老年冠心病患者脂蛋白谱剖析

Profiling of lipoprotein pattern in elderly coronary heart disease patients

目的探讨老年冠心病患者的脂蛋白谱特点。方法以诊断明确的老年男性冠心病１４３例为观察对象，以年龄与生活水平相匹配的健康老年男性１４３名为对照，两组中均排除与脂代谢有关的其它疾病。以同一份血清用优选方法作１４项检查，包括总胆固醇（ＴＣ），甘油三酯（ＴＧ），高密度脂蛋白胆固醇及其亚类（ＨＤＬ－Ｃ、ＨＤＬ２－Ｃ、ＨＤＬ３－Ｃ），低密度脂蛋白胆固醇（ＬＤＬ－Ｃ），脂蛋白（ａ）〔Ｌｐ（ａ）〕，载脂蛋白（ａｐｏ）ＡⅠ、ＡⅡ、Ｂ、ＣⅠ、ＣⅡ、ＣⅢ和Ｅ。结果除ａｐｏＣⅠ、ＣⅢ两项外，其它１２项均值在冠心病组与对照组之间的差异均有显著性。逐步回归分析中顺次选入ａｐｏＡⅠ、ＬＤＬ－Ｃ与ＴＧ３项为优选指标，相关分析示Ｌｐ（ａ）是一项独立变量。结论在ＴＣ水平接近正常时，老年冠心病组最突出的改变是代表ＨＤＬ的５项参数均明显低下，其中以ａｐｏＡⅠ为最明显。临床上选用检验指标仍应以ＴＣ、ＴＧ、ＨＤＬ－Ｃ和ＬＤＬ－Ｃ为主，如果采用ａｐｏＡⅠ、Ｂ及Ｌｐ（ａ）测定，必须注意所用商品试剂的质量。

Objective To study the characteristics of lipoprotein (LP) pattern of coronary heart disease (CHD) in the aged men, and to propose an idea about proper selection of tests of LP analysis for clinical use. Methods One hundred and fourty three male CHD cases were diagnosed either by coronary angiography or with definite acute or old myocardial infarction.The control group included 143 healthy men with comparable age and living standard to the CHD patients. Other diseases relevant to abnormal lipid metabolism were excluded in both groups. Serum total cholesterol (TC), triglycerides (TG), high and low density LP cholesterol (HDL C,HDL 2 C,HDL 3 C and LDL C), LP(a) and apolipoprotein (apo) AⅠ,AⅡ, B, CⅠ,CⅡ, CⅢ and E, etc were analysed simultaneously on same fasting serum with carefully selected methods. Results Except apo CⅠ and CⅢ, the mean values of other 12 analytes showed statistical significant difference between CHD and control group. All the HDL parameters were significantly lower in CHD, among them apo AⅠ was the best discriminator. The HDL subgroup (HDL 2 C and HDL 3 C) were not better than HDL C determination in differen tiating CHD from control group. LDL Cand TG entered the multivariant regression model at 2nd and 3rd steps of forward selection. After that, other analytes such as apo AⅡ,CⅡ and E were not selected, LP(a) was the only independent variable which showed no significant correlation with all other parameters. Conclusions When TC level was nearly normal, the characteristic LP pattern of CHD was significant lowering of parameters representing HDL, and apo AⅠ was the best discriminator between CHD and control group. The basic items of lipid analysis should include TC, TG, HDL C, and LDL C if necessary. Among various apos, apoAⅠ,B and LP(a) are the tests of choice. Because of technical difficulties and insufficient clinical evaluation, it is inappropriate to use apo AⅠ, B and LP(a) without careful case selection and strict laboratory quality assurance.