Reduced serum high-density lipoprotein cholesterol levels and aberrantly expressed cholesterol metabolism genes in colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a common malignant tumor of the gastrointestinal tract.Lipid metabolism,as an important part of material and energy circulation,is well known to play a crucial role in CRC.AIM To explore the relationship between serum lipids and CRC development and identify aberrantly expressed cholesterol metabolism genes in CRC.METHODS We retrospectively collected 843 patients who had confirmed CRC and received surgical resection from 2013 to 2015 at the Cancer Hospital of the Chinese Academy of Medical Sciences as our research subjects.The levels of serum total cholesterol(TC),triglycerides,low-density lipoprotein cholesterol(LDL-C),highdensity lipoprotein cholesterol(HDL-C),LDL-C/HDL-C and clinical features were collected and statistically analyzed by SPSS.Then,we used the data from Oncomine to screen the differentially expressed genes(DEGs)of the cholesterol metabolism pathway in CRC and used Gene Expression Profiling Interactive Analysis to confirm the candidate DEGs.PrognoScan was used to analyze the prognostic value of the DEGs,and Search Tool for the Retrieval of Interacting Genes was used to construct the protein-protein interaction network of DEGs.RESULTS The serum HDL-C level in CRC patients was significantly correlated with tumor size,and patients whose tumor size was more than 5 cm had a lower serum HDL-C level(1.18±0.41 mmol/L vs 1.25±0.35 mmol/L,P<0.01)than their counterparts.In addition,TC/HDL(4.19±1.33 vs 3.93±1.26,P<0.01)and LDL-C/HDL-C(2.83±1.10 vs 2.61±0.96,P<0.01)were higher in patients with larger tumors.The levels of HDL-C(P<0.05),TC/HDL-C(P<0.01)and LDL-C/HDL-C(P<0.05)varied in different stages of CRC patients,and the differences were significant.We screened 14 differentially expressed genes(DEGs)of the cholesterol metabolism pathway in CRC and confirmed that lipoprotein receptor-related protein 8(LRP8),PCSK9,low-density lipoprotein receptor(LDLR),MBTPS2 and FDXR are upregulated,while ABCA1 and OSBPL1A are downregulated in cancer tissue.Higher expression of LDLR(HR=3.12,95%CI:1.77-5.49,P<0.001),ABCA1(HR=1.66,95%CI:1.11-2.48,P=0.012)and OSBPL1A(HR=1.38,95%CI:1.01-1.89,P=0.041)all yielded significantly poorer DFS outcomes.Higher expression of FDXR(HR=0.7,95%CI:0.47-1.05,P=0.002)was correlated with longer DFS.LDLR,ABCA1,OSBPL1A and FDXR were involved in many important cellular function pathways.CONCLUSION Serum HDL-C levels are associated with tumor size and stage in CRC patients.LRP8,PCSK9,LDLR,MBTPS2 and FDXR are upregulated,while ABCA1 and OSBPL1A are downregulated in CRC.Among them,LDLR,ABCA1,OSBPL1A and FDXR were valuable prognostic factors of DFS and were involved in important cellular function pathways.

High-density Lipoprotein Cholesterol and In-hospital Mortality in Patients with Acute Aortic Dissection

The association between high-density lipoprotein cholesterol（HDL-C） and mortality in patients with acute aortic dissection（AAD） is unclear. From January 2007 to January 2014, a total of 928 consecutive AAD patients who were admitted within 48 h after the onset of symptoms were enrolled in the study. Patients were divided into two groups according to whether serum HDL-C level was below the normal lower limit or not. The Cox proportional hazard regression model was used to identify the predictive value of HDL-C for in-hospital mortality in patients with AAD. As compared with normal HDL-C group（n=585）, low HDL-C group（n=343） had lower levels of systolic blood pressure and hemoglobin and higher levels of leukocyte, alanine aminotransferase, blood glucose, blood urea nitrogen, creatinine and urea acid. Low HDL-C group had significantly higher in-hospital mortality than normal HDL-C group（21.6% vs. 12.6%, log-rank=10.869, P=0.001）. After adjustment for baseline variables including demographics and biologic data, the increased risk of in-hospital mortality in low HDL-C group was substantially attenuated and showed no significant difference（adjusted hazard ratio, 1.23; 95% confidence interval, 0.86–1.77; P=0.259）. Low HDL-C is strongly but not independently associated with in-hospital mortality in patients with AAD.

A Possible Mechanism Linking Hyperglycemia and Reduced High-density Lipoprotein Cholesterol Levels in Diabetes

This study investigated the role of glucose in the biogenesis of high-density lipoprotein cholesterol(HDL-C).Mouse primary peritoneal macrophages were harvested and maintained in Dulbecco’s modified Eagle’s medium(DMEM) containing glucose of various concentrations.The cells were divided into 3 groups in terms of different glucose concentrations in the cultures:Control group(5.6 mmol/L glucose),high glucose concentration groups(16.7 mmol/L and 30 mmol/L glucose).ATP-binding cassette transporter A1(ABCA1) mRNA expression in the macrophages was detected by semi-quantitative RT-PCR 24,48 and 72 h after glucose treatment.The results showed that ABCA1 mRNA expression in the 16.7 mmol/L glucose group was not significantly different from that in the control group at all testing time points(P>0.05 for each).In the 30 mmol/L glucose group,macrophage ABCA1 mRNA expression was not changed significantly at 24 h(P=0.14),but was substantially decreased by 40.4% at 48 h(P=0.009) and by 48.1% at 72 h(P=0.015) as compared with that in the control group.It was concluded that ABCA1 is of vital importance for HDL-C biogenesis.High glucose may hamper HDL-C biogenesis by decreasing ABCA1 expression,which contributes to low HDL-C level in diabetes.

