高密度脂蛋白颗粒亚型与心血管病事件关系的荟萃分析

A meta-analysis on the association between high-density lipoprotein particle subfractions andcardiovascular disease events

目的观察性研究显示高密度脂蛋白胆固醇（HDL-C）具有心血管保护功能，但随机对照临床试验发现单纯升高HDL-C并未减少心血管病事件。可能的假设是不同的高密度脂蛋白颗粒（HDL-P）亚型与心血管病发生风险的关联不同。对HDL-P及其亚型与心血管病事件关系的前瞻性研究进行荟萃分析。方法数据来源MEDLINE、Cochrane图书馆和CNKI数据库，对相关参考文献进行核查。检索截止日期为2013年7月1日。纳入和排除标准：关于HDL-P亚型与心血管病事件关系的前瞻性研究。排除结果中未提供与HDL-P亚型相关的相对危险且未调整任何心血管病（CVD）危险因素的研究。数据提取与合并：2名作者独立进行资料提取和文献质量评价。进行异质性检验，计算合并效应指标相对风险（RR）及其95％可信区间。结果共6项研究入选。核磁共振方法可将HDL-P分为大、中、小三类。仅大HDL-P与CVD风险降低有关，RR为0．65（95％可信区间：0．55～0．76）。中HDL-P和小HDL-P则与CVD事件发生无关联。结论大HDL-P水平升高对CVD事件发生具有保护作用，对HDL-P亚型水平进行评估对于认识HDL的作用具有重要意义。

Objective High-density lipoprotein cholesterol （HDL-C） has cardio-protective effects. However, results from clinical trials showed that improving HDL-C levels alone did not reduce the cardiovascular disease （CVD） events and different HDL particles （HDL-P） subfractions may relate to different CVD risk. In this meta-analysis, we reviewed prospective studies reported relationships of HDL-P subfractions with CVD risk. Methods Data sources： MEDLINE, Coehrane Library and China National Knowledge Infrastructure （CNKI） were searched up to July 1st, 2013. Study selection： Prospective studies that reported an association of HDL-P subfractions with the incidence of CVD were included and studies did not assess the hazard ratio, relative risk, or odds ratio of HDL-P and studies did not adjust for any other risk factors were excluded. Data extraction and synthesis： All studies were extracted by 1 researcher and verified by another researcher. Full data were extracted from the studies meanwhile the quality was evaluated. Heterogeneity was analyzed. Pooled relative risk （RR） and 95% confidence interval were calculated. Results Six studies were enrolled in this meta-analysis. HDL-P can be grouped into three subfractions： large HDL-P, medium HDL-P and small HDL-P. Only higher large HDL-P concentration was associated with decreased risk for CVD and pooled RR was 0. 65 （95% CI：O. 55 -0. 76）. Medium HDL-P and small HDL- P were not associated with the incidence of CVD events. Conclusion Higher large HDL-P concentration is associated with lower CVD risk. Assessment of HDL-P subfraetions may thus be of great clinical importance for evaluatin~ the CVD risk.