小而密低密度脂蛋白与急性冠脉综合征及其危险因素的关系

Significance of small dense low-density lipoproteins and other risk factors in patients with acute coronary syndrome

目的 观察急性冠脉综合征 (ACS)患者血浆小而密低密度脂蛋白 (sLDL)水平 ,探讨sLDL与ACS及其危险因素的关系。方法 按病例 对照方法收集ACS患者 2 10例 ,其中急性心肌梗死患者 114例为AMI组 ,不稳定性心绞痛患者 96例为UAP组。选取 2 10名年龄、性别相匹配的健康人作为对照 ,用 2 %～ 16%的非变性聚丙烯酰胺梯度胶电泳法检测sLDL血浆水平 ,观察各组间的sLDL的变化 ;并对sLDL的影响因素采用多元逐步回归进行分析 ,了解ACS的危险因素对sLDL的影响。结果 ( 1)sLDL在AMI组和UAP组含量明显增高。 ( 2 )多元逐步回归分析结果显示sLDL与TG、性别、腰臀比、高血压史有关 ,校正了这些因素的影响后 ,sLDL与ACS仍有相关性 (r =0 .2 15 ,P<0 .0 0 1)。 ( 3 )与对照组比较 ,sLDL异常者 ,发生ACS的危险性是 3 .85倍 (OR =3 .85 ,95 %的可信区间 2 .40 4～ 6.164 ;χ2 =3 3 .64 ,P <0 .0 0 1)。结论 sLDL水平升高是ACS的重要危险因素 ,使发生ACS的危险性增加。

Objective The purpose of this study is to inv es tigate the plasma level of small dense low-density lipoproteins (sLDL) in patien ts with acute coronary syndrome and to explore roles of sLDL on acute coronary s yndrome.Methods We examined the plasma sLDL level using 2%～16% non-den aturing gradient gel electrophoresis in 210 patients with acute coronary syndrom e,including 114 cases of acute myocardial infarction and 96 cases of unstable an gina pectoris,and in 210 healthy age- and sex-matched subjects,who served as c ontrol.Results (1)The plasma sLDL level in patients with acute myocard ial infarction and unstable angina pectoris is higher than that in matched-cont rols.(2)Multi-variate regression analysis showed that there were close relation ship between sLDL and triglyceride,sex,waist-to-hip ratio (WHR),history of hyp ertension,and plasma sLDL levels still were closely related with acute coronary syndrome( r =0.215, P <0.001) after triglyceride,sex,WHR and history of hyp ertension were adjusted.(3)Compared with the matched-control subjects,the calcu lation of odds ratios indicated relative risk estimates of 3.85 for the acute co ronary syndrome (OR=3.85,95% CI 2.404～6.164;χ 2=33.64, P <0.001).Conclusion Plasma sLDL is positively correlated with acute coro nary syndrome.Abnormality in plasma sLDL is an important risk factor for acute c oronary syndrome.