）。非线性RCS曲线结果表明，HbA_1c/ApoA-1与CACS非线性相关(P_非线性=0.007),TyG-BMI与CACS线性相关(P_非线性=0.636)。结论 HbA_1c/ApoA-1、TyG-BMI及两者联合与CAC严重程度具有显著的相关性，对严重CAC具有一定预测价值，值得临床推广应用。更多还原

【Abstract】 Background Previous studies have shown that the ratio of glycated hemoglobin A1c to apolipoprotein A-1(Hb A1c/Apo A-1) and the triglyceride-glucose-body mass index(Ty G-BMI) are associated with the development of coronary artery disease, but their association with the severity of coronary artery calcification(CAC) remains unclear. Objective Investigating the association between Hb A1c/Apo A-1, Ty G-BMI, and their combination with the severity of CAC. Methods A retrospective analysis was performed on 441 patients who underwent coronary artery CT angiography(CTA) at Northern Jiangsu People’s Hospital Affiliated to Yangzhou University in 2024. Patients were divided into no/mild calcification group [coronary artery calcification score(CACS)=0-99, n=223] and moderate/severe calcification group(CACS ≥ 100, n=218). Clinical data were collected, and Hb A1c/Apo A-1 and Ty G-BMI were calculated. Univariate and multivariate Logistic regression analyses were used to identify risk factors for moderate/severe CAC. The association between Hb A1c/Apo A-1, Ty G-BMI, and CACS was assessed using restricted cubic spline(RCS) curves. Receiver operating characteristic(ROC) curves were plotted to evaluate the predictive value of Hb A1c/Apo A-1, Ty G-BMI, and their combination for moderate/severe CAC. Subgroup analyses by gender, age, hypertension, type 2 diabetes, smoking, and alcohol consumption history were conducted, with interaction tests using likelihood ratio tests. Results The median age of patients was 70.0(62.0, 75.0) years, including 276 males and 165 females. Multivariate Logistic regression analysis revealed fasting blood glucose(OR=1.018, 95%CI=1.009-1.028), lipoprotein(a)(OR=1.001, 95%CI=1.001-1.002), Hb A1c/Apo A-1(OR=1.158, 95%CI=1.059-1.267), and Ty G-BMI(OR=1.013, 95%CI=1.006-1.020) as risk factors for moderate/severe CAC(P<0.05). When analyzed separately as continuous and categorical variables, Hb A1c/Apo A-1 and Ty G-BMI groups Q2, Q3, and Q4 were identified as risk factors for moderate/severe CAC(P<0.05). ROC curve analysis indicated areas under the curve(AUC) for fasting blood glucose, lipoprotein(a), Hb A1c/Apo A-1, and Ty G-BMI in predicting moderate/severe CAC were 0.675(95%CI=0.625-0.725), 0.609(95%CI=0.557-0.661), 0.672(95%CI=0.622-0.732), and 0.693(95%CI=0.644-0.742), respectively. The combined AUC of Hb A1c/Apo A-1 and Ty G-BMI was 0.728(95%CI=0.682-0.775). Nonlinear RCS curve analysis showed a nonlinear relationship between Hb A1c/Apo A-1 and CACS(Pnon-linear=0.007), whereas Ty G-BMI was linearly related to CACS(Pnon-linear=0.636). Conclusion Hb A1c/Apo A-1, Ty G-BMI, and their combination are significantly correlated with the severity of CAC and have certain predictive value for severe CAC, making them worthy of clinical promotion and application.更多还原