An Analysis of Health Factors Affecting Employees’ Absenteeism: Influences of HDL Cholesterol and Blood Sugar Levels

Background: Workers’ health condition is an important issue. It affects not only the well-being of workers but also the firms and society as a whole through medical costs and productivity losses due to absenteeism and presenteeism. Data and Methods: Data were obtained from 1136 employees at an operational site of a large corporation. The dataset contained both medical checkups and working record information. Health factors affecting long-term absence (over three days in three months) were analyzed. Logistic regression models and the procedure for selecting proper covariates based on likelihood test statistics and the Akaike information criterion were used. Results: Among health factors, high-density lipoprotein cholesterol (HDL-C) and blood sugar levels were important in the selected model. For HDL-C, the odds ratio (OR) based on one standard deviation difference was 0.75 with a 95% confidence interval (CI) of 0.59 - 0.95. For blood sugar, the OR was 1.20 with a 95% CI of 1.01 - 1.42. Improving HDL-C and blood sugar levels would reduce long-term absence by 25% and 20%, respectively. Conclusion: Controlling HDL-C and blood sugar levels is important to reduce long-term absenteeism. These factors can be improved by modifying eating habits. Since the operational site has its own company cafeterias, which most employees use, nutritional intervention is relatively easy with little or no cost. It may be worthwhile to implement nutritional intervention, especially for patients with low HDL-C or high blood sugar levels. Limitations: The results of this study were based on one operational site of a corporation. The employees were mainly operators working inside the building. The results may be different from other types of jobs and working conditions, such as fieldwork. Analyses of different types of jobs and working conditions are necessary.

The pleiotropic vasoprotective functions of high density lipoproteins(HDL)

The pleiotropic functions of circulating high density lipoprotein（HDL） on peripheral vascular health are well established. HDL plays a pivotal role in reverse cholesterol transport and is also known to suppress inflammation,endothelial activation and apoptosis in peripheral vessels. Although not expressed in the central nervous system, HDL has nevertheless emerged as a potential resilience factor for dementia in multiple epidemiological studies. Animal model data specifically support a role for HDL in attenuating the accumulation of P-amyloid within cerebral vessels concomitant with reduced neuroinflammation and improved cognitive performance. As the vascular contributions to dementia are increasingly appreciated, this review seeks to summarize recent literature focused on the vasoprotective properties of HDL that may extend to cerebral vessels, discuss potential roles of HDL in dementia relative to brainderived lipoproteins, identify gaps in current knowledge, and highlight new opportunities for research and discovery.

THE DIFFERENCES OF SERUM CHOLESTEROL AND LIPOPROTEINS IN ANIMALS SUSCEPTIBLE AND NONSUSCEPTIBLE TO ATHEROSCLEROSIS

The differences of serum lipid and lipoprotein (LP,profiles of animals susceptible (rabbit)and nonsusceptible (Beijing duck) to atherosclerosis as well as the distribution of apolipo-protein (apo) A-I and its catabolism in vivo were studied.Eight items,i.e.total cholesterol(TC),high density lipoprotein (HDL) cholesterol,triglyceride,percentage of a-LP and β-LP,β-LP concentration,lecithin cholesterol acyl transferase (LCAT),and agarose and polyacryla-mide gel electrophoresis of both species were assayed before and after feeding a high fat,high cholesterol diet.Results indicate that the exogenous cholesterol consumed by Beijingducks was carried and transported by HDL,while that in rabbits was transported by lowdensity lipoprotein (LDL).The biological half lives of apo A-I in serum and in HDL were41.11±2.4 and 42.8±1.7 h respectively.and its distribution in different organs was in theorder of liver】kidney】spleen】lung】heart】intestine】muscles】aorta.These resultsshow that the liver is the major organ for metabolizing HDL apo A-I.and the kidneyis also important.The results also imply that in Beijing ducks the cholesterol carried byHDL may be catabolized through apo A-I receptors in the liver and kidney.The differencesin cholesterol binding and in lipoprotein and apolipoprotein metabolism of the two speciesprovide important clues for the elucidation of the pathogenesis of atherosclerosis.

