高密度脂蛋白胆固醇水平与复杂冠状动脉病变程度相关性研究

Relation between high-density lipoprotein cholesterol level and severity of complex coronary artery disease

目的探讨复杂冠状动脉病变患者高密度脂蛋白胆固醇(HDL-C)的特点及其与冠状动脉病变程度的关系。方法选取2013年1月至2016年7月于首都医科大学附属北京安贞医院住院诊断为冠状动脉粥样硬化性心脏病并行冠状动脉造影的复杂冠状动脉病变患者633例为观察组,选取同期住院行冠状动脉造影诊断为简单病变患者580例为对照组。比较2组患者临床资料,分析HDL-C与复杂冠状动脉病变的相关性。结果观察组患者男性比例、体重指数、既往心肌梗死病史和吸烟比例、Gensini评分均高于对照组,HDL-C、左心室射血分数水平均低于对照组[79.9%(506/633)比69.0%(400/580)、(24±3)kg/m^2比(23±3)kg/m^2、27.2%(172/633)比16.9%(98/580)、86.1%(545/633)比82.6%(479/580)、32(16,56)分比20(8,28)分、0.91(0.79,1.07)mmol/L比0.98(0.84,1.18)mmol/L、64(58,68)%比65(60,68)%],差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示HDL-C是复杂冠状动脉病变的独立危险因素(比值比:0.421,95%置信区间:0.275～0.646,P<0.001)。Spearman相关性分析显示HDL-C水平与冠状动脉狭窄程度Gensini评分呈负相关(r=-0.247,P=0.019)。结论低HDL-C水平是复杂冠状动脉病变的独立危险因素。

Objective To investigate the relation between high-density lipoprotein cholesterol（HDL-C） level and the severity of coronary lesions in patients with complex coronary artery disease. Methods Clinical records of 633 patients with complex coronary artery disease （observation group） and 580 patients with simple coronary artery disease （control group） diagnosed by coronary angiography from January 2013 to July 2016 in Beijing Anzhen Hospital, Capital Medical University were analyzed. The relation between HDL-C level and coronary artery lesions was analyzed. Result Male rate, body mass index, previous history of myocardial infarction rate, smoking rate and the Gensini score in observation group were significantly higher than those in control group; HDL-C level and left ventricular ejection fraction in observation group were significantly lower than those in control group[ 79.9% （506/633） vs 69.0% （ 400/580）, （ 24 ±3 ） kg/m2 vs （ 23±3 ） kg/m2, 27.2% （ 172/633 ） vs 16.9% （98/580）, 86. 1% （545/633） vs 82.6% （479/580）, 32（16,56） vs 20（8,28）, 0.91（0.79,1.07）mmol/L vs 0. 98 （0.84,1.18 ） mmol/L, 64 （ 58,68 ） % vs 65 （ 60,68 ） % ] （ P 〈 0.05 ）. Logistic regression analysis showed that HDL-C level was an independent risk factor of complex coronary artery disease （odds ratio： 0. 421, 95% confidence interval： 0. 275-0.646, P 〈 0. 001 ）. Spearman correlation analysis showed that HDL-C level was negatively related to the Gensini score （ r = - 0. 247, P = 0. 019）. Conclusion Low HDL-C level is a visk factor of complex coronary artery disease.