血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与颈动脉斑块的关系

Relationship among serum small dense low-density lipoprotein cholesterol,homocysteine and carotid atherosclerotic plaque

目的：研究血清同型半胱氨酸（Hcy）和小而密低密度脂蛋白胆固醇（sdLDL-C）对颈动脉粥样硬化斑块的影响。方法选择2013年6月-2014年12月在苏州市吴江区第一人民医院内科住院的患者302例，按是否有颈动脉斑块分为正常组140例，斑块组162例。所有患者均行颈动脉超声检测，详细询问有无吸烟、饮酒、脑卒中、糖尿病、高血脂、冠心病等病史，检测患者血糖（GLU）、尿酸（UA）、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、sdLDL-C、Hcy水平。将斑块组中有一处斑块形成的患者纳入单发斑块组，有两处斑块形成的患者纳入双发斑块组，有大于两处斑块形成的患者纳入多发斑块组，进行三组间sdLDL-C、Hcy水平比较。结果斑块组吸烟人数、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C水平较正常组高，差异有统计意义（P〈0.05）；颈动脉斑块形成的独立危险因素为吸烟、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C（P〈0.05）；组间Hcy、sdLDL-C水平由高到低排序依次为多发斑块组、双发斑块组、单发斑块组，差异有高度统计学意义（P〈0.01）。结论 Hcy、sdLDL-C为颈动脉粥样硬化的独立危险因素，两者与粥样硬化斑块的数量具有一致性。联合检测两者对心脑血管疾病的预防和干预有重要意义。

Objective To study the effect of serum small dense low-density lipoprotein cholesterol and homocysteine on carotid atherosclerostic plaque. Methods 302 patients in Department of Internal Medicine, the First People＇s Hospital of Wujiang District in Suzhou City from June 2013 to December 2014 were selected. According to had carotid plaque or not, patients were divided into the normal group （n=140） and plaque group （n=162）. All patients were given carotid ultrasound detection, and collected medical history, including smoking, drinking, stroke, diabetes, hyperlipidemia, coro-nary heart disease. The levels of GLU, UA, TG, TC, LDL-C, HDL-C, sdLDL-C, Hcy were detected. According to the plaque conditions, patients in the plaque group were divided into the single plaque group, double plaque group and multiple plaques group, and the levels of sdLDL-C and Hcy among the three groups were compared. Results In the plaque group, number of smokers, systolic blood pressure, UA, GLU, Hcy, LDL-C, sdLDL-C were higher than those of the normal group, with statistically significant differences （P〈0.05）. Smoking, systolic blood pressure, UA, GLU, Hcy, LDL-C, sdLDL-C were the independent risk factors of carotid artery plaque （P〈 0.05）. Levels of Hcy and sdLDL-C sorted high to low were multiple plaques group, double plaque group and single plaque group, with statistically signifi-cant differences （P 〈 0.01）. Conclusion Hcy and sdLDL-C are independent risk factors of carotid atherosclerosis, they have consistency with the number of atherosclerotic plaques. Joint detection of Hcy and sdLDL-C has impor-tant significance for cardiovascular disease prevention and intervention.