血清高密度脂蛋白3亚型胆固醇水平与冠心病严重程度及支架内再狭窄的关系  

Association between serum high-density lipoprotein subtype 3 cholesterol levels and coronary artery diseases severity and in-stent restenosis

作　　者：吴嘉 薛丽君 于晓阳 周雨潇 张乐乐 汪俊军 Wu Jia;Xue Lijun;Yu Xiaoyang;Zhou Yuxiao;Zhang Lele;Wang Junjun(Department of Clinical Laboratory,Jinling Hospital,Medical School of Nanjing University,General Hospital of the Eastern Theater of the Chinese People′s Liberation Army,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院、解放军东部战区总医院检验科,南京210002

出　　处：《中华检验医学杂志》2023年第7期681-688,共8页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(81871702,82172360);江苏省科教能力提升工程省医学重点学科资助项目(ZDXK202238)。

摘　　要：目的探讨血清高密度脂蛋白3亚型胆固醇(HDL3-C)水平与冠状动脉病变严重程度及冠心病支架内再狭窄的关系。方法回顾性病例对照研究。选取2020年11月至2021年11月南京大学医学院附属金陵医院冠心病患者124例和健康对照者62例,其中冠心病患者包括急性冠状动脉综合征患者28例和稳定性冠心病患者96例;检测血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)和HDL3-C水平。根据冠心病患者入院时冠状动脉造影结果,计算Gensini积分,并将其分为支架内再狭窄(22例)、支架内未狭窄(23例)和无支架(79例)3个亚组;HDL3-C水平与其他参数间相关性采用Pearson或Spearman相关性分析;采用多因素Logistic回归分析HDL3-C水平与冠心病支架内再狭窄的关系。结果与对照组比较,冠心病组的血清HDL3-C、HDL-C水平均较低(P均<0.05);且血清HDL3-C水平与Gensini积分呈负相关(r=-0.201,P=0.043)。冠心病患者中,支架内再狭窄亚组的血清HDL3-C、TC、TG水平均低于支架内未狭窄亚组和无支架亚组(P均<0.05)。多因素Logistic回归分析显示,在校正了年龄、性别、调脂药物和TC、TG、LDL-C的影响后,血清HDL3-C(OR=0.885,95%CI 0.791~0.990,P=0.033)、HDL-C(OR=0.018,95%CI 0.001~0.426,P=0.013)均与冠心病发生相关;且仅HDL3-C(以支架内未狭窄亚组为参考,OR=0.833,95%CI 0.698~0.994,P=0.042;以无支架亚组为参考,OR=0.812,95%CI 0.685~0.963,P=0.017)与冠心病支架内再狭窄相关。结论冠心病尤其是支架内再狭窄患者的血清HDL3-C水平降低,且HDL3-C与冠状动脉病变严重程度、冠心病及支架内再狭窄的发生相关。Objective To explore the association between serum high density lipoprotein subtype 3 cholesterol(HDL3-C)levels and the severity and in-stent restenosis of patients with coronary artery disease.Methods 124 patients with coronary artery diseases and 62 healthy controls were included in this clinical case-control retrospective study.Participants were hospitalized from November 2020 to November 2021 at Jinling Hospital,Medical School of Nanjing University were enrolled.Patients with coronary artery disease were as follows:28 patients with acute coronary syndrome and 96 patients with stable coronary heart disease.Serum HDL3-C levels as well as total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)levels were determined.According to the coronary artery angiography results of all patients at the time of admission,Gensini scores were calculated and patients were divided into in-stent restenosis group(n=22),no in-stent stenosis group(n=23)and non-stent implantation group(n=79).The correlation between HDL3-C levels and other parameters was analyzed by Pearson or Spearman correlation analyses.Multivariate Logistic regression analyses were used to determine the impact of HDL3-C on the in-stent restenosis of coronary artery diseases.Results Compared with controls,serum levels of HDL3-C and HDL-C were significantly decreased in patients with coronary artery diseases(all P<0.05).There was a significantly negative correlation between HDL3-C levels and Gensini scores(r=-0.201,P=0.043).Among patients with coronary artery disease,serum levels of HDL3C,TC and TG in the in-stent restenosis group were significantly lower than in no in-stent stenosis group as well as than in the non-stent implantation group(all P<0.05).Multivariate Logistic regression analyses showed that after adjusting for age,sex,lipid-lowering drugs and TC,TG,LDLC parameters,HDL3-C(OR=0.885,95%CI 0.791-0.990,P=0.033)and HDL-C(OR=0.018,95%CI 0.001-0.426,P=0.013)levels were both independently

关 键 词：冠状动脉疾病 脂蛋白类 HDL3 血管成形术 经腔 经皮冠状动脉 冠状动脉再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]