不同血脂成分与冠状动脉病变相关性的初步探讨  

Preliminary study on the correlation between different blood lipids and coronary artery disease

作　　者：吴祖飞 陈诗 刘叶红 苏文韬 宗刚军[1,2] 吴刚勇 WU Zufei;CHEN Shi;LIU Yehong;SU Wentao;ZONG Gangjun;WU Gangyong(Department of Cardiology,Wuxi Clinical College of Anhui Medical University,Wuxi,Jiangsu,214044,China;Department of Cardiology,the 904th Hospital of the PLA Joint Logistics Support Force)

机构地区：[1]安徽医科大学无锡临床学院心内科,江苏无锡214044 [2]中国人民解放军联勤保障部队第904医院心血管内科

出　　处：《临床心血管病杂志》2021年第9期816-824,共9页Journal of Clinical Cardiology

基　　金：江苏省青年医学人才基金(No:QNRC2016883);无锡市科技局医疗与公众健康技术创新应用项目资助(No:N20202035)。

摘　　要：目的:探讨不同血脂成分与患者冠状动脉病变的相关性,识别预测冠状动脉病变的最佳血脂指标。方法:入选因胸痛行冠状动脉造影检查的患者,根据造影结果将患者分为冠状动脉正常组(对照组,123例)和冠心病组(366例),进而依据Gensini积分将冠心病组分为轻度病变亚组(Gensini评分<30,177例)、重度病变亚组(Gensini评分≥30,189例)。检测各组患者的TC、TG、LDL-C、HDL-C、ApoA-1、ApoB等指标,计算non-HDLC、TC/HDL-C、LDL-C/HDL-C、ApoB/ApoA-1等,并进行统计分析。结果:①与对照组相比,冠心病组患者ApoA-1水平显著降低,而ApoB/ApoA-1显著升高,差异均有统计学意义(P<0.05)。②多因素logistic回归分析结果提示年龄、糖尿病、吸烟、ApoB/ApoA-1是冠心病的独立危险因素;年龄、糖尿病、吸烟、ApoB/ApoA-1是冠状动脉重度病变的独立危险因素,ApoA-1是冠心病、冠状动脉重度病变的独立保护因素。③相关性分析结果表明ApoA-1与Gensini积分、冠状动脉病变血管数之间呈负相关(分别r=-0.367,r=-0.341,均P<0.01),ApoB/ApoA-1与Gensini积分、冠状动脉病变血管数之间呈正相关(分别r=0.371,r=0.350,均P<0.01)。④ROC曲线分析结果显示,ApoB/ApoA-1、ApoA-1对冠心病及冠状动脉重度病变具有一定的预测价值,相较其他血脂指标其预测价值较强。结论:相较于其他血脂指标,ApoA-1、ApoB/ApoA-1与冠心病发生发展的相关性最强。Objective:To explore the correlation between different blood lipid components and patients with coronary artery disease,and identify the best blood lipid index for predicting coronary artery disease.Methods:Patients who were selected for coronary angiography due to chest pain were divided into normal coronary artery group(control group,Gensini score=0,n=123)and coronary heart disease group(n=366)according to the results of the angiography,and then according to Gensini scores Coronary heart disease was divided into the subgroup of mild disease(Gensini score<30,n=177)and the subgroup of severe disease(Gensini score≥30,n=189).Detect TC,TG,LDL-C,HDL-C,ApoA-1,ApoB and other indicators of each group of patients,and calculate non-HDL-C,TC/HDL-C,LDL-C/HDL-C,ApoB/ApoA-1.AI,AIP,LCI.Results:(1)Compared with the control group,the levels of ApoA-1in the coronary heart disease group were significantly reduced,while ApoB/ApoA-1were significantly increased(P<0.05).(2)Multivariate logistic regression analysis suggested that age,diabetes,smoking,and ApoB/ApoA-1were independent risk factors for coronary heart disease,and age,diabetes,smoking,and ApoB/ApoA-1were independent risk factors for severe coronary artery disease.ApoA-1 was an independent protective factor for coronary heart disease and severe coronary artery disease.(3)The results of correlation analysis showed that ApoA-1was negatively correlated with Gensini score and the number of coronary artery diseased blood vessels(r=-0.367,r=-0.341,P<0.01),ApoB/ApoA-1was a positive correlation with Gensini score and the number of coronary artery diseased vessels(r=0.371,r=0.350,respectively,P<0.01).(4)ROC curve analysis results showed that ApoB/ApoA-1and ApoA-1have certain predictive values for coronary heart disease and severe coronary artery disease,and their predictive value were stronger than other blood lipid indexes.Conclusion:Compared with other blood lipid indexes,ApoA-1,ApoB/ApoA-1have the strongest correlation with coronary heart disease.

关 键 词：载脂蛋白A-1 载脂蛋白B/载脂蛋白A-1 GENSINI积分 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病]