【目的】 探讨载脂蛋白B（apoB）及其与载脂蛋白A1（apoA1）的比值（apoB/A1）对急性心肌梗死（AMI）痰瘀互结证的预测价 值。【方法】 收集试验周期内就诊于佛山市中医院的经冠脉造影确诊为AMI的患者共200例，收集患者的性别、年龄、既往病 史（高血压病、冠心病、糖尿病）、吸烟史等基本信息以及四诊资料和血脂、冠脉病变支数、Gensini评分等相关指标，通过 单因素和多因素 Logistic回归分析以及绘制受试者工作特征（ROC）曲线等统计学方法探讨 apoB、apoB/A1对 AMI痰瘀互结证 的预测价值。【结果】（1）中医证型分布方面：200例AMI患者中，痰瘀互结证74例，气虚血瘀证41例，气滞血瘀证36例，其 他证型 49例（包括寒凝心脉证 16例、气阴两虚证 22例、正虚阳脱证 11例）。（2）不同中医证型的冠脉病变情况方面：不同中 医证型的 Gensini评分比较，差异有统计学意义（H = 43.735，P = 0.000 < 0.001），其中，气虚血瘀证、气滞血瘀证、痰瘀互 结证的 Gensini评分较高，分别为 60.0（43.0，87.0）、70.0（48.5，84.0）、65.0（40.0，95.0）分，均高于其他证型的 44.0（32.0， 64.0）分，组间比较，差异均有统计学意义（P < 0.05）；而不同中医证型的病变支数比较，差异无统计学意义（H = 1.180，P = 0.758 > 0.05）。（3）相关性分析结果显示，冠脉病变支数、Gensini评分与 apoB/A1呈显著性正相关（r = 0.140，P = 0.049 < 0.05；r = 0.205，P = 0.004 < 0.01）。（4）单因素和多因素Logistic回归分析结果显示，apoB、apoB/A1是痰瘀互结证的独 立危险因素（P < 0.01）。ROC曲线分析结果显示，apoB/A1对AMI痰瘀互结证有较高的预测价值，其敏感性和特异性均较高。 【结论】 apoB/A1可以作为临床中预测痰瘀互结型AMI的客观指标。

Objective To analyze the predictive value of apolipoprotein B（apoB）and apoB to apolipoprotein A1 （apoA1）ratio（apoB / A1）in acute myocardial infarction（AMI）of phlegm blended with blood stasis syndrome. Methods A total of 200 patients with AMI confirmed by coronary angiography in Foshan Hospital of Traditional Chinese Medicine during the trial period were collected. Data collection covered the basic information of gender， age，medical history of hypertension，coronary heart disease and diabetes mellitus，and smoking history，the information of four diagnostic methods of traditional Chinese medicine（TCM），and relevant indicators of blood lipids，the number of lesioned branches of coronary arteries and the Gensini scores. The predictive value of apoB and apoB/A1 for AMI of phlegm blended with blood stasis syndrome was explored by univariate Logistic regression analysis and multivariate Logistic regression analysis as well as by plotting the Receiver Operating Characteristic （ROC）curves. Results（1）Among the 200 AMI patients，41 cases were differentiated as qi deficiency and blood stasis syndrome，36 cases as qi stagnation and blood stasis syndrome，74 cases as phlegm blended with blood stasis syndrome， and 49 cases as other syndromes（including 16 cases of cold accumulation in heart vessels syndrome，22 cases of qi and yin deficiency syndrome，and 11 cases of healthy-qi deficiency and yang collapse syndrome）.（2）The difference of Gensini scores among the patients with various TCM syndrome types were statistically significant（H = 43.735，P = 0.000 < 0.001）. And the Gensini scores in the patients with syndromes of qi deficiency and blood stasis，qi stagnation and blood stasis，and phlegm blended with blood stasis were relatively high， being 60.0（43.0， 87.0）， 70.0（48.5， 84.0）and 65.0（40.0， 95.0）points， respectively， which were higher than that of the other TCM syndrome types [44.0（32.0，64.0）points]. The pairwise comparison between various TCM syndrome types showed that the differences were statistically significant（P < 0.05）. However，there was no statistically significant difference in the number of lesioned branches of coronary arteries among the patients with various TCM syndrome types（H = 1.180，P = 0.758 > 0.05）.（3）The results of correlation analysis showed that the number of lesioned branches of coronary arteries， Gensini score and apoB / A1 were significantly and positively correlated（r = 0.140，P = 0.049 < 0.05；r = 0.205，P = 0.004 < 0.01）.（4）The results of univariate Logistic regression analysis and multivariate Logistic regression analysis showed that apoB and apoB / A1 were the independent risk factors for phlegm blended with blood stasis syndrome（P < 0.01）. ROC curve analysis showed that apoB/A-1 exerted a high predictive value for AMI of phlegm blended with blood stasis syndrome，with high sensitivity and specificity. Conclusion It is indicated that ApoB / A1 can be used as an objective indicator for predicting AMI of phlegm blended with blood stasis syndrome in clinical practice.

R259.414

佛山市科技局科研项目（编号：2220001004579）；佛山市卫生健康局科研项目（编号：20230382）；佛山市高水平医院建设 “登峰计划”实施方案项目（编号：佛卫函 【2021】 73号）