sd-LDL与LDL比值与冠状动脉病变程度关系的研究

Relationship between ratio of small and dense low-density lipoprotein to low-density lipoprotein and severity of coronary artery lesions

目的研究急性冠脉综合征(ACS)患者小而密低密度脂蛋白(sd-LDL)与低密度脂蛋白(LDL)的比值与冠状动脉(冠脉)病变程度的关系。方法纳入2020年度于徐州医科大学附属医院心内科住院并行冠脉造影检查的ACS患者210例,其中不稳定性心绞痛(UAP)71例、急性非ST段抬高型心肌梗死(NSTEMI)69例、急性ST段抬高型心肌梗死(STEMI)72例。依据造影结果计算Gensini积分,结果分为第1四分位组(n=52)、第2四分位组(n=53)、第3四分位组(n=53)、第4四分位组(n=52)。测定所有患者血浆sd-LDL、LDL水平,计算出sd-LDL/LDL,分析与冠脉病变严重程度的关系。结果在Gensini积分四分位分组中,sd-LDL/LDL均随积分的增加呈升高趋势,差异有统计学意义(P<0.05)。Logistic回归分析表明,sd-LDL/LDL(OR=1.845,95%CI:1.441~2.246,P<0.001)是ACS患者冠脉病变程度的独立危险因素。相关性分析显示:sd-LDL/LDL与Gensini积分呈显著正相关(r=0.561,P<0.001),明显高于sd-LDL与Gensini积分的相关程度(r=0.445,P<0.01)。ROC曲线显示,sd-LDL/LDL的曲线下面积0.716,最佳截断值0.461,灵敏度58.5%,特异性77.9%。结论对于ACS患者,sd-LDL/LDL可能为预测冠脉病变严重程度更敏感的指标,具有更好的临床指导意义。

Objective To study the relationship between ratio of small and dense low-density lipoprotein(sd-LDL)to low-density lipoprotein(LDL,sd-LDL/LDL)and severity of coronary artery lesions in patients with acute coronary syndrome(ACS).Methods ACS patients(n=210)undergone coronary angiography(CAG)were chosen from Department of Cardiology in the Affiliated Hospital of Xuzhou Medical University in 2020,including 71 with unstable angina pectoris(UAP),69 with acute non-ST-segment elevation myocardial infarction(NSTEMI)and 72 with acute ST segment elevation myocardial infarction(STEMI).After calculating Gensini integrals according to CAG outcomes,the patients were divide into the first quartile group(n=52),the second quartile group(n=53),the third quartile group(n=53)and the fourth quartile group(n=52).The levels of plasma sd-LDL and LDL were detected,sd-LDL/LDL was calculated and relationship between sd-LDL/LDL and severity of coronary artery lesions was analyzed.Results In all quartile groups,sd-LDL/LDL showed an ascending trend with the increase of Gensini integrals(P<0.05).The results of Logistic regression analysis showed that sd-LDL/LDL(OR=1.845,95%CI:1.441~2.246,P<0.001)was an independent risk factor of severity of coronary artery lesions in ACS patients.The results of correlation analysis showed that there was a significant positive correlation between sd-LDL/LDL and Gensini integrals(r=0.561,P<0.001),which was significantly higher than the correlation between e between sd-LDL and Gensini integrals(r=0.445,P<0.01).The results of ROC curve analysis showed that AUC of sd-LDL/LDL was 0.716,the optimal cutoff value was 0.461,sensitivity was 58.5%and specificity was 77.9%.Conclusion In ACS patients,sd-LDL/LDL may be a more sensitive index for predicting the severity of coronary artery lesions with a higher clinical significance.