冠心病肥胖及非肥胖患者血白细胞水平变化及临床意义

Change of white blood cell level and its clinical significance in obese and non-obese patients with coronary artery disease

目的探讨冠心病肥胖及非肥胖患者血白细胞水平变化及其临床意义。方法收集冠心病患者230例,以体重指数(BMI)≥28.0kg/m2,或者腰臀比男性>0.9、女性>0.85为肥胖标准,分为冠心病肥胖组(n=115)和冠心病非肥胖组(n=115)。130例健康体检者作为对照组。根据1984年美国心脏病协会规定的冠脉血管图像分段评价标准和Gensini积分系统对每支血管狭窄程度进行定量分析。比较各组血总白细胞计数及其分类水平变化。相关分析及多因素逐步回归分析血总白细胞计数与肥胖指标及血糖、血脂等生化指标的相关性。结果冠心病肥胖患者的血总白细胞计数[(7.83±2.93)×109/L]高于非肥胖患者及对照组[(7.00±1.83)×109/L、(6.36±1.72)×109/L,P<0.05],低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)及冠状动脉Gensini积分也高于非肥胖患者(P均<0.05)。肥胖患者载脂蛋白A(ApoA)水平低于对照组(P<0.05),但与非肥胖患者无差异(P>0.05)。冠心病肥胖患者血总白细胞计数与载脂蛋白B呈正相关;非肥胖患者血总白细胞计数与载脂蛋白A呈负相关。结论冠心病肥胖组患者血总白细胞计数高于非肥胖患者。载脂蛋白B水平是影响肥胖患者血总白细胞计数的主要因素;载脂蛋白A水平是影响非肥胖患者血总白细胞计数的主要因素。

Objective To examine the change of white blood cell level in obese and non-obese patients with coronary heart disease(CHD) and its clinical significance.Methods Two hundred and thirty patients with CHD were divided into two groups: obesity with CHD [n=115,body mass index(BMI) ≥28 kg/m2 or waist-to-hip ratio(WHR)>0.9(male) or 0.85>(female)],and non-obesity with CHD(n=115).Another 130 subjects served as the control group.The degree of coronary stenosis was quantitatively assessed according to the fractional imaging of coronary artery evaluation standard(American Heart Association,1984) and Gensini scoring system.The changes of the total white blood cell count and white blood cell classification were compared between obese and non-obese patients with CHD.The correlation of the total white blood cell count with obesity index and blood biochemical parameters was analyzed by correlation analysis and multivariate stepwise regression analysis.Results The total white blood cell count of obesity CHD group was significantly higher than that of non-obesity CHD group and control group [(7.83±2.93),(7.00±1.83) and(6.36±1.72)(109/L,respectively;all P<0.05).The levels of low-density lipoprotein(LDL-C),apolipoprotein-B(ApoB) and Gensini score were also significantly higher in obesity group than in non-obesity group(all P<0.05).The level of apolipoprotein-A(ApoA) was significantly lower in obesity group than in control group(P<0.05),but obesity group and non-obesity group did not differ significantly in ApoA(P>0.05).In obesity group,the total white blood cell count was positively correlated with ApoB while in non-obesity group the total white blood cell count was negatively correlated with ApoA.Conclusion The count of total white blood cells of obesity patients with coronary heart disease is higher than that of non-obesity coronary heart disease patients.ApoB and ApoA are the major factors affecting total white blood cells in obesity group and in non-obesity group,respectively.