血脂水平在冠心病患者冠状动脉狭窄评估和治疗中的价值  

Role of blood lipid levels in assessment of coronary artery stenosis and its treatment in patients with coronary heart disease

作　　者：乌有弘[1] 宋云霄[2] 朱勇[1] 葛雯[2] 卞晓波 袁文华[2] 赵智赟[2] WU Youhong;SONG Yunxiao;ZHU Yong;GE Wen;BIAN Xiaobo;YUAN Wenhua;ZHAO Zhiyun(Department of Radiology,Shanghai Xuhui Central Hospital,Shanghai 200031,China;Department of Clinical Laboratory,Shanghai Xuhui Central Hospital,Shanghai 200031,China)

机构地区：[1]上海市徐汇区中心医院放射科,上海200031 [2]上海市徐汇区中心医院检验科,上海200031

出　　处：《检验医学》2023年第6期584-589,共6页Laboratory Medicine

摘　　要：目的探讨血脂相关指标在评估冠心病患者冠状动脉狭窄程度和治疗方案中的价值。方法收集2018年1月—2022年12月上海市徐汇区中心医院确诊为冠心病的患者470例。按冠状动脉狭窄程度分为Ⅰ级组(80例)、Ⅱ级组(137例)、Ⅲ级组(204例)、Ⅳ级组(49例);按是否需接受外科/介入治疗分为治疗组(260例)和非治疗组(210例)。检测所有研究对象的低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白(apo)A1、apo B、总胆固醇(TC)和脂蛋白(a)[Lp(a)]水平。采用Logistic回归分析评估冠心病患者冠状动脉狭窄或需治疗的危险因素。采用LASSO回归分析建立基于血脂指标的判断冠心病患者治疗与否的模型。采用受试者工作特征(ROC)曲线评估模型判断冠心病患者需接受治疗的效能。结果Ⅰ级组、Ⅱ级组、Ⅲ级组和Ⅳ级组血清TC、TG、LDL-C、apo A1和apo B水平依次升高(P<0.05),血清HDL-C水平依次降低(P<0.05)。Ⅲ级组和Ⅳ级组血清Lp(a)水平显著高于Ⅱ级组和Ⅰ级组(P<0.001),Ⅱ级组显著高于Ⅰ级组(P<0.001)。Logistic回归分析结果显示,TG和LDL-C水平升高是狭窄Ⅱ级和Ⅲ级的危险因素(P<0.05),HDL-C水平降低是狭窄Ⅱ级和Ⅲ级的危险因素(P<0.05),TC水平升高是狭窄Ⅲ级和Ⅳ级的危险因素(P<0.05)。治疗组血清TC、TG、LDL-C、apo A1、apo B和Lp(a)水平显著高于非治疗组(P<0.001),HDL-C水平显著低于非治疗组(P<0.001)。Logistic回归分析结果显示,TC、TG、LDL-C、apo A1、apo B和Lp(a)水平升高和HDL-C水平降低均是冠心病患者需接受治疗的危险因素(P<0.01)。LASSO回归分析结果显示,基于TC、TG和Lp(a)的联合检测模型判断冠心病患者需接受治疗的曲线下面积为0.939。结论血脂相关指标可用于评估冠状动脉狭窄程度,并可作为指导临床进行干预性治疗的潜在指标。Objective To investigate the value of blood lipid-related indexes in assessing the degree of coronary artery stenosis and treatment in patients with coronary heart disease.Methods Totally,470 patients diagnosed with coronary heart disease in Shanghai Xuhui Central Hospital were collected from January 2018 to December 2022.According to the degree of coronary artery stenosis,the patients were classified into gradeⅠgroup(80 cases),gradeⅡgroup(137 cases),gradeⅢgroup(204 cases)and gradeⅣgroup(49 cases).The patients were classified into treatment groups(260 cases)and non-treatment groups(210 cases)according to whether they needed surgical or interventional treatment.The levels of low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),apolipoprotein(apo)A1,apo B,total cholesterol(TC)and lipoprotein(a)[Lp(a)]were determined.Logistic regression analysis was used to evaluate the risk factors for coronary artery stenosis or treatment in patients with coronary heart disease.LASSO regression analysis was used to establish a model for judging the treatment of coronary heart disease patients based on blood lipid indicators.Receiver operating characteristic(ROC)curve was used to evaluate the model's efficacy in determining the need for treatment in patients with coronary heart disease.Results The levels of TC,TG,LDL-C,apo A1 and apo B in gradeⅠgroup,gradeⅡgroup,gradeⅢgroup and gradeⅣgroup were increased successively(P<0.05),and serum HDL-C levels were decreased successively(P<0.05).Lp(a)levels in gradeⅢandⅣgroup were higher than those in gradeⅠandⅡgroups(P<0.001),and that in gradeⅡgroup was higher than that in gradeⅠgroup(P<0.001).Logistic regression analysis showed increased TG and LDL-C levels were risk factors for gradeⅡandⅢstenosis(P<0.05).Decreased HDL-C level was a risk factor for gradeⅡandⅢstenosis(P<0.05),and increased TC level was a risk factor for gradeⅢandⅣstenosis(P<0.05).The serum levels of TC,TG,LDL-C,apo A1,apo B and Lp(a)in t

关 键 词：血脂 冠状动脉狭窄 冠心病 治疗 

分 类 号：R446.1[医药卫生—诊断学]