高密度脂蛋白胆固醇和高密度脂蛋白颗粒与颈动脉粥样硬化发生及严重程度的相关性

Correlations between HDL-C,HDL-P with the incidence and severity of carotid arterial atherosclerosis

目的探讨高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)和高密度脂蛋白颗粒(highdensity lipoprotein-particle,HDL-P)与颈动脉粥样硬化(carotid arterial atherosclerosis,CAS)发生及严重程度的相关性。方法选取619例前来中国人民解放军陆军总医院干部门诊行健康体检的离退休干部,根据颈动脉彩色多普勒超声检查分为正常对照组、颈动脉内-中膜厚度(carotid intima-media thickness,cIMT)增厚组与斑块形成组。检测血清三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、HDL-C、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、人胆固醇酯转移蛋白(cholesterol ester transfer protein,CETP)及高密度脂蛋白亚型颗粒HDL-P_大、HDL-P中、HDL-P_小浓度。斑块形成组记录双侧颈动脉内各个独立斑块的厚度并将所测得所有独立斑块厚度相加作为Crouse积分,考察各血脂参数与斑块总积分的相关性。结果 cIMT增厚组、斑块形成组的TC、LDL-C、CETP及HDL-P_小浓度显著高于正常对照组,HDL-P_大浓度显著低于正常对照组,差异均有统计学意义(P<0.05)。而斑块形成组的TC、LDL-C、CETP及HDL-P_小浓度显著高于cIMT增厚组,HDL-P_大浓度显著低于cIMT增厚组,差异均有统计学意义(P<0.05)。Crouse积分值与LDL-C、CETP及HDL-P_小呈正相关(P<0.05),与HDL-P_大呈负相关(P<0.05)。结论 HDL-C与CAS发生及严重程度关系不确切,TC、LDL-C、CETP、HDL-P_小及HDL-P_大与CAS发生关系密切,HDL-P_小可能增加CAS严重程度风险,而HDL-P_大对CAS可能具有保护作用。

Objectives To investigate the correlations between high density lipoprotein-cholesterol(HDL-C),high density lipoprotein-particle(HDL-P)with the incidence and severity of carotid arterial atherosclerosis(CAS).Methods Totally619retired people from healthy body check in PLA Army General Hospital were divided into three groups:nor?mal control group,carotid intima-media thickness(cIMT)thickening group and plaque formation group,according to carotid ultrasonography.Serum concentrations of triglyceride(TG),total cholesterol(TC),HDL-C,low density lipo?protein cholesterol(LDL-C),human cholesterol ester transfer protein(CETP)and high-density lipoprotein subclasses particles(HDL-Plarge,HDL-Pmiddle,HDL-Psmall)were measured in all patients.Thicknesses of the bilateral separateplaques in carotid artery were measured and recorded in turn in plaque formation group by using color Doppler ultra?sound and then added together serving as Crouse scores.Correlations between plasma lipid parameters and Crouse scores were analyzed.Results Serum concentrations of TC,LDL-C,CETP and HDL-Psmall of cIMT thickening group and plaque formation group were significant higher than those of normal control group,while serum concentration of HDL-Plarge was significant lower than that of normal control group(P<0.05).Serum concentrations of TC,LDL-C,CETP and HDL-Psmall of plaque formation group were significant higher than those of cIMT thickening group,while se?rum concentration of HDL-Plarge was significant lower than that of cIMT thickening group(P<0.05).Serum concentra?tions of LDL-C,CETP and HDL-Psmall had significant positive correlations,while HDL-Plarge had a significant negative correlation with Crouse scores(P<0.05).Conclusions Relationship of HDL-C with CAS is unclear.TC,LDL-C,CETP,HDL-Psmall and HDL-Plarge have close relationships with CAS formation.HDL-Psmall may be a risk factor,while HDL-Plarge may be a protective factor in the severity of CAS.