Associations between C-Reactive Protein and Apolipoproteins, Lipoprotein (a) and Conventional Serum Lipids in Outpatients: Correlations and Time Trends

Background: Correlations between CRP and serum lipids are weak, and there are conflicting and incomplete results in the literature. The aim of the present study was to clarify the strength and independence of relationships between CRP and serum lipids in outpatients. Methods: Inclusion criteria were outpatients where all the following analyses were requested in clinical routine: high sensitivity CRP, total cholesterol, triglycerides, LDL-cholesterol, HDL-cholesterol, ApoB, ApoA-1 and Lp(a). Data for patients meeting the above criteria during a period of six years (2004-2010) were copied from Aleris Medilab’s Laboratory Information System to the software Statistica. Basic statistics and correlations were calculated for 2771 patients. In patients with two (n = 959) or more sampling times changes over time were calculated. The study was a quality assurance project without access to patient files. Results: Median age was 59 years and median serum CRP concentration was 1.5 mg/L. The strongest correlations (Spearman R) were seen between CRP and triglycerides (0.25), ApoB/ApoA-1 ratio (0.21) and HDL-cholesterol (−0.18). Stepwise regression analysis showed that ApoB, total cholesterol, log triglycerides and log Lp(a) together explained 8% of the variation in log CRP. Unfavourable time trends for CRP and triglycerides counteracted a significant decrease in LDL-cholesterol and total cholesterol. Conclusion: In a large cohort of outpatients CRP showed stronger correlation with triglycerides and ApoB/ApoA-1 ratio than with LDL-cholesterol and Lp(a). LDL-cholesterol concentrations changed favorably over time whereas CRP and triglycerides did not.

陕西省延安市成年人群血清n-HDL-C水平参考区间的建立及影响因素分析

目的建立陕西省延安市成年人血清非高密度脂蛋白-胆固醇(non-high-density lipoprotein cholesterol,n-HDL-C)的参考区间并分析影响因素。方法采用随机整体抽样的方法,抽取2023年1~9月陕西省延安市10个乡镇16921例成人为研究对象。调查年龄、性别、吸烟、饮酒、锻炼、高血压、糖尿病、血脂异常、慢性病、居住、饮食习惯、婚姻状况、文化程度、月收入等。测量身高、体重、腰围和血压。检测血清三酰甘油(TG)、总胆固醇(TCHO)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)及脂蛋白a[Lp(a)]水平,计算n-HDL-C水平,n-HDL-C(mmol/L)=TCHO(mmol/L)-HDL-C(mmol/L)。按照WS/T402-2012《中华人民共和国卫生行业标准》建议的百分位数法计算95%参考区间(P_(2.5)~P_(97.5))。采用多因素Logistic回归分析影响血清n-HDL-C水平的影响因素。结果男性和女性血清n-HDL-C水平均呈非正态分布(S=2.119,2.091,均P<0.001)。男性>60岁血清n-HDL-C水平[2.98(2.50,3.37)mmol/L]与18~30岁[2.84(2.49,3.26)mmol/L],31~40岁[2.98(2.62,3.42)mmol/L],41~50岁[3.10(2.62,3.47)mmol/L]和51~60岁[3.05(2.64,3.46)mmol/L]比较,差异具有统计学意义(H=3.618~5.680,均P<0.05);女性51~60岁血清n-HDL-C水平[3.08(2.71,3.44)mmol/L]与18~30岁[2.64(2.29,3.07)mmol/L],31~40岁[2.67(2.31,3.08)mmol/L],41~50岁[2.94(2.58,3.29)mmol/L]比较(H=8.161~13.445,均P<0.001),>60岁血清n-HDL-C水平[2.98(2.57,3.34)mmol/L]与18~30岁、31~40岁、41~50岁比较,差异具有统计学意义(H=7.985~14.018,均P<0.001)。将无统计学意义的年龄组合并,得到成年人群血清n-HDL-C水平参考区间:男性18~60岁(1.97~3.97mmol/L),>60岁(1.86~3.91mmol/L);女性18~50岁(1.82~3.74mmol/L),>50岁(1.94~3.88mmol/L)。将纳入的16921例成人分为n-HDL-C水平正常组和异常组,两组血清TG(1.02±0.31 mmol/L vs 1.24±0.37mmol/L),TCHO(3.97±1.02 mmol/L vs 4.66±1.25 mmol/L),LDL-C(2.37±0.58mmol/L vs 2.59±0.67 mmol/L)水平及年龄(43.55±11.52岁vs 46.27±8.13岁)比较,差异具有统计学意义(t=2.041~3.151,均P<0.05),血清n-HDL-C水平异常率42.50%。经多因素Logistic回归分析,男性、锻炼缺乏、超重和肥胖、血脂异常、城市居民、高中及以上学历是该地区成年人血清n-HDL-C水平的影响因素(均P<0.05)。结论初步建立了该地区成年人血清n-HDL-C水平参考区间,男性、锻炼缺乏、超重和肥胖、血脂异常、城市居民、高中及以上学历是该地区成年人血清n-HDL-C水平异常的影响因素。

