胸痹痰瘀互结证血脂指标与冠状动脉病变程度的关系

The relationship between blood lipid indexes in chest obstruction patients with the phlegm and blood stasis syndrome and the degree of coronary artery lesions

目的:探讨胸痹痰瘀互结证血脂指标与冠状动脉病变程度的关系。方法:选取辽宁中医药大学附属医院以“胸闷”“胸痛”为主诉,中医诊断为胸痹-痰浊血瘀证,西医诊断为冠状动脉粥样硬化性心脏病(简称冠心病),在入院24 h内空腹抽血,检查血脂指标并行冠状动脉造影的102例患者。根据冠状动脉造影结果算出Gensini积分,将冠状动脉病变程度分为轻度、重度两组,进行统计学分析。结果:(1)各组间Gensini积分在吸烟史、饮酒史、高血压病史、糖尿病病史、性别方面的差异无统计学意义(P>0.05),冠状动脉病变组载脂蛋白(Apolipoprotein,Apo)A-1、高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol,HDL-C)、ApoB/ApoA-1水平均低于冠状动脉无病变组。冠状动脉重度病变组ApoA-1、ApoB/ApoA-1、低密度脂蛋白胆固醇(Low Density Lipoprotein Cholesterol,LDL-C)/HDL-C水平低于冠状动脉轻度病变组,而总胆固醇(Total Cholesterol,TC)高于冠状动脉轻度病变组(P<0.05)。(2)冠状动脉发生病变、冠状动脉不同程度的单因素Logistic回归显示:ApoA-1(P<0.05)是冠心病的独立保护因素。(3)Spearman相关分析结果显示:ApoA-1、TC、HDL-C、ApoB/ApoA-1、LDL-C/HDL-C与Gensini积分具有相关性(P<0.05);ApoB/ApoA-1与Gensini积分、冠状动脉不同程度病变呈正相关,ApoA-1与Gensini积分、冠状动脉病变程度呈负相关。(4)受试者工作特征曲线预测模型:ApoA-1较其他指标可以更好地预测。结论:胸痹-痰瘀互结证冠心病患者的ApoA-1与冠状动脉是否发生病变以及病变严重程度呈最密切的负相关关系,且优于HDL-C、ApoB/ApoA-1、LDL-C/HDL-C等其他指标。

Objective:To explore the relationship between blood lipid indexes in chest obstruction patients with the phlegm and blood stasis syndrome and the degree of coronary artery lesions.Methods:102 cases were selected.The included patients had fasting blood drawn within 24 hours of admission,blood lipid indexes were checked,and coronary angiography was performed.According to the results of coronary angiography,the Gensini score was calculated,and according to the degree of coronary lesions,the patients were divided into the mild group and the severe group.A statistical analysis was performed on related data.Results:(1) There was no significant difference in smoking history,drinking history,hypertension disease history,diabetes history and gender among groups(P>0.05).The levels of ApoA-1,HDL-C,ApoB/ApoA-1 in the patients with coronary artery disease were lower than the patients with non-coronary artery disease.The levels of ApoA-1,ApoB/ApoA-1,and LDL-C/HDL-C in the severe group were lower than the mild group,while the TC level in the severe group was higher than the mild group(P<0.05).(2) The univariate Logistic regression of coronary artery lesions and different degrees of coronary artery showed that ApoA-1 was an independent protective factor for coronary heart disease(P<0.05).(3) The results of Spearman correlation analysis showed that ApoA-1,TC,HDL-C,ApoB/ApoA-1,and LDL-C/HDL-C were correlated with the Gensini score(P<0.05).ApoB/ApoA-1 was positively correlated with the Gensini score and different degrees of coronary artery lesions,while ApoA-1 was negatively correlated with the Gensini score and different degrees of coronary artery lesions.(4) The ROC curve prediction model showed that ApoA-1 can better predict coronary artery disease and the severity than other indicators.Conclusion:The ApoA-1 in chest obstruction patients with the phlegm and blood stasis syndrome has the closest negative correlation with the occurrence of coronary artery lesion and the severity degree of coronary artery disease,and it is better than HDL-C,ApoB/ApoA-1,LDL-C/HDL-C and other indicators.