血清小而密低密度脂蛋白胆固醇、同型半胱氨酸与颈动脉粥样硬化关系研究  

Relationship among small and dense low density lipoprotein cholesterol,homocysteine and carotid atherosclerosis

作　　者：程小兵[1] 罗娟娟[2] 陈燕[1] 韩卫星[3] 李庆群 潘文博[1] Cheng Xiaobing;Luo Juanjuan;Chen Yan;Han Weixing;Li Qingqun;Pan Wenbo(Department of Cardiovascular Medicine,Hefei Third Clinical College,Anhui Medical University,Hefei 230001,China;不详)

机构地区：[1]安徽省合肥市安徽医科大学合肥第三临床学院(合肥市第三人民医院)心血管内科,合肥230001 [2]江西省赣州市赣南医学院生理教研室,赣州341000 [3]安徽医科大学第一附属医院心血管内科,合肥230001 [4]深圳市中国科学院大学深圳医院(光明)内科,深圳518107

出　　处：《中国循证心血管医学杂志》2021年第2期173-177,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：江西省教育厅青年基金项目(GJJ161004);合肥市卫生计生委应用医学研究重点课题(Hwk2016zd009);安徽医科大学合肥第三临床学院重点扶持课题(SYKF201902);安徽医科大学合肥第三临床学院重点课题(SYKZ202002)。

摘　　要：目的探讨血清小而密低密度脂蛋白胆固醇(sdLDL-C),小而密低密度脂蛋白胆固醇与低密度脂蛋白胆固醇之比(sdLDL-C/LDL-C)及同型半胱氨酸(Hcy)与颈动脉硬化的关系,并分析sdLDL-C/LDL-C评价颈动脉斑块的价值。方法选取2017年10月至2019年10月于安徽医科大学合肥第三临床学院心内科住院并行颈动脉彩超检查的200例患者为研究对象,根据颈动脉超声结果分为颈动脉内膜中层厚度(IMT)异常组(n=122)和对照组(n=78)。其中,IMT异常组又分为IMT增厚组(n=30)及颈动脉斑块组(n=92)。Spearman相关分析sdLDL-C与年龄、体质指数(BMI)、LDL-C、高密度脂蛋白胆固醇(HDL-C)、sdLDL-C/LDL-C、超敏C反应蛋白(hs-CRP)、Hcy的相关性;二元Logistic逐步回归方程及有序多分类Logistic回归模型评估颈动脉斑块的独立危险因素。结果IMT异常组血清sdLDL-C、sdLDL-C/LDL-C和Hcy水平均明显高于对照组,差异有统计学意义(P<0.05)。颈动脉斑块组血清sdLDL-C、sdLDL-C/LDL-C和Hcy水平均明显高于IMT增厚组,差异亦均有统计学意义(P<0.001)。Logistic逐步回归分析显示年龄、糖尿病、Hcy、sdLDL-C/LDL-C、sdLDL-C是IMT增厚和颈动脉斑块的独立危险因素。结论在伴有IMT增厚、颈动脉斑块患者中sdLDL-C、sdLDL-C/LDL-C、Hcy水平显著升高。血清sdLDL-C/LDL-C、sdLDL-C、Hcy含量具有颈动脉斑块的预测价值,且是颈动脉粥样硬化的独立危险因素。Objective To investigate the relationship among small and dense low density lipoprotein cholesterol(sdLDL-C),ratio of sdLDL-C and LDL-C(sdLDL-C/LDL-C),homocysteine(Hcy)and carotid atherosclerosis(CAS),and analyze value of sdLDL-C/LDL-C in reviewing carotid plaques.Methods CAS patients(n=200)hospitalized and undergone carotid color ultrasound examination were chosen from Department of Cardiovascular Medicine in Hefei Third Clinical College of Anhui Medical University from Oct.2017 to Oct.2019,and divided,according to their ultrasound examination results,into abnormal intima-media thickness group(abnormal IMT group,n=122)and control group(n=78).The abnormal IMT group was further divided into IMT thickening group(n=30)and carotid plaque group(n=92).The correlation among sdLDL-C and BMI,LDL-C,HDL-C,sdLDL-C/LDL-C,hsCRP and Hcy was analyzed by using Spearman correlation analysis.The independent risk factors of carotid plaques were reviewed by using binary Logistic stepwise regression equation and ordinal ploytomous Logistic regression model.Results The levels of serum sdLDL-C,sdLDL-C/LDL-C and Hcy were significantly higher in abnormal IMT group than those in control group(P<0.05).The levels of serum sdLDL-C,sdLDL-C/LDL-C and Hcy were significantly higher in carotid plaque group than those in IMT thickening group(P<0.001).The results of Logistic stepwise regression analysis showed that age,diabetes,Hcy,sdLDL-C/LDL-C and sdLDL-C were independent risk factors of IMT thickening and carotid plaques.Conclusion The levels of sdLDL-C,sdLDL-C/LDL-C and Hcy increase significantly in CAS patient with IMT thickening and carotid plaques.The levels of sdLDL-C/LDL-C,sdLDL-C and Hcy have predictive value to carotid plaques and are independent risk factors of CAS.

关 键 词：颈动脉斑块 小而密低密度脂蛋白胆固醇 同型半胱氨酸 颈动脉粥样硬化 

分 类 号：R589.2[医药卫生—内分泌]