BDNF和HDL-C与老年帕金森病患者脑白质病变的关系

目的探讨血清脑源性神经营养因子(BDNF)和高密度脂蛋白胆固醇(HDL-C)与老年帕金森病(PD)患者脑白质病变(WML)的关系。方法筛选116例老年PD患者为研究组,依据Fazckas分级分成PD-WML组和PD组,另选取同期人口学资料匹配的40例健康体检者为对照组。比较不同组别的相关资料,应用多因素Logistic分析PD患者WML的影响因素,受试者工作特征(ROC)曲线分析血清BDNF、HDL-C与PD患者WML的关系。结果116例PD患者WML发生率为72.41%(84/116),Ⅰ、Ⅱ、Ⅲ级分别43、30、11例。PD-WML组年龄、高血压患病率、统一帕金森病评定量表Ⅲ(UPDRS-Ⅲ)评分均高于PD组(P<0.05),血清BDNF[(4.83±1.15)μg/L比(6.12±1.20)μg/L]、TC[(4.37±0.96)mmol/L比(4.84±1.04)mmol/L]和HDL-C[(1.07±0.29)mmol/L比(1.23±0.32)mmol/L]明显低于PD组(P<0.05)。年龄、高血压、BDNF和HDL-C是PD患者发生WML的独立影响因素(P<0.05)。对照组、PD组、WML轻度组(Ⅰ级)、WML中重度组(Ⅱ~Ⅲ级)血清BDNF、HDL-C均呈依次下降趋势(P<0.05),WML中重度组血清BDNF、HDL-C水平均明显低于WML轻度组(P<0.05)。血清BDNF、HDL-C以及联合诊断PD患者发生WML的曲线下面积(AUC)为0.834、0.768、0.899,单独诊断的截断值分别为5.70μg/L、1.15 mmol/L。血清BDNF、HDL-C以及联合诊断PD发生中重度WML的AUC为0.820、0.766、0.833,单独诊断的截断值分别为4.79μg/L、1.02 mmol/L。结论血清BDNF、HDL-C是PD患者发生WML的保护因素,可有效预测PD患者发生WML和评估病情严重程度。

LDL-C、HDL-C动态评估在急性脑梗死溶栓患者预后中的意义

目的:探讨动态评估低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及其比值在急性脑梗死(ACI)溶栓患者预后中的价值。方法:回顾性收集并分析2020年1月~2022年12月于太和县人民医院神经内科就诊并接受rt-PA静脉溶栓治疗的121例ACI患者临床资料,根据患者90 d后mRS评分状况分为预后不良组(n=33)和预后良好组(n=88),检测并比较两组患者溶栓内1 d、溶栓后1个月LDL-C、HDL-C水平差异,并运用受试者工作特征曲线(ROC)评估以上指标的预测价值。结果:预后不良组的NIHSS评分、梗死体积、发病至溶栓的时间、合并高血压比例均高于预后良好组(P<0.05),体质量指数(BMI)低于预后良好组(P<0.05);两组患者溶栓后1个月LDL-C、LDL-C/HDL-C比值较溶栓内1d均下降,HDL-C值上升(P<0.05);且预后良好组HDL-C上升幅度优于预后不良组(P<0.05);多因素Logistic回归分析结果显示,BMI低(OR=0.730,95%CI:0.552~0.966)、梗死体积大(OR=1.088,95%CI:1.014~1.167)、发病至溶栓的时间长(OR=1.012,95%CI:1.000~1.023)、合并高血压(OR=4.911,95%CI:1.599~15.083)、HDL-C差值小(OR=0.753,95%CI:0.571~0.992)是影响ACI患者预后不良的独立危险因素(P<0.05);HDL-C差值预测的AUC面积为0.718(P<0.05)。结论:动态评估HDL-C的水平变化对判断ACI患者静脉溶栓后不良预后具有重要的临床价值。

