血清LDL/HDL比值与冠状动脉病变的相关性

Correlation of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with coronary artery disease

目的 探讨血清低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及LDL-C/HDL-C比值(LHR)对冠状动脉(冠脉)病变的评估价值。方法 回顾性收集2018年1月至2019年2月因胸闷胸痛在南京医科大学第二附属医院心血管内科行冠脉造影检查的患者241例的临床资料。根据冠脉造影结果将其分为冠心病组(直径≥1.5 mm的冠脉其血管狭窄≥50%,n=183)及冠脉正常组(n=58)。记录各组的血清LDL-C、HDL-C水平,并计算LHR。对冠心病及冠脉病变严重程度的危险因素及LHR在其预测中的价值进行分析。结果 冠心病组的LHR高于冠脉正常组(P<0.01)。多因素Logistic回归分析显示,LHR是冠心病和冠脉重度病变的独立危险因素(OR=3.522,P<0.01;OR=2.716,P<0.01)。Spearman相关性分析显示,LHR与Gensini积分、冠脉病变支数分别呈正相关(r=0.462,P<0.01;r=0.499,P<0.05)。ROC曲线分析显示,LHR对冠心病、冠心病重度病变预测的AUC(0.815、0.805)优于LDL-C(0.776、0.760)和HDL-C(0.530、0.511),LHR对冠脉≥3支病变预测的AUC(0.654)优于HDL-C(0.525)。结论 LHR与冠心病及其病变严重程度相关,其诊断价值优于单一的血脂指标,可用于冠心病的病情评估与诊断。

Objective To investigate the diagnostic value of serum low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), and LDL-C to HDL-C ratio(LHR) in coronary artery disease. Methods Clinical data of 241 patients with chest tightness and chest pain who underwent selective coronary angiography in the Cardiovascular Department of the Second Affiliated Hospital of Nanjing Medical University from January 2018 to February 2019 were selected restropectively. According to the results of coronary angiography, patients were divided into coronary heart disease group(coronary artery diameter ≥1.5 mm and stenosis≥50%, n=183) and normal coronary artery group(n=58). The hematological indexes including serum LDL-C, HDL-C, and C-reactive protein of each group were recorded and LHR was calculated. The independent risk factors of coronary heart disease and its severe lesions and the predictive value of LHR in coronary heart disease were analyzed. Results The LHR of the coronary heart disease group was higher than that of the normal coronary artery group(P<0.01). Multivariate Logistic regression analysis showed that LHR was an independent risk factor for coronary heart disease(OR=3.522, 95%CI: 1.965-6.312, P<0.01) and severe coronary artery disease(OR=2.716, 95%CI: 1.462-5.044, P<0.01). Spearman correlation analysis indicated a positive correlation between LHR and Gensini score and a positive correlation between LHR and the number of diseased coronary arteries(r=0.462, P<0.01;r=0.499, P<0.05). The results of receiver operating characteristics curve analysis demonstrated that LHR had higher predictive value for coronary heart disease [area under the curve(AUC)=0.815], severe coronary heart disease(AUC=0.805), was superior to LDL-C(AUC=0.776, AUC=0.760) and HDL-C(AUC=0.530, AUC=0.511). LHR had higher predictive value for three or more coronary artery lesions(AUC=0.654), which was superior to HDL-C(AUC=0.525). Conclusion LHR is related to coronary heart disease and its severity, and its diagnostic value is superior to that of single blood lipid indices. LHR can be used in the evaluation and diagnosis of coronary heart disease.