血清残余胆固醇水平对冠心病的影响及临床意义

Effect and clinical significance of serum residual cholesterol levels on coronary heart disease

目的探讨血清残余胆固醇(RC)水平对冠心病的影响及其临床意义。方法回顾性分析2019年6月至2020年6月因胸闷胸痛于川北医学院附属医院心内科住院行冠脉造影检查的230例患者的临床资料,根据冠脉造影结果分为冠心病组190例和非冠心病组40例(CON组),根据临床诊断标准又将冠心病患者分为稳定性心绞痛组(SAP组)70例和急性冠脉综合征组(ACS组)120例。比较三组患者的一般资料和RC水平,采用Spearman秩相关分析RC水平与Gensini评分的相关性,采用多因素Logistic回归分析影响冠心病发生的风险因素,绘制受试者工作特征曲线(ROC)分析RC对冠心病发生的预测价值。结果ACS组、SAP组和CON组患者的性别、年龄、吸烟史、高血压史、LP(a)比较差异均无统计学意义(P>0.05),但ACS组和SAP组患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)水平明显高于CON组,而高密度脂蛋白胆固醇(HDL-C)水平明显低于CON组,且ACS组患者的TC、LDL-C、ApoB水平明显高于SAP组,差异均有统计学意义(P<0.05);ACS组和SAP组患者的RC水平分别为(0.98±0.37)mmol/L、(0.86±0.23)mmol/L,明显高于CON组的(0.68±0.16)mmol/L,且ACS组的RC水平明显高于SAP组,差异均具有统计学意义(P<0.05);经Spearman秩相关分析结果显示,RC水平与Gensini评分呈正相关(P<0.05);经多因素Logistic回归分析结果显示,年龄、吸烟、RC、LDL-C、ApoA为冠心病的独立危险因素(P<0.05);经ROC分析结果显示,血清RC预测冠心病发生的曲线下面积(AUC)为0.755,灵敏性和特异性分别为53.20%和87.50%。结论RC是冠心病的独立危险因素,且与冠状动脉狭窄程度密切相关,可作为临床评估冠心病病情的辅助指标。

Objective To investigate the effect and clinical significance of serum residual cholesterol(RC)levels on coronary artery disease.Methods The clinical data of 230 patients who were hospitalized in the Department of Cardiology,the Affiliated Hospital of North Sichuan Medical University for coronary angiography due to chest tightness and chest pain from June 2019 to June 2020 were retrospectively analyzed.The patients were divided into coronary artery disease group(190 cases)and non-coronary artery disease group(CON group,40 cases)according to the results of the coronary angiography.The patients with coronary artery disease were further divided into a stable angina group(SAP group,70 cases)and an acute coronary syndrome group(ACS group,120 cases)according to the clinical diagnostic criteria.The clinical features and RC levels were compared between the three groups.Spearman correlation was applied to analyze the correlation between RC levels and Gensini scores.The risk factors of occurrence of coronary heart disease were analyzed by multivariate Logistic regression analysis.The predictive value of RC in the development of coronary heart disease was analyzed through receiver operating characteristic(ROC)curve.Results Comparison of gender,age,smoking history,history of hypertension,and LP(a)among patients in the ACS,SAP,and CON groups showed no statistically significant differences(P>0.05);the TC,LDL-C,ApoA,and ApoB levels of patients in the ACS and SAP groups were significantly higher than those of the CON group,whereas the HDL-C levels were significantly lower than those of the CON group;the TC,LDL-C,and ApoB levels of patients in ACS group were significantly higher than those in the SAP group;the differences were statistically significant(all P<0.05).The RC levels in the ACS group and SAP group were(0.98±0.37)mmol/L and(0.86±0.23)mmol/L,respectively,which were significantly higher than(0.68±0.16)mmol/L in the control group,and the RC level in the ACS group was significantly higher than that in the SAP group,with statistically significant differences(all P<0.05).Spearman correlation analysis showed a positive correlation between RC levels and Gensini scores(P<0.05).Multivariate Logistic regression analysis showed that age,smoking,RC,LDL-C,and ApoA were independent risk factors for coronary heart disease(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum RC for predicting the occurrence of coronary heart disease was 0.755,with a sensitivity and specificity of 53.20%and 87.50%,respectively.Conclusion RC is an independent risk factor for coronary heart disease and is closely related to the degree of coronary artery stenosis.It can be used as an auxiliary indicator for clinical assessment of coronary heart disease.