高密度脂蛋白胆固醇及其相关因子载脂蛋白A-Ⅰ和血清淀粉样蛋白A与非糖尿病性冠心病的关系

High density lipoprotein cholesterol and its associated factors apoA-I and serum amyloid A in non-diabetic patients with coronary heart disease

目的观察高密度脂蛋白胆固醇(HDL-C)相关因子载脂蛋白A-Ⅰ(apoA-Ⅰ)和血清淀粉样蛋白A(SAA)对非糖尿病性冠心病的影响。方法应用酶联免疫吸附法分别检测冠心病组(94例)及对照组(86例)患者血浆中apoA-Ⅰ和SAA,观察HDL-C,apoA-Ⅰ及SAA和冠心病发病之间的关系,并与人口学因素、血脂和炎症相关因素对冠心病的影响进行比较。结果冠心病组患者的高血压病史、吸烟史、早发冠心病家族史的发病率明显高于对照组(P<0.05),同样,甘油三酯、脂蛋白(a)、高敏C反应蛋白、SAA含量高于对照组(P<0.05),而HDL-C和apoA-Ⅰ明显降低(P<0.05)。Logistic回归分析显示HDL-C,apoA-Ⅰ和SAA对冠心病发病的OR分别为0.125(0.039～0.397),0.012(0.001～0.99)和1.166(1.054～1.291)。apoA-Ⅰ对冠心病发病的预测作用不受其他冠心病危险因素的影响,而HDL-C和SAA与冠心病的关系受到血脂相关因素和炎症因子的影响。结论 apoA-Ⅰ含量降低是非糖尿病性冠心病的独立危险因素。观察HDL内apoA-Ⅰ含量的变化是更为准确、有效的评价HDL-C对冠心病影响的方法。

Objective To investigate the effects of high density lipoprotein cholesterol （HDL-C） and its related factors, apolipoprotein A- I （apoA- I ） and serum amyloid A （SAA）, on the non-diabetic patients with coronary heart disease （CHD）. Methods One hundred and eighty consecutive patients were enrolled in this study, with 94 in CHD group and 86 in control group. The data on demography, lipid, and inflammation related factors were obtained from hospital records. Serum concentrations of apoA- I and SAA were measured by ELISA. The association of HDL-C, apoA- I and SAA with CHD was analyzed. Results There were more patients with hypertension, smoking, and early onset CHD history in CHD group than in control group. Compared with control group, the concentrations of triglyceride, lipoprotein, high-sensitivity C-reactive protein （hsCRP） and SAA were significantly higher in CHD group （P〈0.05）, while concentrations of HDL-C （P=0.000） and apoA- I （P=0.000） were significantly lower in control group （P〈0.05）. Logistic analysis showed that the unadjusted odd ratio （OR） for HDL-C, apoA- I and SAA in the presence of CHD was 0.125 （95%CI 0.039-0.397）, 0.012 （95%CI 0.001-0.99） and 1.166 （95% CI 1.054-1.291）, respectively. The associations between apoA- I and the presence of CHD remained strong, regardless of confounding variables. The association of HDL-C and SAA with the presence of CHD were lost after adjusting for lipid status and inflammation related parameters. Conclusion Decreased concentration of apoA- I is an independent risk factor for non-diabetic CHD. Change in apoA- I concentration can reflect the effects of HDL-C on CHD more accurately and effectively.