冠心病调脂治疗靶点研究

Research of treating targets through lipid-lowering therapy on coronary heart disease

目的:探讨冠心病调脂治疗靶点。方法:R型聚类分析低密度脂蛋白胆固醇(LDL-C)等9个血脂评价指标的代表指标。回顾性病例对照研究他汀治疗(119例)与非他汀治疗(108例)两组冠心病患者ApoA1/ApoB、non-HDL-C、LDL-C判定的血脂达标率,达标和不达标者病情进展率及急性冠脉综合征(ACS)发生比值比。结果:9个指标聚为二类,代表指标为non-HDL-C、ApoA1/ApoB。3个指标评价他汀组血脂达标率分别为35.3%(42/119)、33.6%(40/119)和27.7%(33/119),非他汀组不达标率分别为86.1%(93/108)、90.7%(98/108)和95.4%(103/108)。他汀组不达标者病情进展率分别显著低于非他汀组不达标者(χ2分别为21.75、30.19、23.32,P均为0.001)。他汀组non-HDL-C的ACS发生比值与ApoA1/ApoB、LDL-C的ACS发生比值比在0.8～1.2范围之外,ApoA1/ApoB与LDL-C的ACS发生比值比及非他汀组三指标评价不达标者ACS发生比值比在0.8～1.2。结论:提高冠心病患者他汀治疗率显著降低冠心病患者ACS发生率。调脂治疗靶点不同,冠心病例ACS发生几率有差异,调脂治疗靶点值得研究。ApoA1/ApoB、LDL-C作为调脂治疗靶点作用相近。

Objective To explore treating targets through lipid-lowering therapy on coronary heart disease （CHD）. Methods The representative index of nine evaluation indexes on lipid like LDL-C were analyzed by R- cluster. A retrospective case-control study was conducted. All cases with CDH were divided into two groups： group statin （n = 119） and group non-statin （n = 108）. Lipid qualification rate evaluated by ApoA1/ApoB, non-HDL-C and LDL-C, progress rate of CDH and odds ratio of occurrence of ACS were compared in these two groups. Results Nine indexes were grouped into the second categories （A and B）. Representative index of A was non-HDL-C, and B was ApoA1/ApoB. In group statin, lipid qualification rates in three indexes （Apo A1/Apo B, non-HDL-C and LDL- C） were 35.3% （42/119）, 33.6% （40/119） and 27.7%（33/119）. In group non-statin, the non-qualification rates were 86.1% （93/108）, 90.7% （98/108） and 95.4% （103/108）. Progress rates of non-qualification eases was lower in group stain compared with those in group non-statin （X2 = 21.75,P = 0.001 ;X2 = 30.19,P = 0.001;X2 = 23.32,P = 0.001）. The odds ratio of ACS of non-HDL-Cand ApoA1/ApoB,LDL-C was beyond 0.8-1.2 in group stain which was in 0.8-1.2 in group non-statin. Conclusion Incidence of ACS was significantly decreased through treating CHD patients with statin. The occurrence probability of ACS would be different by using different therapeutic target. There is no difference between ApoA1/ApoB and LDL-C as a target of lipid-lowering therapy in statin therapy. It is worth to further study on treating target through lipid-lowering therapy.