低密度脂蛋白胆固醇达标的冠心病患者餐后残粒脂蛋白-胆固醇水平及与冠脉病变严重程度相关性的研究

Study on the relationship between postprandial remnant-like particle cholesterol(RLP-C) level and the severity of coronary artery lesion in patients with normal low density lipoprotein cholesterol

目的观察低密度脂蛋白胆固醇(LDL-C)达标的冠状动脉粥样硬化性心脏病(冠心病)患者餐后残粒脂蛋白-胆固醇(RLP-C)水平,并探讨其与冠状动脉病变严重程度的关系。方法连续入选2015年3月~2015年9月南京市胸科医院心内科收治的临床诊断为冠心病且低密度脂蛋白(LDL)达标的住院患者42例。按冠状动脉造影结果分为冠心病组及对照组,入院第2 d检查空腹及早餐后4 h的血脂水平:总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、LDL-C,使用公式法(RLPC=TC-HDL-C-LDL-C)计算得到RLP-C浓度,比较组间差异,并计算冠心病组冠状动脉病变Gensini评分,分析其与RLP-C的关系。结果两组空腹情况下TG、TC、LDL-C、RLP-C比较差异无统计学意义(P均>0.05);对照组HDL-C高于冠心病组,差异具有统计学意义(P<0.05)。两组餐后4 h情况下TG、TC、LDL-C比较差异无统计学意义(P均>0.05);冠心病组RLP-C高于对照组,对照组HDL-C仍高于冠心病组,差异均具有统计学意义(P<0.05)。冠心病组RLP-C增幅明显高于对照组,对照组HDL-C增幅高于冠心病组,差异均具有统计学意义(P<0.05)。分析空腹、餐后4 h各个血脂指标以及血脂指标增幅和Gensini评分之间的相关性,RLP-C的餐后增幅与Gensini评分具有中度相关性(r=0.450,P<0.05)。结论餐后RLP-C能够更好反应冠心病患者血脂水平及血脂相关性心血管剩留风险。

Objective To investigate postprandial remnant-like particle cholesterol(RLP-C)level in coronary heart disease(CHD)patients with normal low density lipoprotein cholesterol(LDL-C),and the relationship between RLP-C and the severity of coronary artery lesion.Methods42CHD patients with normal LDL-C in Nanjing Chest Hospital were recruited from March2015to September2015and divided into CHD group and control group according to coronary angiography.The levels of total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were measured4hours fasting and after breakfast.RLP-C level was calculated by the equation(RLP-C=TC-HDL-C-LDL-C).The Gensini score of coronary artery disease was calculated and the relationship with RLP-C was analyzed.Results There was nosignificant difference in TG,TC,LDL-C and RLP-C between the two groups(P>0.05).HDL-C in the control group was higher than that in the CHD group,the difference was statistically significant(P<0.05).There was no significant difference in TG,TC and LDL-C between the two groups at4hours postprandial(P>0.05).The level of RLP-C in CHD group was higher than that in control group,and HDL-C in control group was higher than that in CHD group(P<0.05).The increase of RLP-C in CHD group was significantly higher than that in control group,and the increase of HDL-C in control group was higher than that in CHD group(P<0.05).The postprandial increase of RLP-C was moderately correlated with the Gensini score(r=0.450,P<0.05).Conclusion RLP-C was a better index for the lipid level and the lipid-associated cardiovascular risk to CHD patients.