血清载脂蛋白B联合非高密度脂蛋白胆固醇对冠心病的预测价值

The value of serum apolipoprotein B combined with non-high density lipoprotein cholesterol in predicting coronary heart disease

目的探讨血清载脂蛋白B（apoB）联合非高密度脂蛋白胆固醇（non—HDL-C）对冠心病的预测价值。方法入选住院并接受冠状动脉造影的患者848例，根据造影结果分为冠心病组（608例）和对照组（240例）。所有患者检测空腹血脂和血糖，血清non-HDL—C水平通过总胆固醇（TC）减去HDL—C获得。通过多因素Logistic回归分析血清apoB、non-HDL—C与冠心病发病风险的相关性；运用偏相关分析研究血清apoB、non—HDL—C与冠状动脉病变支数的相关性；运用受试者工作特征曲线（ROC）评价血清apoB、non—HDL-C以及apoB联合non—HDL—C对冠心病的预测价值。结果经多因素Logistic回归分析表明，血清apoB及non—HDL—C是冠心病的独立危险因素，且血清apoB与冠心病发病风险的相关性（OR=5．920，95％CI：2．737～12．804）大于non—HDL—C（OR=1．340，95％CI：1．123～1．600）。校正相关影响因素，血清apoB与冠状动脉病变支数的相关性（r=0．244，P〈0．001）大于non-HDL—C（r=0．216，P〈0．001）。合并高apoB、高non—HDL—C的人群冠心病的发病率最高（n=144，81．81％）。血清apoB、non—HDL—C、apoB联合non—HDL-C的曲线下面积分别为0．602、0．577、0．691，提示血清apoB联合BOIl-HDL—C较血清apoB、non—HDL—C预测冠心病的价值更大（P〈0．05）。结论与non-HDL—C相比，血清apoB与冠心病发病风险以及冠状动脉病变支数的相关性更为密切，且血清apoB联合non-HDL—C能提高对冠心病的预测价值。

Objective To evaluate the value of serum apolipoprotein B （apoB） combined with non-high density lipoprotein cholesterol（non-HDL-C） in predicting coronary heart disease （CHD）. Methods A total of 848 patients were enrolled and classified into CHD group（608 cases） and normal group （240 cases） according to the results of coronary angiography. Fasting serum lipid and blood glucose were estimated in all patients. Serum non-HDL-C was calculated by subtracting high density lipoprotein cholesterol （HDL-C） from total cholesterol（TC）. Multivariate logistic regression was applied to estimate the association of serum apoB and non-HDL-C with the risk of CHD. Partial correlation analysis was used to analyze the correlation of serum apoB and non-HDL-C with the number of impaired coronary artery branches. Receiver operating characteristics （ROC） curve analysis was used to assess the value of serum apoB, non-HDL-C and the combined use of apoB with non-HDL-C in predicting CHD. Results Multivariate logistic regression analysis showed that serum apoB and non-HDL-C were independent risk factors of CHD. In addition, the association with an increasing risk of CHD was much stronger for apoB （ OR = 5. 920,95 % CI： 2. 737 ～12. 804） than for non-HDL-C（ OR = 1. 340, 95% CI： 1. 123 ～1. 600）. After adjustment for related factors, the correlation with the number of impaired coronary artery branches was stronger for serum apoB （r = 0. 244, P 〈0. 001 ） than for non-HDL-C（r =0. 216, P 〈0. 001 ）. Individuals with combined high levels of serum apoB with non-HDL-C had the highest risk of CHD（n = 144, 81.81% ）. The area under ROC curve of diagnosing CHD for serum apoB, non-HDL-C and the combined use of serum apoB with non-HDL-C were 0. 602, 0. 577, 0. 691 respectively, which indicated that the combined use of serum apoB and non-HDL-C was significantly better predictor than serum apoB and non-HDL-C（P 〈0. 05）. Conclusion Compared with non-HDL-C, serum apoB is stronger not only in the association with an increasing risk of CHD, but also in the correlation with the number of impaired coronary artery branches. The combination of serum apoB with non-HDL-C has even greater value than serum apoB or non-HDL-C in prediction of CHD.