脑梗死患者Hcy/HDL-C比值变化及临床意义

目的探讨脑梗死患者同型半胱氨酸(Hcy)/高密度脂蛋白胆固醇(HDL-C)比值变化及临床意义。方法回顾性选取2022年1月至2023年6月该院148例脑梗死患者作为病例组,另收集同期148例健康体检者作为对照组。比较病例组和对照组Hcy、HDL-C水平及Hcy/HDL-C比值;比较病例组不同神经功能缺损程度、梗死灶体积、预后患者Hcy、HDL-C水平及Hcy/HDL-C比值;采用Kendall′s Tau-b检验对Hcy、HDL-C水平及Hcy/HDL-C比值与神经功能缺损程度、梗死灶体积的相关性进行分析;绘制受试者工作特征(ROC)曲线,以曲线下面积(AUC)评估Hcy、HDL-C及Hcy/HDL-C对脑梗死患者预后的预测价值。结果病例组Hcy水平、Hcy/HDL-C比值均明显高于对照组,HDL-C水平明显低于对照组,差异均有统计学意义(P<0.05)。轻度神经功能缺损患者Hcy水平、Hcy/HDL-C比值均低于中、重度神经功能缺损患者,HDL-C水平高于中、重度神经功能缺损患者,差异均有统计学意义(P<0.05);中度神经功能缺损患者Hcy水平、Hcy/HDL-C比值均低于重度神经功能缺损患者,HDL-C水平高于重度神经功能缺损患者,差异均有统计学意义(P<0.05)。小梗死灶患者Hcy水平、Hcy/HDL-C比值均低于中、大梗死灶患者,HDL-C水平高于中、大梗死灶患者,差异均有统计学意义(P<0.05);中梗死灶患者Hcy水平、Hcy/HDL-C比值均明显低于大梗死灶患者,HDL-C水平明显高于大梗死灶患者,差异均有统计学意义(P<0.05)。相关性分析结果显示,Hcy水平、Hcy/HDL-C比值与神经功能缺损程度、梗死灶体积均呈正相关(P<0.05);HDL-C水平与神经功能缺损程度、梗死灶体积均呈负相关(P<0.05)。预后良好患者Hcy水平、Hcy/HDL-C比值均明显低于预后不良患者,HDL-C水平明显高于预后不良患者,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,Hcy、HDL-C及Hcy/HDL-C对脑梗死患者预后均具有中等预测价值,且以Hcy/HDL-C的预测价值最高,AUC分别为0.741、0.753、0.820。结论脑梗死患者Hcy水平、Hcy/HDL-C比值均呈升高状态,HDL-C水平呈降低状态,Hcy、HDL-C水平及Hcy/HDL-C比值与神经功能损伤程度、梗死灶体积均有关;Hcy、HDL-C及Hcy/HDL-C对脑梗死患者预后均有一定的预测价值,且以Hcy/HDL-C的预测价值最高。

中性粒细胞与HDL-C比值和单核细胞与HDL-C比值对冠状动脉狭窄程度的预测价值

目的:分析中性粒细胞与高密度脂蛋白胆固醇比值(NHR)和单核细胞与高密度脂蛋白胆固醇比值(MHR)对冠状动脉狭窄程度的预测价值。方法:回顾性分析2021年10月至2022年4月于本院心内科住院行冠脉造影的患者273例。根据冠脉造影结果分为冠脉正常组89例,轻中度病变组(0<Gensini积分≤40分)97例、重度病变组(Gensini积分>40分)87例。比较三组患者的NHR和MHR。采用ROC曲线分析NHR和MHR对冠脉狭窄程度的预测价值。结果:与冠脉正常组相比,轻中度病变组和重度病变组的MHR[0.35(0.27,0.43)比0.49(0.34,0.64)比0.47(0.35,0.63)]、NHR[3.63(3.01,4.76)比4.91(3.77,6.52)比5.86(4.65,7.98)]均显著增加(P均<0.001);且重度病变组NHR值显著高于轻中度病变组(P=0.022)。ROC曲线分析提示,NHR预测轻中度和重度病变的曲线下面积(AUC)分别为0.723(95%CI:0.651~0.795)、0.820(95%CI:0.757~0.882);MHR预测轻中度和重度病变的AUC分别为0.689(95%CI:0.612~0.766)、0.706(95%CI:.0.628~0.882)。结论:NHR、MHR对冠脉动脉狭窄严重程度有较强的预测价值,并随着狭窄程度越严重,其预测价值越大。

LDL-C/HDL-C对急性非ST段抬高型急性心肌梗死患者介入治疗预后的预测价值

目的 探讨低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)对急性非ST段抬高型急性心肌梗死(NSTEMI)患者介入治疗预后的预测价值。方法 选择医院2021年6月至2022年6月收治的105例接受经皮冠状动脉介入治疗的NSTEMI患者为研究对象,所有患者入院时记录一般资料,采集血液标本,检测血清LDL-C、HDL-C水平,并计算LDL-C/HDL-C值。介入治疗后均进行为期1 a的随访,观察患者预后情况,采用logistic回归分析NSTEMI患者介入治疗预后的危险因素,并绘制受试者工作特征(ROC)曲线,检验LDL-C/HDL-C对NSTEMI患者介入治疗预后的预测价值。结果 105例NSTEMI患者介入治疗出院后被随访1 a, 25例(23.81%)发生主要心血管不良事件,纳入预后不良组,80例未发生主要心血管不良事件,纳入预后良好组。预后不良组血清cTnT、LDL-C、LDL-C/HDL-C水平均高于预后良好组,HDL-C水平低于预后良好组(P<0.05);经logistic回归分析,cTnT、LDL-C、LDL-C/HDL-C是NSTEMI患者介入治疗预后不良的危险因素(OR>1,P<0.05),HDL-C是NSTEMI患者介入治疗预后不良的保护因素(OR<1,P<0.05)。LDL-C、HDL-C、LDL-C/HDL-C预测NSTEMI患者介入治疗预后情况的曲线下面积(AUC)分别为0.677、0.795、0.808。结论 LDL-C/HDL-C与NSTEMI患者介入治疗预后情况密切相关,其水平上调可提示介入治疗预后不良发生风险增加。

