高HDLC水平与冠状动脉粥样硬化性心脏病的关系

The association of high HDLC level with the occurrence of coronary atherosclerotic heart disease

目的分析高高密度脂蛋白胆固醇(HDLC)水平对冠状动脉粥样硬化性心脏病(CHD)的影响。方法选取住院患者1987例,将确诊的CHD患者1559例作为CHD组,非CHD 428例为对照组。根据HDLC水平分为低HDLC组、正常HDLC组、高HDLC组、极高HDLC组。比较不同HDLC组间一般临床资料。采用Logistic回归模型分析CHD发生的危险因素及冠状动脉病变程度的危险因素。结果与正常HDLC组比较,低HDLC组总胆固醇(TC)降低,吸烟史、甘油三酯升高(P<0.05);高HDLC组、极高HDLC组体质指数和吸烟史占比降低(P<0.05);高HDLC组糖尿病占比降低(P<0.05);极高HDLC组TC升高(P<0.05)。肌酐随着HDLC升高呈降低趋势(P<0.05)。男性、女性CHD组低HDLC占比明显高于对照组,女性CHD组极高HDLC占比低于对照组(P<0.05)。与正常HDLC组比较,低HDLC组CHD发生率、冠状动脉病变程度>50%占比升高,而极高HDLC组则均降低(P<0.05)。与稳定型CHD比较,低HDLC水平组不稳定型心绞痛和急性心肌梗死占比升高(P<0.05)。Logsitic回归分析结果显示,低HDLC组CHD风险增加,而极高组CHD及严重冠状动脉病变发生的风险降低。结论极高HDLC对CHD和冠状动脉粥样硬化具有保护作用,并存在性别差异。

Aim To investigate the association of high high density lipoprotein cholesterol(HDLC)level with the occurrence of coronary atherosclerotic heart disease(CHD).Methods 1987 hospitalized patients were selected,with 1559 confirmed CHD patients as the CHD group and 428 non CHD patients as the control group.According to HDLC levels,they were divided into low HDLC group,normal HDLC group,high HDLC group,and extremely high HDLC group.General clinical data between different HDLC groups were compared.The risk factors for CHD occurrence and the degree of coronary artery disease were analyzed by using Logistic regression.Results Compared with the normal HDLC group,total cholesterol(TC)in the low HDLC group was decreased,while smoking history and triglycerides were increased(P<0.05).The body mass index and proportion of smoking history were decreased in the high HDLC group and the extremely high HDLC group(P<0.05).The proportion of diabetes in high HDLC group was decreased(P<005).TC in the extremely high HDLC group was increased(P<0.05).Creatinine showed a decreasing trend with the increase of HDLC(P<0.05).The proportion of low HDLC in the male and female CHD groups was significantly higher than that in the control group,while the proportion of high HDLC in the female CHD group was lower than that in the control group(P<0.05).Compared with the normal HDLC group,the incidence of CHD and the proportion of coronary artery disease severity>50%in the low HDLC group were increased,while those in the extremely high HDLC group were decreased(P<0.05).Compared with stable CHD,the proportion of unstable angina and acute myocardial infarction were increased in the low HDLC level group(P<0.05).The results of Logstic regression analysis showed that the risk of CHD was increased in the low HDLC group,while the risk of CHD and severe coronary artery disease were decreased in the extremely high HDLC group.Conclusion The level of extremely high HDLC has protective effect on CHD and coronary atherosclerosis,and there is gender difference.