脂质代谢水平与冠状动脉粥样硬化病变的关系

Relationship between the levels of lipid metabolism and coronary atherosclerotic lesions

目的探讨脂质代谢水平与冠状动脉粥样硬化病变的关系。方法回顾性分析182例疑似冠状动脉粥样硬化病变患者的资料,均实施冠状动脉数字减影血管造影(DSA)检查,将有冠状动脉粥样硬化病变者列为研究组,否则列为对照组。检测受试者血浆甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、载脂蛋白AⅠ(ApoAⅠ)、载脂蛋白B(ApoB)水平,采用Logistic逐步回归分析探讨这些指标与冠状动脉粥样硬化病变的关系;根据研究组Gensini积分分组,对比Gensini积分<20分、20~40分、>40分患者脂质代谢水平差异;采用Pearson相关性分析法评价研究组脂质代谢指标水平与Gensini积分的相关性。结果受试者中冠状动脉粥样硬化病变检出率为59.34%,且研究组血浆HDLC、ApoAⅠ水平均低于对照组(P<0.05),TG、TC、LDLC、ApoB水平均高于对照组(P<0.05);研究组年龄≥80岁、合并高血压、合并2型糖尿病、合并高脂血症、肥胖、吸烟史、饮酒史、TG>2.3 mmol/L、TC>5.98 mmol/L、HDLC<1.2 mmol/L、LDLC>3.1 mmol/L、ApoAⅠ<1.02 g/L、ApoB>1.14 g/L占比均高于对照组(P<0.05),且均是冠状动脉粥样硬化病变的危险因素。研究组中不同Gensini积分患者血浆ApoAⅠ、ApoB水平对比差异均有统计学意义(P<0.05),血浆HDLC、ApoAⅠ水平在Gensini积分<20分组最高,20~40分组稍低,>40分组最低,而血浆TG、TC、LDLC、ApoB水平在Gensini积分>40分组最高,20~40分组次之,<20分组最低;研究组中血浆HDLC、ApoAⅠ与Gensini积分呈负相关(r=-0.842,P=0.023;r=-0.789,P=0.007),TG、TC、LDLC、ApoB水平与Gensini积分呈正相关(r=0.798,P=0.004;r=0.812,P=0.015;r=0.803,P=0.008;r=0.808,P=0.013)。结论在冠状动脉粥样硬化病变患者中血浆HDLC和ApoAⅠ水平偏低,TG、TC、LDLC、ApoB水平偏高,均可增加冠状动脉粥样硬化病变发生风险,且前者与Gensini积分呈负相关,后者与Gensini积分呈正相关。

Aim To explore the relationship between the levels of lipid metabolism and coronary atherosclerosis.Methods The data of 182 patients with suspected coronary atherosclerotic lesions were retrospectively analyzed. All patients underwent coronary digital subtraction angiography( DSA),and those with coronary atherosclerotic lesions were recorded as the study group,otherwise as the control group. The levels of triglyceride( TG),total cholesterol( TC),high density lipoprotein cholesterol( HDLC),low density lipoprotein cholesterol( LDLC),apolipoprotein AⅠ( Apo AⅠ) and apolipoprotein B( Apo B) were measured and compared between the two groups. Logistic stepwise regression analysis was used to explore the relationship between them and coronary atherosclerosis. According to the Gensini scores group of the study group,the difference of lipid metabolism between patients with Gensini scores <20,20 ~ 40 and >40 were compared.Pearson correlation analysis was used to evaluate the correlation between the level of lipid metabolism indexes and Gensini scores in the study group. Results The detection rate of coronary atherosclerotic lesions was 59. 34%,and the levels of plasma HDLC and Apo AⅠ in the study group were lower than those in the control group( P< 0. 05),and the levels of TG,TC,LDLC and Apo B were higher than those in the control group( P<0. 05). The incidence of age≥80 years old,hypertension,type 2 diabetes,hyperlipidemia,obesity,smoking,drinking,TG>2. 3 mmol/L,TC>5. 98 mmol/L,HDLC<1. 2 mmol/L,LDLC>3. 1 mmol/L,Apo AⅠ < 1. 02 g/L,Apo B > 1. 14 g/L in the study group were higher in the study group than those in the control group( P< 0. 05),which were risk factors for the coronary atherosclerotic lesions. There were significant differences in the levels of TG,TC,HDLC,LDLC,Apo AⅠ and Apo B in patients with different Gensini scores( P<0. 05). Compared with the plasma HDLC,Apo AⅠ levels of each two groups,the highest was in the group of Gensini scores <20,slightly lower in the group of Gensini scores 20 ~ 40,and the lowest in the group of scores >40. Compared with TG,TC,LDLC and Apo B levels between each two groups,the levels of TG,TC,LDLC and Apo B were the highest in group of Gensini scores > 40,followed by group of Gensini scores 20 ~ 40,and the lowest in group of Gensini scores <20. There were negative correlations between the levels of HDLC,Apo AⅠ and the Gensini scores( r =-0. 842,P = 0. 023;r =-0. 789,P = 0. 007),and there were positive correlations between the levels of TG,TC,LDLC,Apo B and the Gensini scores( r = 0. 798,P = 0. 004;r = 0. 812,P = 0. 015;r = 0. 803,P = 0. 008;r = 0. 808,P = 0. 013). Conclusion In patients with coronary atherosclerotic disease,the levels of plasma HDLC and Apo AⅠ are low,and the levels of TG,TC,LDLC and Apo B are high,which can increase the risk of coronary atherosclerotic disease. The former are negatively correlated with Gensini scores,while the latter are positively correlated with Gensini scores.