肾功能损害及过高HDL-C对急性大血管闭塞性缺血性卒中血管内治疗患者预后的预测价值

目的:探讨肾功能损害(RI)及过高高密度脂蛋白胆固醇(HDL-C)对急性大血管闭塞性缺血性卒中(AIS-LVO)血管内治疗(EVT)患者预后的预测价值。方法:回顾性分析2018年7月~2022年12月黄山市人民医院神经内科接受EVT治疗的AIS-LVO患者临床资料,根据估算肾小球过滤器(eGFR)分为RI组和非RI组,比较两组的相关资料,同时采用单因素及多因素Logistic回归分析探讨RI和其他可能的危险因素与接受EVT的AIS-LVO患者预后的相关性,运用ROC曲线及AUC分析比较RI联合其他可能的危险因素对90 d预后的预测价值。结果:本研究共纳入248例患者,多因素Logistic回归分析显示RI、基线ASPECTs、颈内动脉闭塞、过高HDL-C与90 d预后具有独立相关性(P<0.05)。RI联合过高HDL-C可以提高对90 d预后的预测能力(AUC=0.702,P<0.001)。结论:RI及过高HDL-C均是接受EVT的AIS-LVO患者90 d不良预后的独立危险因素,两者联合可以提高对90 d预后的预测能力。

血清LDL-C/HDL-C、non-HDL-C、RLP-C及sLOX-1水平与老年急性脑梗死的相关性研究

目的分析血清低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、残粒脂蛋白胆固醇(RLP-C)及可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)水平与老年急性脑梗死(ACI)的相关性。方法选取2022年1月—2023年8月收治的230例老年ACI作为研究组,另选择同期、同年龄段115例健康体检者作为对照组。比较2组LDL-C/HDL-C、non-HDL-C、RLP-C及sLOX-1水平,比较研究组不同斑块稳定性、神经功能缺损程度[采用美国国立卫生研究院卒中量表(NIHSS)评分评估]、颈动脉内中膜厚度(IMT)患者上述指标水平,偏回归分析上述指标与老年ACI的关系,并分析上述指标与斑块稳定性、IMT、NIHSS评分的相关性。结果研究组LDL-C/HDL-C、non-HDL-C、RLP-C、sLOX-1水平高于对照组(P<0.01)。老年ACI患者LDL-C/HDL-C、non-HDL-C、RLP-C及sLOX-1水平,无斑块患者<稳定斑块患者<不稳定斑块患者,轻度神经功能缺损患者<中度神经功能缺损患者<重度神经功能缺损患者,IMT正常患者<IMT增厚患者<斑块形成患者(P<0.05)。LDL-C/HDL-C、non-HDL-C、RLP-C、sLOX-1水平与老年ACI密切相关(P<0.01)。研究组LDL-C/HDL-C、non-HDL-C、RLP-C及sLOX-1水平分别与斑块稳定性、IMT、NIHSS评分呈正相关(P<0.01)。结论老年ACI患者LDL-C/HDL-C、non-HDL-C、RLP-C、sLOX-1水平明显升高,且与神经功能缺损程度及颈动脉粥样硬化斑块密切相关。

