餐后血脂水平与冠状动脉粥样硬化发生发展的关系

Relationship between the postprandial blood lipid level and the development and progression of coronary atherosclerosis

目的:研究餐后血脂水平与冠状动脉粥样硬化(CAS)发生、发展的关系。方法:依据冠脉造影结果,我院704例患者被分为冠心病(CHD)组(448例)和非冠心病(NCHD)组(256例);依据是否行冠脉介入治疗,CHD组被分为介入亚组(323例)与非介入亚组(125例),比较各组空腹和餐后血脂:TG、TC、HDL-C、LDL-C及载脂蛋白(Apo)水平及其与CAS发生、发展的关系。结果:与NCHD组比较,空腹时,CHD组血清HDL-C、Apo A1水平、血清Apo A1/B水平比值均显著降低,血清TG水平显著升高(P均<0.01);餐后,CHD组血清TG水平显著升高,血清TC、HDL-C、LDL-C、Apo A1水平、ApoA1/B水平比值均显著降低(P<0.05或<0.01)。与非介入亚组比较,空腹时,介入亚组血清HDL-C、Apo A1水平、血清Apo E水平均显著降低(P<0.05或<0.01);餐后,介入亚组血清TC、HDL-C、Apo A1、Apo E水平均显著降低(P<0.05或<0.01)。多因素Logistic回归分析显示,空腹TG、男性和糖尿病史是CAS的独立危险因素(OR=1.361~2.383,P均<0.01),餐后Apo A1是CAS的独立保护因素(OR=0.371,P=0.024);餐后HDL-C与Apo E是CAS斑块发展的独立保护因素(OR=0.293、0.886,P=0.002、0.031),而糖尿病史是其独立危险因素(OR=1.785,P=0.020)。结论:餐后血脂水平变化与CAS的发生发展密切联系,餐后HDL-C水平对CAS斑块发展具一定的预测价值。

Objective:To study relationship between postprandial blood lipid levels and occurrence and development of coronary atherosclerosis(CAS).Methods:According to results of coronary angiography,a total of 704 patients from our hospital were divided into coronary heart disease(CHD)group(n=448)and non-CHD(NCHD)group(n=256);according to whether coronary intervention or not,CHD group was further divided into intervention subgroup(n=323)and non-intervention subgroup(n=125).Fasting and postprandial blood lipids:TG,TC,HDL-C,LDL-C and apolipoprotein(Apo)levels were compared among all groups;and relationship among blood lipid levels and occurrence and development of CAS were analyzed.Results:Compared with NCHD group,when fasting,there were significant reductions in serum levels of HDL-C,Apo A1 and ratio of serum Apo A1/B level,and significant rise in serum TG level in CHD group(P<0.01 all);after meal,there was significant rise in serum TG level and significant reductions in serum levels of TC,HDL-C,LDL-C,Apo A1 and ratio of serum Apo A1/B level in CHD group(P<0.05 or<0.01).Compared with non-intervention subgroup,when fasting,there were significant reductions in serum levels of HDL-C,Apo A1 and Apo E in intervention subgroup(P<0.05 or<0.01);after meal,there were significant reductions in serum levels of TC,HDL-C,Apo A1 and Apo E in intervention subgroup(P<0.05 or<0.01).Multivariate Logistic regression analysis indicated that fasting TG,male and diabetes mellitus history were independent risk factors for CAS(OR=1.361~2.383,P<0.01 all)and postprandial Apo A1 was its independent protective factor(OR=0.371,P=0.024);postprandial HDL-C and Apo E were independent protective factors for CAS plaque development(OR=0.293,0.886,P=0.002,0.031),while diabetes mellitus history was its independent risk factor(OR=1.785,P=0.020).Conclusion:Changes in postprandial blood lipid levels are closely associated with occurrence and development of CAS,and postprandial HDL-C level possesses certain predictive value for CAS plaque development.