血清sd-LDL-C与2型糖尿病患者冠状动脉病变严重程度和心血管事件发生风险的相关性  

Correlation between serum sd-LDL-C,the severity of coronary heart disease and the risk of cardiovascular events in type 2 diabetes mellitus patients

作　　者：张爱民[1] 殷悦[1] 秦莉[1] 张娜[1] 王春燕[1] 贾玫[1] 裴林[1] ZHANG Aimin;YIN Yue;QIN Li;ZHANG Na;WANG Chunyan;JIA Mei;PEI Lin(Department of Clinical Laboratory,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院检验科,北京100044

出　　处：《检验医学》2025年第1期66-72,共7页Laboratory Medicine

基　　金：北京市自然科学基金项目(7222194)。

摘　　要：目的探讨血清小而密低密度脂蛋白胆固醇(sd-LDL-C)与2型糖尿病(T2DM)患者冠状动脉病变严重程度和发生心血管事件风险的相关性。方法选取2016年1月—2019年3月北京大学人民医院汉族T2DM患者3315例。收集所有患者的一般资料,并检测空腹血糖(FBG)、同型半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(apo A1)、载脂蛋白B(apo B)、脂蛋白(a)[Lp(a)]、sd-LDL-C和糖化血红蛋白(HbA1c)。根据冠状动脉造影(CAG)结果将所有患者分为冠心病(CHD)组(T2DM合并CHD,1998例)和非CHD组(T2DM未合并CHD,1317例)。根据Gensini评分[≤25分(低)、26~40分(中)、≥41分(高)]和CAG结果(1支、2支、3支病变)将T2DM合并CHD患者分别分组。对所有患者随访5年,记录主要不良心血管事件(MACE)。采用二元Logistic回归分析评估sd-LDL-C与CHD发生风险和冠状动脉病变严重程度的关系。采用Kaplan-Meier生存曲线分析MACE的发生情况。结果与非CHD组比较,CHD组apo B、LDL-C、hs-CRP、Hcy和sd-LDL-C水平显著升高(P<0.05),apo A1、HDL-C水平显著降低(P<0.05)。高Gensini评分组LDL-C、apoB、Hcy水平高于低Gensini评分组(P<0.05),TC和sd-LDL-C水平高于中Gensini评分组和低Gensini评分组(P<0.05);中Gensini评分组sd-LDL-C水平高于低Gensini评分组(P<0.05)。校正年龄、性别、体重指数、FBG、HbA1c、apo B、apo A1、TC、TG、HDL-C、LDL-C、Lp(a)、hs-CRP和Hcy后,sd-LDL-C仍是T2DM患者发生CHD和冠状动脉病变严重程度的独立危险因素。在T2DM患者中,sd-LDL-C>0.95 mmol·L^(-1)的患者发生CHD的风险是sd-LDL-C<0.57 mmol·L^(-1)的患者的2.030倍[比值比(OR)=2.030,95%可信区间(CI)为1.770~4.974,P=0.021]。T2DM合并CHD患者中,sd-LDL-C>1.07mmol·L^(-1)的患者发生3支病变、高Gensini评分的风险分别是sd-LDL-C<0.58 mmol·L^(-1)的患者的3.168倍、2.451倍(OR值分别为3.1Objective To investigate the relationship between serum small and dense low-density lipoprotein cholesterol(sd-LDL-C),the severity of coronary vessel lesion and the risk of cardiovascular events in patients with type 2 diabetes mellitus(T2DM).Methods Totally,3315 Han T2DM patients from Peking University People's Hospital from January 2016 to March 2019 were enrolled.The general data of all patients were collected,and fasting blood glucose(FBG),homocysteine(Hcy),high-sensitivity C-reactive protein(hs-CRP),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(apo A1)and apolipoprotein B(apo B),lipoprotein(a)[Lp(a)],sd-LDL-C and glycated hemoglobin A1c(HbA1c)were determined.According to the results of coronary angiography(CAG),all the patients were classified into coronary heart disease(CHD)group(1998 cases of T2DM with CHD)and non-CHD group(1317 cases of T2DM without CHD).According to the Gensini(GS)scores[≤25(low),26-40(medium),≥41(high)],T2DM patients with CHD were classified into low GS subgroup,medium GS subgroup and high GS subgroup.T2DM combined with CHD patients were classified into 1 vessel,2 vessel and 3 vessel lesions.All the patients were followed for 5 years,and major adverse cardiovascular events(MACE)were recorded.Binary Logistic regression analysis was used to evaluate the relationship between sd-LDL-C,the severity of coronary vessel lesion and the risk of CHD.Kaplan-Meier survival curve was used to analyze the occurrence of MACE.Results Compared with non-CHD group,the levels of apo B,LDL-C,hs-CRP,Hcy and sd-LDL-C in CHD group were increased(P<0.05),while the levels of apo A1 and HDL-C were decreased(P<0.05).The LDL-C,apoB and Hcy levels in high GS subgroup were higher than those in low GS subgroup(P<0.05),and the TC and sd-LDL-C levels were higher than those in medium GS subgroup and low GS subgroup(P<0.05).The sd-LDL-C level in medium GS subgroup was higher than that in low GS subgroup(P<0.05).After adjust

关 键 词：小而低密度脂蛋白胆固醇 冠心病 2型糖尿病 冠状动脉病变 

分 类 号：R446.1[医药卫生—诊断学]