Non-HDL-C水平和ApoB/ApoA1比值与初发心肌梗死的相关性研究

目的探究不同非高密度脂蛋白胆固醇(non-HDL-C)水平初次急性心肌梗死患者的临床特征及载脂蛋白B(Apo B)和载脂蛋白A1(Apo A1)比值以及non-HDL-C与冠状动脉(冠脉)病变程度的相关性。方法选取2021年12月至2023年4月于重庆医科大学附属第一医院心内科入院治疗的首次诊断为急性心肌梗死且行冠脉造影的患者410例。计算Apo B/Apo A1比值及non-HDL-C,根据non-HDL-C三分位数分为低non-HDL-C组(≤2.89 mmol/L)、中non-HDL-C组(2.9~4.16 mmol/L)、高non-HDL-C组(≥4.17 mmol/L),比较三组患者一般临床资料及冠脉病变特点的差异性。另采用Spearman秩相关和二元Logistics回归分析non-HDL-C水平、Apo B/Apo A1对冠脉病变严重程度的影响。结果与低non-HDL-C组相比,中non-HDL-C组和高non-HDL-C组患者年龄更小(P<0.05);高non-HDL-C组较另外两组具有更高水平的体质指数(BMI)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、ApoB、ApoA1、ApoB/ApoA1、白蛋白、γ-谷酰转移酶、尿酸(P<0.05)。三组间左前降支病变、回旋支病变、多支血管病变、Gensini评分相比,差异有统计学意义(P<0.05)。偏相关分析显示Apo B/Apo A1和non-HDL-C均与多支血管病变、Gensini评分呈正相关(P<0.05);多因素二元Logistics回归分析显示ApoB/ApoA1比值(OR=3.149,95%CI:1.209~8.201,P=0.019)、non-HDL-C≥4.17 mmol/L(OR=4.199,95%CI:1.524~11.565,P=0.006)是多支血管病变的独立危险因素。结论在初次急性心肌梗死青年患者有冠脉病变或(冠状动脉粥样硬化性心脏病)危险因素中,更应关注ApoB/ApoA1及non-HDL-C,同时严格控制non-HDL-C是心肌梗死患者潜在的降脂目标。

Liver as a new target organ in Alzheimer's disease:insight from cholesterol metabolism and its role in amyloid-beta clearance

Alzheimer's disease,the primary cause of dementia,is characterized by neuropathologies,such as amyloid plaques,synaptic and neuronal degeneration,and neurofibrillary tangles.Although amyloid plaques are the primary characteristic of Alzheimer's disease in the central nervous system and peripheral organs,targeting amyloid-beta clearance in the central nervous system has shown limited clinical efficacy in Alzheimer's disease treatment.Metabolic abnormalities are commonly observed in patients with Alzheimer's disease.The liver is the primary peripheral organ involved in amyloid-beta metabolism,playing a crucial role in the pathophysiology of Alzheimer's disease.Notably,impaired cholesterol metabolism in the liver may exacerbate the development of Alzheimer's disease.In this review,we explore the underlying causes of Alzheimer's disease and elucidate the role of the liver in amyloid-beta clearance and cholesterol metabolism.Furthermore,we propose that restoring normal cholesterol metabolism in the liver could represent a promising therapeutic strategy for addressing Alzheimer's disease.

心力衰竭患者中Lp(a)、HDL-C和ApoA1的联合检测对预后的预测价值

目的:探究脂蛋白(a)[Lp(a)]、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(ApoA)联合预测心力衰竭患者预后的价值。方法:选取2020年1月至2022年1月在本院就诊的160例心力衰竭患者为研究组,另选取同期于本院体检的40例健康人群为对照组,比较两组Lp(a)、HDL-C、ApoA水平。随访1 y,依据是否发生主要不良心血管事件(MACE)将研究组患者分为预后良好组与预后不良组,比较不同预后心力衰竭患者临床指标、Lp(a)、HDL-C、ApoA水平的差异;Logistic回归分析心力衰竭患者预后不良的影响因素;绘制ROC曲线分析上述指标对心力衰竭患者预后的预测价值。结果:研究组患者的Lp(a)水平高于对照组,但其HDL-C、ApoA水平均较对照组更低(P<0.05)。在Lp(a)水平比较上,NYHA分级Ⅱ级<Ⅲ级<Ⅳ级(P<0.05);在HDL-C、ApoA水平比较上,NYHA分级Ⅱ级>Ⅲ级>Ⅳ级(P<0.05)。160例心力衰竭患者,1 y随访,预后良好120例,预后不良40例,NYHA分级Ⅳ级、Lp(a)、HDL-C、ApoA均为心力衰竭患者预后不良的危险因素(P<0.05)。Lp(a)、HDL-C、ApoA诊断心力衰竭患者预后不良的AUC为0.843(95%CI为0.777-0.896)、0.784(95%CI为0.712-0.845)、0.783(95%CI为0.710-0.844);三者联合诊断心力衰竭患者预后不良的AUC为0.913(95%CI为0.858-0.952),均较各单一指标诊断效能更高(Z=3.087、3.619、3.233,P<0.05)。结论:心力衰竭患者血清Lp(a)异常升高,HDL-C、ApoA异常降低,三者联合检测对心力衰竭患者预后具有较高的评估预测价值。

甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)对原发性肝癌发病的影响

目的探究甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)对原发性肝癌发病的影响。方法采用前瞻性队列研究的方式,收集2006年7月—2007年12月参加开滦集团健康体检的99750例在职及离退休职工的体检资料,并对其原发性肝癌的发病情况进行随访,随访截止时间为2021年12月31日。根据TG/HDL-C三分位水平将受试者分成3组,分别为Q1组(TC/HDL-C<0.66,n=33229)、Q2组(0.66≤TC/HDL-C<1.14,n=33302)、Q3组(TC/HDL-C≥1.14,n=33219)。计算各组原发性肝癌的发病密度。符合正态分布的计量资料多组间比较采用单因素方差分析;符合偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验。采用Kaplan⁃Meier法计算各组原发性肝癌的累积发病率,以Logrank检验比较各组间累积发病率的差异。采用Cox比例风险模型分析不同TG/HDL-C水平分组对原发性肝癌发病的影响。结果3组受试者年龄、男性比例、腰围、BMI、空腹血糖、收缩压、舒张压、TG、TC、HDL-C、LDL-C、ALT、超敏C-反应蛋白、慢性肝病、高血压病、糖尿病、恶性肿瘤家族史、饮酒、吸烟、体育锻炼、受教育程度组间对比差异均有统计学意义(P值均<0.05)。在平均(14.06±2.71)年的随访过程中,新发肝癌共计484例,其中男446例,女38例。Q1组、Q2组、Q3组原发性肝癌的发病密度分别是0.39/千人年、0.35/千人年、0.30/千人年。3组受试者的原发性肝癌累积发病率分别是6.03‰、5.28‰和4.49‰,经Log-rank检验,差异有统计学意义(χ^(2)=6.06,P=0.048)。校正了考虑到的混杂因素后,Cox比例风险模型结果显示,以Q3组为对照,Q1、Q2组的风险比及95%可信区间分别为2.04(1.61~2.58)、1.53(1.21~1.92)(P for trend<0.05)。结论TG/HDL-C水平降低与原发性肝癌发病风险升高有关,特别是在慢性肝病的人群中这种关联更加明显。

Association between sensitivity to thyroid hormones and non-highdensity lipoprotein cholesterol levels in patients with type 2 diabetes mellitus

BACKGROUND Dyslipidemia and type 2 diabetes mellitus(T2DM)are chronic conditions with substantial public health implications.Effective management of lipid metabolism in patients with T2DM is critical.However,there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population,particularly concerning non-high-density lipoprotein cholesterol(non-HDL-C).AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM.METHODS In this cross-sectional study,thyroid hormone sensitivity indices,the thyroid feedback quantile-based index(TFQI),the thyroid-stimulating hormone index(TSHI),the thyrotrophic T4 resistance index(TT4RI),and the free triiodothyronine(FT3)/free thyroxine(FT4)ratio were calculated.Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels.Random forest variable importance and Shapley Additive Explanations(SHAP)summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor.RESULTS Among the 994 participants,389(39.13%)had high non-HDL-C levels.Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI(OR:1.584;95%CI:1.088-2.304;P=0.016),TSHI(OR:1.238;95%CI:1.034-1.482;P=0.02),and TT4RI(OR:1.075;95%CI:1.006-1.149;P=0.032)but was not significantly correlated with the FT3/FT4 ratio.The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex.An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men(OR:1.331;95%CI:1.003-1.766;P=0.048)but elevated TFQI levels in women(OR:2.337;95%CI:1.4-3.901;P=0.001).Among the analyzed variables,the average SHAP values were highest for TSHI,followed by TT4RI.CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

Non-HDL-C/HDL-C和NHR与冠状动脉病变严重程度的相关性

目的探讨非高密度脂蛋白胆固醇/高密度脂蛋白胆固醇比值(non-high-density lipoprotein cholesterol to high density lipoprotein cholesterol ratio,non-HDL-C/HDL-C)和中性粒细胞计数/高密度脂蛋白胆固醇比值(neutrophil to high-density lipoprotein cholesterol ratio,NHR)与冠状动脉病变严重程度的相关性。方法选取2022年1月至2023年6月因胸闷、胸痛于华北理工大学附属医院心内科住院初次行冠状动脉造影检查的患者284例,根据冠状动脉造影结果分为冠状动脉病变组(n=223)和对照组(n=61)。收集两组临床资料(一般资料和实验室资料),计算non-HDL-C/HDL-C和NHR,比较两组临床资料。根据Gensini评分将冠状动脉病变组分为低、高分值两个亚组,Gensini评分<30分为低分值亚组、Gensini评分≥30分为高分值亚组,比较两亚组实验室资料。采用Spearman相关性分析探讨冠状动脉病变患者Gensini评分与non-HDL-C/HDL-C、NHR的相关性。应用多因素Logistic回归分析探讨冠状动脉病变患者高Gensini评分的影响因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线以评价non-HDL-C/HDL-C和NHR对冠状动脉病变患者高Gensini评分的预测价值。结果冠状动脉病变组non-HDL-C/HDL-C和NHR水平高于对照组(均P<0.05);Gensini评分高分值亚组non-HDL-C/HDL-C、NHR水平高于低分值亚组(均P<0.05)。相关性分析显示,non-HDL-C/HDL-C、NHR与Gensini评分均呈正相关(均P<0.05)。多因素Logistic回归分析显示,NHR升高是冠状动脉病变患者高Gensini评分的独立危险因素(OR=1.650,95%CI:1.262-2.158,P<0.05)。绘制ROC曲线,non-HDL-C/HDL-C和NHR预测冠状动脉病变严重程度的ROC曲线下面积分别为0.657(95%CI:0.582-0.732,P<0.01)和0.736(95%CI:0.666-0.807,P<0.01)。结论non-HDL-C/HDL-C、NHR与冠状动脉病变严重程度呈正相关,且NHR是冠状动脉病变患者高Gensini评分的独立预测因子。

