残粒脂蛋白胆固醇及非高密度脂蛋白胆固醇水平不一致性与冠状动脉狭窄严重程度的相关性研究

Correlation of Discordance between Remnant Lipoprotein Cholesterol and Non-high-density Lipoprotein Cholesterol and Severity of Coronary Stenosis

背景已有研究表明血脂之间的不一致性与冠心病患者发生严重冠状动脉事件相关,可能会导致冠状动脉事件的发生风险被高估或低估。目前残粒脂蛋白胆固醇(RLP-C)与非高密度脂蛋白胆固醇(non-HDL-C)水平不一致性的临床意义尚不明确。目的研究RLP-C和non-HDL-C之间的不一致性与冠心病患者冠状动脉狭窄严重程度的相关性。方法回顾性分析既往血压正常高值队列研究数据库中于2004年1月—2014年12月进行冠状动脉造影检查具备完整冠状动脉造影记录且Gensini评分可完整计算的冠心病患者共398例,根据队列中RLP-C和non-HDL-C水平的中位数将纳入患者分为4组:一致低RLP-C组(RLP-C<RLP-C_(中位数)且non-HDL-C<non-HDL-C_(中位数),n=129),不一致低RLP-C组(RLP-C<RLP-C_(中位数)且non-HDL-C≥non-HDL-C_(中位数),n=69),不一致高RLP-C组(RLP-C≥RLP-C_(中位数)且non-HDL-C<non-HDL-C_(中位数),n=67)和一致高RLP-C组(RLP-C≥RLP-C_(中位数)且non-HDL-C≥non-HDL-C_(中位数),n=133)。采用Gensini评分系统评估冠状动脉狭窄的严重程度。比较4组患者的基线资料,通过Pearson相关分析RLP-C和non-HDL-C之间的相关性,通过Logistic回归分析探究RLP-C和non-HDL-C水平不一致性与冠状动脉狭窄严重程度的相关性。结果纳入的患者中有34%(136/398)合并血脂水平不一致现象。一致低RLP-C组、不一致低RLP-C组、不一致高RLP-C组和一致高RLP-C组中分别有15.5%、18.9%、32.3%和24.9%的患者出现严重冠状动脉狭窄。Logistic回归分析结果显示,RLP-C和non-HDL-C的不一致性与冠状动脉狭窄严重程度之间存在相关性(P<0.05)。分别选取不一致低RLP-C组和不一致高RLP-C组与一致组进行Logistic回归分析,结果显示,在校正性别、年龄、吸烟、饮酒、他汀类药物使用情况和是否患有糖尿病等混杂因素后,不一致亚组中低RLP-C与患者发生严重冠状动脉狭窄无关〔OR=0.958,95%CI(0.473,1.939),P=0.905〕,而高RLP-C与患者发生严重冠状动脉狭窄相关〔OR=2.084,95%CI(1.110,3.912),P=0.022〕。经多因素Logistic回归模型校正后,RLP-C仍是严重冠状动脉狭窄风险的强预测因子〔OR=1.911,95%CI(1.253,2.914),P=0.003〕。结论合并高RLP-C和低non-HDL-C水平患者中RLP-C和non-HDL-C水平不一致性与其冠状动脉狭窄的严重程度相关,未来有潜力成为在传统血脂指标基础上用以预测冠心病患者发生严重冠状动脉狭窄的新型预测因素,并且独立于年龄、性别和其他危险因素。

Background Discordance between blood lipids has been shown to be associated with the occurrence of serious coronary events in patients with coronary artery disease(CAD),which may lead to the overestimation or underestimation of the risk of coronary events.The clinical significance of discordance between residual lipoprotein cholesterol(RLP-C)and nonhigh-density-lipoprotein cholesterol(non-HDL-C)still remains unclear in present.Objective To determine the correlation of discordance between RLP-C and non-HDL-C and the severity of coronary artery stenosis in patients with CAD.Methods A total of 398 patients with coronary artery disease receiving coronary angiography from January 2004 to December 2014 with complete coronary angiographic records and Gensini score which can be fully calculated from a previous normal high blood pressure cohort study database were retrospectively analyzed and divided into 4 groups based on the median RLP-C and non-HDL-C levels in the cohort,including concordantly low RLP-C group(RLP-C<medianRLP-C and non-HDL-C<median_(non-HDL-C),n=129),discordantly low RLP-C group(RLP-C<medianRLP-C and non-HDL-C≥median_(non-HDL-C),n=69),discordantly high RLP-C group(RLP-C≥medianRLP-C and non-HDL-C<median_(non-HDL-C),n=67),concordantly high RLP-C group(RLP-C≥medianRLP-C and non-HDL-C≥median_(non-HDL-C),n=133).The severity of coronary stenosis was evaluated by using the Gensini scoring system.The baseline data was compared among the 4 groups and the correlation between RLP-C and non-HDL-C was analyzed by Pearson's linear correlation.The correlation of discordance between RLP-C and non-HDL-C and severity of coronary stenosis was explored by Logistic regression analysis.Results Discordance were observed in 34%(136/398)of the included patients.Severe coronary stenosis was observed in 15.5%,18.9%,32.3%,and 24.9%of patients in the concordantly low RLP-C group,discordantly low RLP-C group,discordantly high RLP-C group and concordantly high RLP-C group.Logistic regression analysis results showed that there was no significant correlation of discordance between RLP-C and non-HDL-C and severity of coronary artery stenosis(P<0.05).Logistic regression analysis results of the patients in discordantly low RLP-C group and discordantly high RLP-C group showed that after adjusting for confounders such as sex,age,smoking,alcohol consumption,statin application and presence of diabetes,the low RLP-C level was not associated with the development of severe coronary stenosis〔OR=0.958,95%CI(0.473,1.939),P=0.905〕,high RLP-C was associated with the development of severe coronary artery disease〔OR=2.084,95%CI(1.110,3.912),P=0.022〕in patients in the discordantly groups.In addition,RLP-C remained a strong predictor of the risk of severe coronary artery disease〔OR=1.911,95%CI(1.253,2.914),P=0.003〕after multivariate Logistic regression model adjustment.Conclusion The discordance between RLP-C and non-HDL-C is correlated with severity of coronary stenosis in patients with high RLP-C and low non-HDL-C levels,which has the potential to be a novel risk factor for predicting severe coronary stenosis in CAD patients on the basis of traditional lipid indicators,independent of age,sex and other risk factors.