LDL-C和non-HDL-C对家族性高三酰甘油血症和家族性混合型高脂血症的鉴别诊断价值的比较  

Comparison of the value of LDL-C and non-HDL-C in differential diagnosis of familial hypertriglyceridemia and familial combined hyperlipidemia

作　　者：付晓艳[1] 靳慧亚 何津春[2] 颜丽[3] 苏娜[2] 于海涛[2] 杨静[4] 

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院医学检验中心,甘肃兰州730000 [3]甘肃省人民医院检验中心,甘肃兰州730000 [4]兰州大学第二医院儿童心理行为科,甘肃兰州730000

出　　处：《西安交通大学学报（医学版）》2017年第3期427-430,436,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家"十五"重大科技专项(No.2002BA711A08-17);教育部科技基础平台建设(No.505015);甘肃省自然科学研究基金(No.1308RJZA218;1302FKDA034);甘肃省卫生行业科研计划管理项目(No.GW GL2014-48)~~

摘　　要：目的比较低密度脂蛋白胆固醇(LDL-C)和非高密度脂蛋白胆固醇(non-HDL-C)在家族性高三酰甘油血症(FHTG)和家族性混合型高脂血症(FCHL)鉴别诊断中的应用价值。方法选取9个FHTG家系共94人、24个FCHL家系共94人,根据血脂异常情况将2个家系再分为受累组和未受累组;另设10个对照家系(共57人)。比较各家系血清三酰甘油(TAG)、总胆固醇(TC)、HDL-C、LDL-C、non-HDL-C等血脂指标水平;FHTG家系和FCHL家系按TAG水平分层后,分析non-HDL-C和LDL-C的相关性;最后用受试者工作特征曲线(ROC曲线)分析比较nonHDL-C和LDL-C用于FHTG家系和FCHL家系鉴别诊断的cut-off值。结果 FHTG家系受累组TAG、TC、nonHDL-C水平均高于未受累组和对照组(P<0.01或P<0.05);FCHL家系受累组TAG、TC、HDL-C、LDL-C、nonHDL-C水平均高于未受累组和对照组(P<0.01或P<0.05);FHTG家系受累组TAG水平显著高于FCHL家系受累组(P<0.01),而TC、HDL-C、LDL-C、non-HDL-C水平低于FCHL家系(P<0.01或P<0.05)。FHTG家系和FCHL家系内non-HDL-C和LDL-C均呈正相关,但随TAG水平升高其相关性均呈下降趋势;LDL-C和non-HDL-C用于FHTG家系和FCHL家系鉴别诊断的最佳cut-off值分别为3.575、4.525mmol/L。结论除常规血脂指标外,non-HDL-C可能是鉴别诊断FHTG家系和FCHL家系的新指标;其鉴别诊断价值可能优于LDL-C。Objective To evaluate the value of low-density lipoprotein-cholesterol(LDL-C)and non-highdensity lipoprotein-cholesterol(non-HDL-C)in differential diagnosis of familial hypertriglyceridemia(FHTG)and familial combined hyperlipidemia(FCHL).Methods We recruited9 FHTG pedigrees(94 subjects)and24 FCHL pedigrees(94 subjects)and then divided them into affected groups and non-affected groups according to lipid abnormality.Another 10 normal control pedigrees(57 subjects)served as controls.We compared the routine lipid levels such as triglyceride(TAG),total cholesterol(TC),HDL-C and LDL-C and non-HDL-C between the groups.After stratification based on TAG level,we observed the relationship between LDL-C and non-HDL-C.Last we confirmed and analyzed the cut-off value of differential diagnosis between FHTG and FCHL with receiver operating characteristic(ROC)curve.Results The levels of TAG,TC,and non-HDL-C were significantly higher in the affected group of FHTG than in the non-affected group of FHTG and the normal group(P<0.01 or P<0.05).The levels of TAG,TC,HDL-C,LDL-C and non-HDL-C were significantly higher in the affected group of FCHL than in the non-affected group of FCHL and the normal group(P<0.01 or P<0.05).The levels of TAG were significantly higher(P<0.01)while TC,HDL-C,LDL-C and non-HDL-C levels were significantly lower(P<0.01 or P<0.05)in the affected group of FHTG than in the affected group of FCHL.The association between LDL-C and non-HDL-C was positive both in FHTG and FCHL,but the relationship became weaker as TAG level increased.The cut-off value of LDL-C and non-HDL-C was 3.575 mmol/L and 4.525 mmol/L,respectively.Conclusion In addition to the routinely used lipid indexes,non-HDL-C may be a new index for differential diagnosis of FHTG and FCHL,and may be superior to LDL-C in this regard.

关 键 词：低密度脂蛋白胆固醇(LDL-C) 非高密度脂蛋白胆固醇(non-HDL-C) 家族性高三酰甘油血症(FHTG) 家族性混合型高脂血症(FCHL) 

分 类 号：R589.2[医药卫生—内分泌]