血浆氧化低密度脂蛋白水平是冠心病严重程度的独立预报因素

Serum oxidized low density lipoprotein level is an independent predictor of severity of coronary heart disease

目的研究血浆氧化低密度脂蛋白（OxLDL）水平与冠心病严重程度的关系。方法134例怀疑为冠心病的住院患者，进行选择性冠状动脉造影。根据冠脉造影结果，将患者分为冠心病组（113例，至少有1支冠脉狭窄≥50％）和对照组（21例，所有冠脉分支狭窄均〈50％）。冠心病组按照冠脉病变支数进一步分为4个亚组（1支病变26例，2支病变26例，3支病变53例，4支病变8例）；按照发病症状分为稳定型心绞痛组（51例）、不稳定型心绞痛组（22例）和急性心肌梗死组（40例）。血浆OxLDL水平采用ELISA试剂盒检测。其他冠心病危险因素如年龄、性别、体质量指数、血脂等数据也一并收集。结果在冠心病组和对照组之间，除了高血压病史有显著升高外（46％vs19％，P〈0．05），其他指标没有显著差别。冠心病患者血浆OxLDL水平显著高于对照组（1．15±0．32）μkat／ml vs （0．68±0．30）μkat／ml，P〈0．01）。1～4支病变冠心病患者，其血浆OxLDL含量均显著高于对照组（1．10±0．32）μkat／ml、（1．12±0．27）μkat／ml、（1．17±0．32）μkat／ml和（1．33±0．37）μkat／ml vs（0．68±0．30）μkat／ml，P〈0．01）；但不同支数病变患者亚组问无显著性差异。稳定型心绞痛、不稳定型心绞痛和急性心肌梗死患者血浆OxLDL含量均显著高于对照组（1．13±0．30）μkat／ml，（1．23±0．33）μkat／ml和（1．15±0．32）μkat／ml vs （0．68±0．30）μkat／ml，P〈0．01）；但是各分组之间无显著性差异。以血浆OxLDL水平为因变量进行多元回归分析，发现冠脉病变支数是血浆OxLDL水平升高的独立危险因素（P〈0．01）。结论血浆OxLDL水平是冠心病严重程度独立预报因素。

AIM To investigate the relationship between serum oxidized low density lipoprotein （OxLDL） level and the severity of coronary artery disease （CAD）. METHODS One hundred and thirty four suspected CAD in-hospital patients were recruited in this study. All the patients had selected coronary artery angiography （CAG）. According to the CAG results, the patients were divided into CAD group （26 cases） , 2 vessels diseased group （26 cases） , 3 vessels diseased group （53 cases） and 4 vessels diseased group （8 cases）. Or according to the clinical symptoms, the CAD group was divided into 3 subgroups： stable angina pectoris （SAP） group （51 cases）, unstable angina pectoris （UAP） group （22 cases） and acute myocardial infarction （AMI） group （40 cases）. Serum OxLDL levels were detected with ELISA method. Other CAD related risk factors including age, sex, body mass index （BMI） and serum lipids levels were also examined. All these factors were statistically analyzed and their relationship with the severity of CAD was evaluated. RESULTS There were no significant differences between CAD group and control group in the above clinical CAD risk factors, except that the hypertension history ratio in CAD group was significantly higher than that in control group （46% vs 19%, P 〈0.05）. The serum OxLDL concentration in CAD group was much higher than that in control group （ 1.15 ±0.32） μkat/ml vs （0.68 ±0.30） μkat/ml; P 〈0.01 ）. The 1 -4 vessels diseased subgroups also had a significantly higher serum OxLDL concentrations compared with those in control group （ 1. 10 ± 0. 32 ） μkat/ml, （ 1.12 ± 0.27 ） μkat/ml, （ 1. 17 ± 0.32 ） μkat/ml and （ 1.33 ± 0.37 ） μkat/ml vs （ 0. 68 ± 0. 30） μkat/ml, P 〈 0.01, but there was no significant difference among these four subgroups. The OxLDL levels of SAP, UAP and AMI groups were also significantly higher than those in control group （1.13 ±0. 30） μkat/ml, （ 1.23 ± 0.33） μkat/ml and （ 1.15 ± 0.32） μkat/ml vs （ 0. 68 ± 0.30） μkat/ml, P 〈 0.01, but there was no significant difference among these 3 subgroups either. Multi-variable regression analysis with the serum OxLDL level as a dependent variable indicated that the number of diseased vessels was an independent risk factor related with the serum OxLDL level （ P 〈 0.01 ）. CONCLUSION The serum OxLDL level is a independent risk factor of the severity of CAD.