血脂亚组与冠状动脉粥样硬化性心脏病患者冠状动脉狭窄程度相关性的研究  

Study on the correlation between subgroup of blood lipid with degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease

作　　者：王欣怡[1] 彭琰君 韩雪晶[3] 贾克刚[1,3] Xinyi Wang;Yanjun Peng;Xuejing Han;Kegang Jia(Clinical School of Cardiovascular Diseases,Tianjin Medical University,Tianjin 300457,China;Department of Clinical Laboratory,Second People′s Hospital of Yuhang District,Hangzhou 211121,China;Department of Clinical Laboratory,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院,天津300457 [2]杭州市余杭区第二人民医院检验科,杭州211121 [3]泰达国际心血管病医院检验科,天津300457

出　　处：《中华预防医学杂志》2021年第12期1435-1441,共7页Chinese Journal of Preventive Medicine

摘　　要：目的探讨低密度脂蛋白颗粒(low-density lipoprotein particles,LDL-P)与其他脂蛋白指标相关性,结合冠状动脉造影结果分析LDL-P及其亚组颗粒(LDL1-P~LDL6-P)浓度与冠状动脉粥样硬化性心脏病(coronary atherosclerotic heart disease,CHD)患者冠状动脉狭窄程度的相关性,探索脂蛋白亚组颗粒预防CHD患者冠状动脉狭窄严重程度的价值。方法横断面研究,连续选取2019年8至12月泰达国际心血管病医院心内科3个月内未服用降脂药行冠状动脉造影检查的259例患者,同期选取健康体检者52名。采用全自动生化分析仪检测血清超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)水平及其他生化指标,核磁共振波谱法(nuclear magnetic resonance spectroscopy,NMRS)检测血浆LDL-P、LDL1-P~LDL6-P及其他生化指标,分析各生化指标与冠状动脉狭窄程度的相关性。采用方差分析及非参数检验比较各组间指标差异,Pearson相关判断所测指标之间的相关性,Logistic回归进行多因素分析,ROC曲线评估相关指标的辅助诊断价值。结果低密度脂蛋白颗粒(low-density lipoprotein particles,LDL-P)与低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、载脂蛋白B(apolipoprotein B,ApoB)、总胆固醇(total cholesterol,TC)具有高度相关性(r=0.927,P<0.001;r=0.921,P<0.001;r=0.844,P<0.001)。冠状动脉重度狭窄患者LDL-P、LDL4-P、LDL5-P和LDL6-P水平较冠状动脉轻度狭窄患者水平高(U=4172.000,Z=4.256,P<0.001;t=2.573,P=0.011;U=3995.000,Z=4.621,P<0.001;t=5.223,P<0.001),LDL-P和LDL6-P水平较冠状动脉中度狭窄患者水平高(U=1159.000,Z=2.294,P=0.022;t=2.075,P=0.041)。高水平hs-CRP、LDL5-P、LDL6-P是冠状动脉狭窄程度的危险因子(OR=1.095,P=0.036;OR=1.015,P=0.046;OR=1.012,P=0.039)。ROC分析LDL-P、LDL5-P、LDL6-P对冠状动脉狭窄程度的鉴定价值,AUC分别为0.67、0.68、0.69,hs-CRP联合LDL5-P与LDL6-P对冠状动脉狭窄程度的辅助诊断价值最大(AUC=0.70)。结Objective To study the correlation between low-density lipoprotein particles(LDL-P)with other lipoprotein indexes.To explore the correlation between LDL-P and its subgroup particles(LDL1-P—LDL6-P)with the degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease(CHD)combining with the result of coronary arteriography.To explore the value of lipoprotein subgroup granules in preventing the severity of coronary artery stenosis in CHD patients.Methods Cross-sectional study.A total of 259 patients without lipid-lowering drugs for coronary angiography in the department of cardiology of TEDA International Cardiovascular Hospital during 3 months from August 2019 to December 2019 were collected,and 52 healthy subjects were recruited during the same period.The level of high sensitivity C-reactive protein(hs-CRP)and other biochemical indexes were detected by automatic biochemical analyzer.The level of LDL-P and other biochemical indexes were detected by nuclear magnetic resonance spectroscopy(NMRS).The relation between various biomarkers levels with coronary artery stenosis degree was analyzed.Analysis of variance and nonparametric tests were used to compare the differences of indexes among each group.Pearson correlation analysis was used to determine the correlation among the measured indexes.Logistic regression was used for multi-factor analysis,ROC curve was used to evaluate the diagnostic value of related indexes.Results LDL-P was highly correlated with low-density lipoprotein cholesterol(LDL-C),apolipoprotein B(ApoB)and total cholesterol(TC)(r=0.927,P<0.001;r=0.921,P<0.001;r=0.844,P<0.001).LDL-P,LDL4-P,LDL5-P and LDL6-P in patients with severe coronary stenosis were higher than those in patients with mild coronary stenosis(U=4172.000,Z=4.256,P<0.001;t=2.573,P=0.011;U=3995.000,Z=4.621,P<0.001;t=5.223,P<0.001),LDL-P and LDL6-P were higher than those of patients with moderate coronary stenosis(U=1159.000,Z=2.294,P=0.022;t=2.075,P=0.041).High levels of hs-CRP,LDL5-P and LDL6-P were risk f

关 键 词：低密度脂蛋白 冠状动脉粥样硬化性心脏病 核磁共振波谱法 冠状动脉狭窄程度 低密度脂蛋白亚组颗粒 

分 类 号：R541.4[医药卫生—心血管疾病]