血清残余脂蛋白胆固醇浓度对冠状动脉易损斑块的诊断价值  

The diagnostic significance of serum residual lipoprotein cholesterol concentration for coronary artery vulnerable plaque.

作　　者：陈新杰 邓凌达 陈海雄 胡秋根 CHEN Xin-jie;DENG Ling-da;CHEN Hai-xong;HU Qiu-gen(Department of Radiology,Shunde Hos-pital of Southern Medical University(The First People's Hospital of Shunde District),Foshan 52800,Guangdong,China)

机构地区：[1]南方医科大学顺德医院(佛山市顺德区第一人民医院)放射科,广东佛山528000

出　　处：《广东医学》2022年第5期597-602,共6页Guangdong Medical Journal

基　　金：广东省中医药局科研项目(20201344)。

摘　　要：目的探究残余脂蛋白胆固醇(RLP-C)等血脂指标对易损斑块的诊断价值及与心血管残余风险的相关性。方法回顾性收集经冠状动脉CT血管成像(coronary artery computed tomography angiography,CCTA)检查发现任意一支冠状动脉上存在易损斑块并造成管腔狭窄的冠状动脉硬化患者280例,纳入同期非易损斑块组和无冠状动脉斑块组各280例作为对照。收集临床基本资料、血脂、炎症检验相关指标,根据公式计算RLP-C浓度。采用logistic回归分析RLP-C与易损斑块的关系。绘制血脂指标预测易损斑块发生ROC曲线。进一步根据患者血清LDL-C水平进行亚组内分析。结果RLP-C浓度在3组间两两比较,差异均有统计学意义,其中易损斑块组患者RLP-C浓度中位数最高,为1.00(0.73,1.27)mmol/L。校正了性别、年龄、冠心病、传统危险因素(吸烟、高血压、糖尿病)、炎症标志物(NEU、LYM)后,结果显示TG、LDL-C、HDL-C、RLP-C是易损斑块的独立影响因素(OR值分别为2.044、1.942、0.582、3.562;P=0.001、P=0.001、0.025、P<0.001)。绘制不同血脂预测易损斑块的ROC曲线,当RLP-C取值0.78 mmol/L时,曲线下面积最大(AUC=0.757),此时特异度及敏感度分别为56.43%、91.43%(P<0.001)。根据LDL-C水平进行的亚组logistic回归分析显示,在LDL-C<1.80 mmol/L的亚组内,仅RLP-C是易损斑块独立危险因素(OR=7.765,P=0.001)。结论血清LDL-C、TG及RLP-C浓度升高是易损斑块的独立危险因素,HDL-C是易损斑块的保护因素,进一步LDL-C<1.80 mmol亚组内分析,RLP-C浓度升高是心血管残余风险的危险因素。Objective To investigate the diagnostic value of lipid indices such as RLP-C for vulnerable plaque and its correlation with residual cardiovascular risk.Methods A total of 280 patients with coronary atherosclerosis who were found to have vulnerable plaque on any one coronary artery and luminal stenosis by CCTA examination from June 2016 to June 2017 were retrospectively collected,and 280 cases each in the non-vulnerable plaque group or non-plaque group during the same period were included as controls.Basic clinical data,lipids and inflammatory test-related indexes were collected.The RLP-C concentration was calculated according to the formula.Logistic regression was used to ana-lyze the correlation between RLP-C and vulnerable plaque.The ROC curves of lipid and inflammation indexes were plot-ted to predict the occurrence of vulnerable plaque.Further intra-subgroup analysis was performed based on the serum LDL-C levels of patients.Results RLP-C concentrations were significantly differed among the three groups(P<0.05);with patients in the vulnerable plaque group having the highest RLP-C concentration of 1.00(0.73,1.27)mmol/L.After correcting for sex,age,traditional risk factors for coronary heart disease(smoking,hypertension,diabe-tes),and inflammatory markers(NEU,LYM),the results showed that TG,LDL-C,HDL-C and RLP-C were inde-pendent risk factors for vulnerable plaque(OR:2.044,1.942,0.582 and 3.562;P=0.001,P=0.001,P=0.025 and P<0.001).ROC curve analysis yielded that RLP-C predicted vulnerable plaque with the largest area under the curve(AUC=0.757)and the best cutoff value was 0.78 mmol/L,with specificity and sensitivity of 56.43%and 91.43%,re-spectively(P<0.001).Logistic regression analysis of subgroups based on LDL-C levels showed that within the sub-group of 1.80 mmol/L,only RLP-C was an independent risk factor for vulnerable plaque(OR:7.765,P=0.001).Conclusion LDL-C,TG and RLP-C are independent risk factors for vulnerable plaque.HDL-C is a protective fac-tor for vulnerable plaque,and RLP-C is a risk factor for r

关 键 词：冠状动脉粥样硬化性心脏病 冠状动脉CT血管成像 易损斑块 残余脂蛋白胆固醇 

分 类 号：R541.4[医药卫生—心血管疾病] R825.4[医药卫生—内科学]