基线非传统血脂指标对冠状动脉粥样硬化病变风险的预测价值

The predictive values of baseline fasting non-traditional lipid indexes for the severity and morbidity of coronary heart disease

目的 探讨基线空腹非传统血脂指标对冠状动脉粥样硬化性心脏病(冠心病)发病及冠状动脉(冠脉)粥样硬化病变严重程度的预测价值。方法 连续收集2012年1月至2019年12月于中国医科大学附属盛京医院心内科住院行冠脉造影检查且未服用过降脂药物的患者1926例。将患者分为冠心病组(n=1354)和非冠心病组(n=572)。收集所有患者的基线空腹血脂指标,非传统血脂指标包括非-高密度脂蛋白胆固醇(非HDL-C)、残粒脂蛋白-胆固醇(RC)的水平及载脂蛋白B (apoB)与载脂蛋白A1 (apoA1)。采用Gensini System (GS)积分方法评估冠脉粥样硬化病变严重程度,将GS积分>0分患者按三分位分为三组:低危组(n=537)、中危组(n=516)及高危组(n=521)。采用二元logistic回归分析评估各血脂指标对冠心病发病风险的影响,Spearman相关分析及多元线性回归分析各血脂指标与GS积分之间的相关性。结果 非传统血脂指标RC (r=0.017,P<0.001)、非-HDL-C水平(r=0.052,P=0.024)和apoB/apoA1比值(r=0.228,P<0.001)与GS积分显著相关。apoB/apoA1比值(OR=2.161,95%CI:1.098~4.250,P=0.026)、RC水平(OR=3.622,95%CI:2.118~6.195,P<0.01)对冠心病发病有显著贡献。对基线LDL-C水平<1.80 mmol/L的人群,apoB/apoA1比值与GS积分显著相关(r=0.239,P<0.001)。结论 冠心病发病及冠脉病变严重程度的评估中非传统血脂指标apoB/apoA1比值和RC水平更具价值。

Objective To explore the predictive values of baseline fasting non-traditional lipid indexes for the severity and morbidity of coronary heart disease.Methods From January 2012 to December 2019,a total of 1926 patients who had undergone coronary angiography in the Cardiology Department of Shengjing Hospital of China Medical University and did not take lipid-lowering drugs previously were enrolled in this observation study.The patients were divided into coronary heart disease(CHD)group(n=1354)and non-coronary heart disease(non-CHD)group(n=572).Baseline lipid levels in fasting condition were collected in all patients,including non-highdensity lipoprotein cholesterol(non-HDL-C),remnant cholesterol(RC),apolipoprotein B(apo B)and apolipoprotein A1(apo Al).The Gensini System(GS)score was used to evaluate the severity of coronary atherosclerosis.Furthermore,the GS score>0 patients were divided into three groups based on trichotomy:low-risk group(n=537),medium-risk group(n=516)and high-risk group(n=521).The influences of lipid indexes on the risk of CHD were evaluated by binary logistic regression analysis,Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlations between serum lipid levels and GS scores.Results After adjusting for other cardiovascular risk factors:non-traditional lipid indexes such as RC(r=0.170,P<0.001),non-HDL-C levels(r=0.052,P=0.024)and apoB/apoA1 ratio(r=0.145,P<0.01)were significantly correlated with GS score.ApoB/apoA1 ratio(OR=2.161,95%CI:1.098~4.250,P=0.026)and RC level(OR=3.622,95%CI:2.118~6.195,P<0.01)significantly contributed for morbidity of CHD.In patients with baseline LDL-C level below 1.80 mmol/L in fasting condition,the apoB/apoA1 ratio(r=0.239,P<0.001)was significantly associated with GS score.Conclusion Considering the evaluation of the morbidity and severity of CHD,non-traditional lipid indexes,especially apoB/apoA1 ratio and RC level have shown more predictive value.