小而密低密度脂蛋白胆固醇及其与低密度脂蛋白胆固醇之比与颈动脉粥样硬化斑块的关系

Small dense low-density lipoprotein cholesterol and sdLDL-C/LDL-C ratio associate with carotid atherosclerotic plaque

目的评价sdLDL－C和sdLDL－C/LDL－C比值诊断颈动脉斑块标志物的价值。方法横断面调查研究。顺序收集2015年11月至2016年2月北京安贞医院体检中心行颈动脉超声检查者174名，根据超声结果分为颈动脉内膜（IMT）异常组（92例）和对照组（82名），其中IMT异常组分为IMT增厚组（32例）和斑块组（60例），颈动脉斑块组根据斑块数量分为单发斑块组（33例）和多发斑块组（27例）。所有受试者均检测BMI、空腹sdLDL－C、甘油三酯、低密度脂蛋白胆固醇（LDL－C）和高密度脂蛋白胆固醇（HDL－C）水平。采用Pearson′s及Sperman相关分析颈动脉斑块、sdLDL－C和其他指标的相关性，二元Logistic逐步回归方程及有序多分类Logistic回归模型评估颈动脉斑块的独立风险因素，ROC曲线下面积评估sdLDL－C和sdLDL－C/LDL－C比值在颈动脉斑块中的诊断价值。结果sdLDL－C（1.02±0.42 vs. 0.97±0.46 vs. 0.61±0.29, F＝21.07, P〈0.001）和sdLDL－C/LDL－C（0.34±0.17 vs. 0.34±0.17 vs. 0.21±0.09, F＝16.34, P〈0.001）的水平在斑块组和IMT增厚组明显高于对照组。在LDL－C水平正常的受试者中（LDL－C〈2.59 mmol/L），颈动脉内膜异常组的sdLDL－C（0.94±0.41 vs. 0.56±0.25, t＝4.00, P〈0.01）和sdLDL－C/LDL－C比值（0.43±0.19 vs. 0.24±0.08, t＝4.45, P〈0.01）水平依然高于对照组。sdLDL－C是颈动脉IMT增厚和斑块的独立危险因素（P〈0.05）。sdLDL－C和sdLDL－C/LDL－C比值诊断颈动脉多发斑块的AUC分别为0.882（95% CI：0.819～0.945, P〈0.01）和0.830（95% CI：0.747～0.914，P〈0.01），cut－off值分别为0.90 mmol/L（灵敏度，88%；特异度，79.3%）和0.30（灵敏度，84.0%；特异度，74.5%）。结论sdLDL－C水平和颈动脉斑块相关，sdLDL－C和sdLDL－C/LDL－C比值具有诊断颈动脉斑块的价值。（中华检验医学杂志，2018, 41：219－226）

ObjectiveTo explore the association between carotid artery plaque and small dense low-density lipoprotein cholesterol （sdLDL-C） concentrations as well as the probability of sdLDL-C and sdLDL-C/LDL-C ratio as biomarkers of human carotid atherosclerotic plaque.Methods174 subjects in physical examination center of An Zhen Hospital from November 2015 to February 2016 were enrolled one by one as a cross-sectional study. All subjects were divided into carotid IMT abnormal group （n=92） and control group（n=82）according to carotid ultrasound. According to the thickness of IMT characterized by carotid ultrasound, subjects were divided into the thickened IMT group（n=32）, plaques group（n=60）, and plaques group were divided into single plaque group（n=33） and multiple plaques group（n=27）. Body Mass Index（BMI）, fasting serum sdLDL-C, triglyceride（TG）, LDL-C and high-density lipoprotein cholesterol （HDL-C） concentrations were measured. Pearson′s and Spearman correlation coefficient analyses and logistic regression analyses were used to examine the relationships between carotid atherosclerotic plaque, sdLDL-C values, and other clinical variables. Area under curve（AUC） was calculated to determine the diagnostic value of sdLDL-C and sdLDL-C/LDL-C ratio in subjects with carotid atherosclerotic plaque.ResultsLevels of sdLDL-C（1.02±0.42 vs. 0.97±0.46 vs. 0.61±0.29, F=21.07, P〈0.001） and sdLDL-C /LDL-C（0.34±0.17 vs. 0.34±0.17 vs. 0.21±0.09, F=16.34, P〈0.001） in the thickened IMT group and the plaques group were higher than those of the control group）. Even in individuals considered to be at low LDL-C （〈2.59 mmol/L） level, sdLDL-C（0.94±0.41 vs. 0.56±0.25, t=4.00, P〈0.01） and sdLDL-C/LDL-C ratio（0.43±0.19 vs. 0.24±0.08, t=4.45, P〈0.01） remained higher in the carotid abnormal group than those in the control group. Age and sdLDL-C were the independent risk factors of carotid artery plaque. AUC of receiver operator characteristic curve （ROC） for serum sdLDL-C and sdLDL-C/LDL-C ratio were 0.882（95% CI： 0.819-0.945, P〈0.01） and 0.830（95% CI： 0.747-0.914, P〈0.01） to determine the multiple carotid atherosclerotic plaque, and the cut-off level were 0.90 mmol/L （sensitivity, 88.0%; specificity, 79.3%） and 0.30 （sensitivity, 84.0%; specificity, 74.5%）.ConclusionsCarotid atherosclerotic plaque has a close relationship with sdLDL-C concentrations. sdLDL-C and sdLDL-C/LDL-C ratio can be biomarkers when assessing subjects with a carotid atherosclerotic plaque.（Chin J Lab Med, 2018, 41： 219-226）