低密度脂蛋白/载脂蛋白B在他汀类药物治疗冠心病中的监测作用

Monitoring Role of LDL-C/apoB in Statin Drugs for Treating Coronary Artery Disease

目的探索他汀类药物治疗稳定型冠状动脉粥样硬化性心脏病(简称冠心病)患者低密度脂蛋白的基本特征和低密度脂蛋白/载脂蛋白B(LDL-C/apoB)的作用。方法选取2008年11月至2011年4月在医院他汀类药物治疗的男性冠心病患者(试验组)和非冠心病患者(对照组)各107例,检测血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、高敏C反应蛋白(hs-CRP)、甘油三酯(TG)和apoB,计算LDL-C和血清非高密度脂蛋白胆固醇(non-HDL-C)。结果试验组(n=107)的LDL-C/apoB比值显着低于对照组(n=107)(中位数,1.16与1.18,P=0.01)。血清TG≥150 mg/dL组LDL-C/apoB明显低于血清TG<150 mg/dL组(P=0.012),血清HDL-C<40mg/dL组的LDL-C/apoB明显低于血清HDL-C≥40mg/dL组(P=0.002)。Logistic回归分析显示,在所有研究对象中升高的血清TG是小颗粒低密度脂蛋白的独立预测因素(β=-0.154,P=0.02)。在LDL-C<100 mg/dL组中,升高的血清TG也是小颗粒低密度脂蛋白的独立预测因素(β=-0.243,P=0.012)。结论血清LDL-C水平和低密度脂蛋白的定性特征可用于监测冠心病二级预防的效果。由于高TG水平与小颗粒低密度脂蛋白相关,对于血清TG水平升高的患者尤其适合。

Objective To explore the basic characters of（low density lipoprotein cholesterol） LDL-C and the role of LDL-C/ apolipoprotein B（apoB） in the statin drugs for treating coronary artery disease（CAD）.Methods 107 male patient were selected and detected serum total cholestrol （TC）, high density lipoprotein cholestrol （HDL-C）, high sensitivity C reactive protein （hs-CRP）, triglyceride （TG） and apoB. LDL-C,LDL-C/apoB and non- HDL-C were calculated. Results The ratio of LDL-C/apoB in the CAD group was significantly lower than that in the non- CAD group（median 1.16 and 1.18, P =0. 01）. The ratio of LDL- C/apoB in the TG≥ 150 mg/dL group was significantly lower than that in the TG〈150 mg/dL group（P =0. 012）,the ratio of LDL-C/apoB in the HDL-C〈40 mg/dL group was significantly lower than that in HDL-C t〉40 mg/dL group （P=0. 002）. The Logistic regression analysis indicated that elevated serum TG is an independent prediction factor for smaller particle LDL in all subjects （[3=-0. 154, P=0. 02） and in the LDL-C〈100 mg/dl group（13 =-0. 243, P=0. 012）. Conclution The serum LDL-C level and the qualitative character of LDL may be used to monitor the effect of the secondary prevention of coronary heart disease. The patients with increased serum TG are especially suitable for this monitoring because the high TG level is related with smaller particle LDL.