中国人群血脂水平与颈动脉斑块关系的分析——一个基于医院人群的横截面研究

Analysis of relationship between blood lipid level and carotid plaque in Chinese population——a cross-sectional study based on hospital patients

目的评估载脂蛋白B(ApoB)/载脂蛋白A-I(Apo-aⅠ)比值是否比其他任一单个的血脂变量或脂质比值变量预测性较强,以探讨中国人群血脂水平与颈动脉斑块的关系。方法回顾性采集暨南大学第四附属医院神经内科及心血管内科2009年9月至2010年3月期间年龄≥40岁的833名住院患者的病情资料,包括性别、年龄、脂蛋白(a)、其它脂质-脂蛋白变量、超敏CRP、空腹血糖以及颈动脉B超检测资料。根据颈动脉有无斑块出现而将所有患者分为两组,即颈动脉斑块组及颈动脉无斑块组。两组之间的人口学资料采用描述性分析,二元Logistic回归用于筛选出颈动脉斑块出现的独立危险因子。结果斑块组的年龄、超敏CRP、甘油三酯、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、高密度脂蛋白胆固醇(HDL-C)、ApoB、Apo-aⅠ、非高密度脂蛋白胆固醇、LDL-C/HDL-C比值、TC/HDL-C比值、Apo-B/Apo-aⅠ比值的中位数,要高于无斑块组,而HDL-C、Apo-aⅠ的中位数要低于无斑块组;斑块组的男性人数要明显多于无斑块组;两组之间空腹血糖水平没有差异(P>0.05)。二元Logistic回归显示男性(OR=1.745,95%CI:1.262～2.415)、年龄(岁)(OR=1.085,95%CI:1.068～1.101)、Apo-B/Apo-aⅠ比值(OR=9.860,95%CI:4.550～21.364)是颈动脉斑块出现的独立危险因子。结论男性、年龄、Apo-B/Apo-aⅠ比值是颈动脉出现斑块的独立危险因子。Apo-B/Apo-aⅠ预测颈动脉出现斑块要优于其他任一的脂质或脂质比值变量。

Objective In order to investigate the relationship between blood lipid level and carotid plaque in Chinese population,this study will determine whether the ratio of apoB/apoal is superior to any of the lipids or lipid ratios in predicting the presence of carotid plaque. Methods Medical data of 833 patients aged 40 or over 40 was ret- rospectively collected from the Department of Neurology and the Department of Cardiovascular of the Forth Affiliated Hospital of Jinan University from September 2009 to March 2010. The data including age, sex, ultrasound data derived from carotid, Lp （a） and other lipid lipoprotein variables, hsCRP, fasting glucose values was collected. All patients were divided into 2 groups according to the presence or absence of carotid plaque,namely,the plaque group（n： 537） and the non-plaque group（n： 296）. Demographic data was under descriptive analysis between 2 groups. A binary lo- gistic regression analysis was performed to identify independent risk factors for the presence of carotid plaque. Results The median of age, hsCRP, triglyceride, total cholesterol, LDL-C, VLDL-C, ApoB, Apo a I , Lp （a）, nonHDL-C, LDL-C/HDL-C ratio,TC/HDL-C ratio,ApoB/Apo a I ratio of the plaque group were significantly higher than those of the non plaque group and their median of HDL-C and ApoA1 were significantly lower. The male number was larger in the plaque group. There was no difference in the median of fasting glucose between 2 groups. Logistic regression revealed that man （OR： 1. 745,95%CI： 1. 262-2. 415）,age（year）（OR： 1. 085,95 %60CI：1. 068-1. 101）,Apo-B/Apo-a I ratio （OR= 9. 860,95%CI.. 4. 550-21. 364） were risk factors for the presence of carotid plaque. Conclusion Age, man, Apo B/Apo a I ratio are independent risk factors for the presence of carotid plaque. Apo-B/Apo-a I ratio is superior to any of the lipids or lipid ratios in predicting the presence of carotid plaque in Chinese population.