冠心病病人HDL-C/LDL-C、ApoA1/ApoB、Lp(a)变化及与冠脉病变程度支数的关系分析

目的:探究冠心病(CHD)病人高密度脂蛋白胆固醇/低密度脂蛋白胆固醇(HDL-C/LDL-C)、载脂蛋白A1/载脂蛋白B(ApoA1/ApoB)、脂蛋白a[Lp(a)]变化及与冠脉病变程度支数的关系。方法:选取冠心病病人90例作为CHD组,同期体检健康者100名作为对照组,比较2组及不同病变程度支数病人的HDL-C/LDL-C、ApoA1/ApoB及Lp(a)水平。结果:CHD组病人的HDL-C/LDL-C、ApoA1/ApoB水平低于对照组(P<0.01和P<0.05),Lp(a)水平高于对照组(P<0.05);90例CHD病人中,26例病人为单支病变,30例为双支病变,34例为多支病变,随着病变支数的增加,病人的HDL-C/LDL-C和ApoA1/ApoB水平呈降低趋势(P<0.01),Lp(a)水平呈升高趋势(P<0.01);Pearson相关性分析结果显示,病变支数与HDL-C/LDL-C、ApoA1/ApoB水平成负相关(r=-0.474、-0.501,P<0.01),与Lp(a)水平成正相关(r=0.379,P<0.01)。ROC结果显示,上述3项指标联合(并联)评估CHD病人双支及以上病变程度支数的AUC及敏感度均高于单一指标诊断(P<0.01),3项指标对诊断两支及以上病变的切点值分别为0.405、1.425、273.120 mg/L。结论:HDL-C/LDL-C、ApoA1/ApoB及Lp(a)水平与CHD病人冠状动脉病变程度支数密切相关,三者联合检测对评估CHD病人冠脉病变支数程度具有较高的价值相关性,建议临床密切监测。

TyG指数、RC及NonHDL-C与急性冠脉综合征血管病变严重程度的相关性研究

目的探讨非高密度脂蛋白胆固醇(NonHDL-C)、甘油三酯葡萄糖指数(TyG指数)及残余脂蛋白胆固醇(RC)水平与急性冠脉综合征(ACS)冠状动脉血管病变严重程度的相关性。方法选取我院收治的147例经PCI术治疗的ACS患者作为研究对象。收集患者的基线资料,并使用Gensini评分评估冠状动脉病变的严重程度。依据Gensini评分,将患者分轻度组(4≤Gensini评分≤16,n=52)和中重度组(Gensini评分>16,n=95)。采用多因素Logistic回归分析确定ACS患者血管病变严重程度的独立危险因素。采用Spearman相关分析评估RC、NonHDL-C和TyG指数水平与Gensini评分的相关性,并通过ROC曲线评估RC、TyG指数及NonHDL-C水平对ACS患者血管病变严重程度的预测价值。结果中重度组与轻度组相比,NonHDL-C、RC和TyG指数水平均显著增加(P<0.05)。多因素Logistic回归分析结果显示,RC(OR=7.673,P=0.012)、TyG指数(OR=2.537,P=0.013)和NonHDL-C(OR=2.144,P=0.001)水平是ACS患者冠状动脉病变严重程度的独立危险因素。RC、TyG指数、NonHDL-C水平的AUC为0.653、0.671、0.711。TyG指数与NonHDL-C水平的联合AUC为0.739。Spearman相关分析结果显示:Gensini评分与TyG指数、RC和NonHDL-C水平呈正相关(P<0.05)。结论RC、TyG指数和NonHDL-C的水平升高可能是ACS患者冠状动脉病变严重程度的危险因素,并对日后的血管病变严重程度有一定的预测价值。