不同类型心绞痛患者低密度脂蛋白及氧化型低密度脂蛋白的比较研究  

Comparison of plasma low-density lipoprotein and oxidized low-density lipoprotein levels with coronary lesion severities in patients with coronary artery disease

作　　者：何喜民[1] 向定成[1] 何建新[1] 洪长江[1] 邱健[1] 马骏[1] 张金霞[1] 

机构地区：[1]广州军区广州总医院心血管内科,510010

出　　处：《中华心血管病杂志》2007年第5期451-454,共4页Chinese Journal of Cardiology

基　　金：广东省自然科学基金(032186)

摘　　要：目的探讨血浆低密度脂蛋白胆固醇(LDL-C)和氧化型低密度脂蛋白(ox-LDL)与冠状动脉粥样硬化病变严重程度的关系。方法病例选择:冠状动脉痉挛组(CAS,n=31),临床上具有胸痛表现、冠状动脉造影无显著狭窄并经过乙酰胆碱试验确诊的患者,根据痉挛血管形态分为节段性痉挛组和弥漫性痉挛组;稳定性心绞痛组(SAP,n=35),为稳定的劳力型心绞痛患者,根据冠状动脉造影结果分为单支病变组和多支病变组;对照组(n=24),为健康体检患者。各组于清晨空腹采取静脉血,采用全自动生化分析仪测定血浆 LDL-C,用 ELISA 法检测血浆 ox-LDL 含量,分组比较其 LDL-C及 ox-LDL 水平。结果血浆 LDL-C 水平 SAP 亚组[单支病变组(2.6±0.9)mmol/L,多支病变组(2.8±0.9)mmol/L]和 CAS 亚组[弥漫性痉挛组(3.2±0.5)mmol/L,节段性痉挛组(2.9±0.8)mmol/L]间差异无统计学意义,但均高于对照组[(2.2±0.5)mmol/L,P<0.05];SAP 组血浆 ox-LDL含量[(575±219)μg/L]高于对照组[(218±35)μg/L,P<0.01]和 CAS 组[(299±117)μg/L,P<0.01],CAS 组与对照组比较,差异无统计学意义(P>0.05);弥漫性痉挛组[(225±63)μg/L]、节段性痉挛组[(328±123)μg/L]、单支血管病组[(462±72)μg/L]、多支血管病变组[(672±92)μg/L]的血浆 ox-LDL 浓度逐步上升,各组间差异有统计学意义(P<0.05),与冠状动脉硬化程度呈一致趋势,而血浆 LDL 水平组间差异无统计学意义。结论血浆 ox-LDL 比 LDL-C 更能准确地预测冠状动脉粥样硬化的严重程度,调脂治疗应该更为重视降低 ox-LDL,而不应单纯控制 LDL 水平。Objective To explore the relationship between plasma low-density lipoprotein （LDL） and oxidized low-density lipoprotein （ox-LDL） levels and the severity of coronary atherosclerosis. Methods Fasting plasma ox-LDL was measured by enzyme-linked immunosorbent assay and plasma LDL was measured by biochemical autoanalyser in 31 patients with coronary artery spasm （CAS group, chest pain with positive acetyleholine provocation test but without significant coronary artery stenosis）, 35 patients with stable angina pectoris （SAP group） and 24 healthy persons （control group）. Results Plasma LDL levels were similar between CAS and SAP groups but significantly higher than that in control group. Plasma ox-LDL levels significantly increased in proportion to coronary lesion severities [ SAP （575 ± 219 μg/L） 〉 CAS （299 ± 117 μg/L） 〉 control （218 ± 35 μg/L）]. In SAP group, plasma ox-LDL level was also significantly higher in multi-vessel disease group than that in single-vessel disease group （672 ± 92 vs. 462 ± 72 μg/L, P 〈0.05 ）. Conclusion Plasma ox-LDL but not LDL level is significantly correlated to the severity of coronary atheroselerosis and should therefore be the focused therapy target in patients with coronary artery disease.

关 键 词：冠状动脉硬化 心绞痛 脂蛋白类 LDL 

分 类 号：R541.4[医药卫生—心血管疾病]