残粒脂蛋白-胆固醇与早发冠心病及冠状动脉病变程度的相关性

Relationship among residual lipoprotein cholesterol,premature coronary heart disease and the degree of coronary artery

目的:探讨残粒样脂蛋白-胆固醇(RLP-C)与早发冠心病(PCHD)及冠状动脉(冠脉)病变程度的相关性。方法:选取江苏省苏北人民医院心内科通过冠脉造影诊断为PCHD患者共858例作为研究组,排除冠心病共341例为对照组。依据Gensini评分评估研究组患者冠脉病变程度,将研究组分为轻度病变组(<16分)、重度病变组(≥16分),统计各组患者一般资料及各项血脂水平并计算RLP-C,进行统计分析。结果:①研究组RLP-C水平明显高于对照组(P<0.05),研究组中冠脉重度病变组RLP-C水平高于轻度病变组(P<0.05)。②相关性分析中,RLP-C水平与Gensini评分呈正相关(r=0.598,P<0.001)。③多因素logistic相关分析显示,男性、高血压、吸烟史、LDL-C、RLP-C为PCHD患病的独立危险因素;HDL-C为PCHD独立保护因素(P<0.05);年龄、吸烟史、LDL-C、RLP-C为冠脉重度病变的独立危险因素,HDL-C为冠脉重度病变独立保护因素(P<0.05)。④ROC曲线分析中,RLP-C对PCHD重度病变具有一定的预测作用,ROC曲线下面积为0.735,截点值为0.498mmol/L,灵敏度为76.6%,特异度为73.2%。结论:在PCHD患者中,RLP-C水平明显升高,与冠脉病变程度呈正相关,为PCHD及重度冠脉病变的独立危险因素,能够在一定程度上预测PCHD重度病变的发生。

Objective To investigate the correlation between residual lipoprotein-cholesterol(RLP-C)and premature coronary heart disease and the degree of coronary artery disease.Methods A total of 858 patients with premature coronary heart disease diagnosed by coronary angiography in the department of Cardiology,North Jiangsu People's Hospital of Jiangsu Province were selected as the study group,and 341 patients with coronary heart disease were excluded as the control group.Gensini score was used to evaluate the degree of coronary artery lesions in patients in the study group,and the study group was divided into mild lesions group(<16 points)and severe lesions group(≥16 points).General information and blood lipid levels of patients in each group were counted and RLP-C was calculated for statistical analysis.Results①The level of RLP-C in the study group was significantly higher than that in the control group(P<0.05),and the level of RLP-C in the study group was significantly higher than that in the mild coronary artery disease group(P<0.05).②In correlation analysis,RLP-C level was positively correlated with Gensini score(r=0.598,P<0.001).③Multivariate logistic correlation analysis showed that male,hypertension,smoking history,LDL-C and RLP-C were independent risk factors for premature coronary heart disease.HDL-C was an independent protective factor for early coronary heart disease(P<0.05).Age,smoking history,LDL-C and RLP-C were independent risk factors for severe coronary artery disease,while HDL-C was independent protective factor for severe coronary artery disease(P<0.05).④In ROC curve analysis,RLP-C had a certain predictive effect on early-onset severe coronary heart disease,with an area under ROC curve of 0.735(95%CI0.700-0.769,P<0.001),cut-off value of 0.498 mmol/L,corresponding sensitivity of 76.6%,specificity of 73.2%.Conclusion In patients with premature coronary heart disease,the level of RLP-C is significantly increased,which is positively correlated with the degree of coronary artery disease.RLP-C is an independent risk factor for early-onset coronary heart disease and severe coronary artery disease,which can predict the occurrence of severe early-onset coronary heart disease.