血浆非高密度脂蛋白胆固醇浓度与冠状动脉粥样硬化性心脏病严重程度的关系

Relationship between the concentration of non-high-density lipoprotein cholesterol and the severity of coronary artery disease

目的 探讨血浆非高密度脂蛋白胆固醇（non-high-density lipoprotein cholesterol,non-HDL-C）浓度与冠状动脉粥样硬化性心脏病（冠心病）严重程度的关系。方法采用回顾性分析的方法,收集2013年1月至2014年1月在广东省人民医院行冠状动脉造影检查的患者资料共378例,依据冠状动脉造影检查结果,将入选患者分为冠状动脉无明显狭窄组（血管直径狭窄〈50%）、单支病变组（单支血管直径狭窄〉50%）和多支病变组（两支或三支血管直径狭窄〉50%）。通过电子数据表的形式收集所有入选患者的人口学资料、实验室数据和药物使用情况。采用单因素和多因素回归分析non-HDL-C浓度和冠状动脉病变支数的相关性。结果 （1）与冠状动脉无明显狭窄组相比,冠状动脉多支病变组冠心病危险因素,如年龄、吸烟、原发性高血压和糖尿病患者的比例明显增多,差异有统计学意义（P〈0.05）;实验室指标,如糖化血红蛋白、空腹血糖、总胆固醇、低密度脂蛋白胆固醇和non-HDL-C浓度随着冠状动脉病变的严重程度逐渐升高,两组比较,差异有统计学意义（P〈0.05）。（2）单因素回归分析显示,吸烟、糖尿病、血浆低密度脂蛋白胆固醇、non-HDL-C和糖化血红蛋白A1c浓度与冠状动脉病变支数具有正相关性（P〈0.05）,而抗血小板药物和他汀类药物与冠状动脉病变支数具有负相关性（P〈0.05）;进一步行多因素回归分析提示血浆低密度脂蛋白胆固醇（OR=1.78,95%CI：1.33~2.67,P〈0.05）、non-HDL-C（OR=1.54,95%CI：1.24~2.11,P〈0.05）和糖化血红蛋白A1c（OR=1.34,95%CI：1.26~2.08,P〈0.05）浓度与冠状动脉病变支数具有正相关性。结论血浆non-HDL浓度的升高与冠状动脉病变严重程度具有独立的相关性,评估non-HLD-C可能对提高冠心病患者心血管事件风险预测的准确性有积极意义。

Objectives To investigate the relationship between the concentration of non-high-density lipoprotein cholesterol（non-HDL-C） and the severity of coronary artery disease（CAD）. Methods Retrospective method was used and totally 378 patients undergoing coronary angiography were enrolled from January 2013 to January 2014 in Guangdong General Hospital. According to the results of coronary angiography, all the participants were divided into non-significant stenosis（stenosis 〉50%） group, single-vessel stenosis（single-vessel stenosis 50%） group and multiple-vessel stenosis（two- or three-vessel stenosis 〉50%） group. Data on demography, laboratory examinations and medicine usage were collected through electronic forms. Univariate and multivariate regression analyses were used to evaluate the relationship between the concentration of non-HDL-C and numbers of stenosis. Results（1） Compared to non-significant stenosis group, patients with multiple-vessel stenosis have more risk factors such as older ages, higher percentage of smoking, hypertension and diabetes mellitus（P〈0.05）. Levels of Hb A1 c, fasting blood glucose, total cholesterol, LDL-C and non-HDL-C gradually increased in parallel with stenosis severity;（2） Univariate regression analysis showed that smoking, diabetes mellitus, LDL-C, non-HDL-C and Hb A1 c were positively associated with the number of coronary artery stenosis（P0.05）, while anti-platelet drugs and statins were negatively associated with the number of coronary artery stenosis（P0.05）. Multivariate regression analysis showed that LDL-C（OR=1.78, 95% CI：1.33-2.67, P〈0.05）, non-HDL-C（OR =1.54,95% CI： 1.24-2.11,P〈0.05） and Hb A1c（OR =1.34, 95% CI：1.26-2.08, P0.05） were independently associated with the number of coronary artery stenosis. Conclusions The concentration of non-HDL-C is significantly associated with the severity of CAD, and evaluating the non-HDL-C concentration can improve the accuracy in cardiovascular risk prediction.