高密度脂蛋白亚组分与高血压的关系  

Association Between High-density Lipoprotein Subfractions and Hypertensive Status

作　　者：刘硕霖 张彦[1] 李莎[1] 徐瑞霞[1] 郭远林[1] 朱成刚[1] 高莹[1] 董倩[1] 刘庚[1] 孙静[1] 吴娜琼[1] 李建军[1] LIU Shuo-lin;ZHANG Yan;LI Sha;XU Rui-xia;GUO Yuan-lin;ZHU Cheng-gang;GAO Ying;DONG Qian;LIU Geng;SUN Jing;WU Na-qiong;LI Jian-jun(Division of Dyslipidemia,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院血脂异常与心血管疾病诊治中心,北京市100037

出　　处：《中国循环杂志》2018年第9期846-850,共5页Chinese Circulation Journal

基　　金：首都卫生发展科研专项基金(201614035);中国医学科学院重要协作创新项目基金(2016-I2M-1-011)

摘　　要：目的:探讨高密度脂蛋白(HDL)亚组分与高血压的关系。方法:连续入选953例患者,并根据有无高血压分为高血压组(n=550)和非高血压组(n=403)。高血压组患者根据降压药物应用情况分为服用药物亚组(n=319,其中单药治疗患者193例,≥2种药物治疗患者126例)和未服用药物亚组(n=231)。应用Lipoprint脂蛋白分类检测仪对HDL颗粒进行分类。分析HDL亚组分与高血压的相关性。结果:高血压组患者的血浆大颗粒高密度脂蛋白胆固醇(HDL-C)水平显著低于非高血压组患者,但其血浆小颗粒HDL-C水平高于非高血压组患者(P均<0.05)。血压控制良好的高血压患者的小颗粒HDL-C水平明显低于血压控制不佳的高血压患者(P<0.05)。多因素Logistic回归模型分析在校正了混杂因素后,大颗粒HDL-C(OR=0.957,95%CI:0.934~0.981,P<0.001)与高血压患病呈负相关,而小颗粒HDL(OR=1.047,95%CI:1.020~1.074,P<0.001)与高血压患病呈正相关。在高血压组患者中,无论是单因素还是多因素Logistic回归分析,各种HDL亚组分与冠心病均不相关(P>0.05)。结论:HDL亚组分受血压的影响,高血压患者大颗粒HDL-C水平降低。高血压不利于大颗粒HDL对心血管的保护作用。Objectives： The exact mechanisms of hypertension contributing to atherosclerosis have not been fully elucidated. Although multiple studies have clarified the association of hypertension with low-density lipoprotein（LDL） subfractions, uncertainty remains about its relationship with high-density lipoprotein（HDL） subfractions. Therefore, we comprehensively determined the relationship between HDL subfractions and hypertensive status. Methods： A total of 953 consecutive subjects without previous lipid-lowering drug treatment were enrolled and were divided as hypertension（n=550） and normotensive（n=403） group. Hypertensive patients were further divided into medication subgroup（n=319, monotherapy n=193, ≥2 medications n=193） and untreated group（n=231）. Baseline clinical and laboratory data were collected. HDL separation was performed using the Lipoprint System. Results： Plasma large HDL-cholesterol（HDL-C） level was significantly lower whereas the small HDL-C level was significantly higher in patients with hypertension（all P〈0.05）. The small HDL subfraction level was significantly lower in patients with well-controlled blood pressure than in patients with uncontrolled blood pressure（P〈0.05）. Multiple regression analysis showed that large HDL-C was inversely related to hypertension（OR=0.957, 95%CI：0.934-0.981, P 0.001）, whereas small HDL-C was positively related to hypertension（OR=1.047, 95%CI：1.020-1.074, P 0.001）after adjusting potential confounders. In the univariate and multivariate logistic analysis conducted in patients with hypertension, HDL subfractions were not related to coronary artery diseases（P〈0.05）.Conclusions： HDL subfractions is closely associated with hypertensive status and hypertension may potentially reduce the cardio-protective value of large HDL subfraction.

关 键 词：高血压 脂蛋白 冠心病 

分 类 号：R54[医药卫生—心血管疾病]