中老年载脂蛋白B/A1、CIMT与冠状动脉病变程度的相关性研究

The study on the degree of coronary artery disease in apolipoprotein B/A1 and carotid artery

目的研究中老年人血清载脂蛋白B(ApoB)/血清载脂蛋白A1(ApoA1),颈动脉内膜中层厚度(CIMT)与冠状动脉(冠脉)病变程度的相关性。方法选择武警广西总队医院心内科病房住院的199例行冠脉造影(CAG)的中老年患者,根据造影结果分为冠脉粥样硬化性心脏病(冠心病)组105例和非冠心病组(对照组)94例,其中单支病变组39例、双支病变组36例、三支病变组30例,并采用修正的Gensini评分系统评价冠脉粥样硬化的严重程度;双侧颈动脉B超系统明确CIMT,同时检测载脂蛋白B(ApoB)、载脂蛋白A1(ApoA1)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血糖、血尿酸(UA)、同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)等指标;分析上述指标与CIMT的相关性。结果冠心病组LDL-C、HDL-C、Hs-CRP、脂蛋白a[LP(a)]、UA、ApoB/ApoA1、Hcy、CIMT与对照组比较存在显著性差异(P<0.05),且ApoB/ApoA1、CIMT随着病变血管狭窄支数的增加而逐渐增高,以3支病变组尤为显著(P<0.05)。Pearson直线相关分析表明ApoB/ApoA1、CIMT与冠脉支数呈正相关(γ分别为0.305、0.311,ρ值分别为0.008、0.006,P均<0.05)及与冠脉狭窄评分Gensini评分呈正相关(γ分别为0.336、0.377,ρ值分别为0.010、0.002,P<0.05)。结论ApoB/ApoA1、CIMT参与冠脉粥样硬化,与冠脉病变程度呈正相关:ApoB/ApoA1、CIMT可能是冠心病发病及进展的独立预测因子。

Objective To investigate the correlation between serum apolipoprotein B(ApoB)/apolipoprotein A1(ApoA1),carotid intima-media thickness(CIMT)and the degree of coronary artery lesions in the elderly.Methods Ninety-nine middle-aged and old-aged patients who underwent coronary angiography(CAG)in the Department of Cardiology of Guangxi Armed Police Corps Hospital were selected and divided into noncoronary heart disease group(control group)94 cases and coronary heart disease group 105 cases according to the angiographic results,including 39 cases in the single-vessel lesion group,36 cases in the double-vessel lesion group and 30 cases in the three-vessel lesion group.The severity of coronary atherosclerosis was evaluated by the modified Gensini scoring system.The lateral carotid artery B-ultrasound system defines CIMT and simultaneously detects ApoB,ApoA1,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),blood glucose,serum uric acid(UA),homocysteine(Hcy),hypersensitive C-reactive protein(hs-CRP)and other indicators;the correlation between the above indicators and CIMT was analyzed.Results There were significant differences in LDL-C,HDL-C,Hs-CRP,lipoprotein a(a),LP(a),UA,ApoB/ApoA1,Hcy,CIMT between the CHD group and the control group(P<0.05),and ApoB/ApoA1,CIMT gradually increased with the increase of the number of stenotic vessels,especially in the 3-vessel lesion group(P<0.05).Pearson linear correlation analysis showed that ApoB/ApoA1 and CIMT were positively correlated with the number of coronary artery branches(gamma was 0.305,0.311,Rho was 0.008,0.006,all P<0.05),and positively correlated with Gensini score of coronary stenosis score(gamma was 0.336,0.377,Rho was 0.010,0.002,P<0.05,respectively).Conclusion ApoB/ApoA1 and CIMT are involved in coronary atherosclerosis and positively correlate with the degree of coronary artery disease:ApoB/ApoA1 and CIMT may be independent predictors of the onset and progression of coronary artery disease(CHD).