High-density lipoprotein endocytosis in endothelial cells

AIM: To describe the way stations of high-density lipoprotein(HDL) uptake and its lipid exchange in endothelial cells in vitro and in vivo. METHODS: A combination of fluorescence microscopy using novel fluorescent cholesterol surrogates and electron microscopy was used to analyze HDL endocytosis in great detail in primary human endothelial cells. Further, HDL uptake was quantified using radio-labeled HDL particles. To validate the in vitro findings mice were injected with fluorescently labeled HDL and particle uptake in the liver was analyzed using fluorescencemicroscopy. RESULTS: HDL uptake occurred via clathrin-coated pits, tubular endosomes and multivesicular bodies in human umbilical vein endothelial cells. During uptake and resecretion, HDL-derived cholesterol was exchanged at a faster rate than cholesteryl oleate, resembling the HDL particle pathway seen in hepatic cells. In addition, lysosomes were not involved in this process and thus HDL degradation was not detectable. In vivo, we found HDL mainly localized in mouse hepatic endothelial cells. HDL was not detected in parenchymal liver cells, indicating that lipid transfer from HDL to hepatocytes occurs primarily via scavenger receptor, class B, type Ⅰ mediated selective uptake without concomitant HDL endocytosis. CONCLUSION: HDL endocytosis occurs via clathrincoated pits, tubular endosomes and multivesicular bodies in human endothelial cells. Mouse endothelial cells showed a similar HDL uptake pattern in vivo indicating that the endothelium is one major site of HDL endocytosis and transcytosis.

Triglycerides and ratio of triglycerides to high-density lipoprotein cholesterol are better than liver enzymes to identify insulin resistance in urban middle-aged and older non-obese Chinese without diabetes

Background Insulin resistance （IR） plays an important pathophysiological role in the development of diabetes,dyslipidemia,hypertension,and cardiovascular disease.Moreover,IR can occur even in non-obese people without diabetes.However,direct detection of IR is complicated.In order to find a simple surrogate marker of IR early in nonobese people,we investigate the association of commonly-used biochemical markers （liver enzymes and lipid profiles） with IR in urban middle-aged and older non-obese Chinese without diabetes.Methods This cross-sectional study included 1 987 subjects （1 473 women）.Fasting blood samples were collected for measurement of glucose,insulin,liver enzymes,lipid profiles and creatinine.Subjects whose homeostasis model of assessment-IR （HOMA-IR） index values exceeded the 75th percentile （2.67 for women and 2.48 for men） of the population were considered to have IR.The area under the receiver operating characteristic curve （ROC） was used to compare the power of potential markers in identifying IR.Results Triglycerides （TG） and ratio of TG to high-density lipoprotein cholesterol （TG/HDL-C） discriminated IR better than other indexes for both sexes; areas under the receiver operating characteristic （ROC） curves （AUC） values were 0.770 （95％ confidence interval 0.733-0.807） and 0.772 （0.736-0.809）,respectively,for women and 0.754 （0.664-0.844）and 0.756 （0.672-0.840）,respectively,for men.To identify IR,the optimal cut-offs for TG and TG/HDL-C ratio were 1.315 mmol/L （sensitivity 74.3％,specificity 71.0％） and 0.873 （sensitivity 70.1％,specificity 73.4％）,respectively,for women,and 1.275 mmol/L （sensitivity 66.7％,specificity 74.4％） and 0.812 （sensitivity 75.8％,specificity 69.2％）,respectively,for men.Conclusion TG and TG/HDL-C ratio could be used to identify IR in urban middle-aged and older non-obese Chinese without diabetes.

Higher testosterone levels are associated with increased highdensity lipoprotein cholesterol in men with cardiovascular disease： results from the Massachusetts Male Aging Study

Aim： To study the relationship between circulating androgens （total testosterone [TT], free testosterone [IT] and dihydrotestosterone [DHT]） and high-density lipoprotein cholesterol （HDL-C） in men with and without cardiovascular disease （CVD）. Methods： Cross-sectional analyses included 1 661 baseline samples from the Massachusetts Male Aging Study （MMAS）, a population-based cohort of men ages 40-70 years. Serum hormones were measured by radioimmunoassay and HDL-C was determined following precipitation of the lower density lipoproteins. CVD was determined by self-report. Analyses were performed using multiple linear regression. Results： TT and HDL-C were positively correlated in the entire sample （r = 0.11, P = 0.0001）. After adjusting for confounders, we found this relationship was mostly limited to the 209 men with CVD. Among men with CVD, TT （P = 0.0004）, iT （P = 0.0172） and DHT （P = 0.0128） were all positively correlated with HDL-C, whereas in men without CVD only TT correlated with HDL-C （P = 0.0099）. Conclusion： Our results suggest that if androgens contribute to CVD in middle-aged men, the effect is not related to a suppressive effect of endogenous T on HDL-C. （Asian JAndrol 2008 Mar; 10： 193-200）

Lipoprotein in cholesterol transport: Highlights and recent insights into its structural basis and functional mechanism

Lipoproteins are protein-lipid macromolecular assemblies which are used to transport lipids in circulation and are key targets in cardiovascular disease （CVD）. The highly dynamic lipoprotein molecules are capable of adopting an array of conformations that is crucial to lipid transport along the cholesterol transport pathway, among which high-density lipopro- tein （HDL） and low-density lipoprotein （LDL） are major players in plasma cholesterol metabolism. For a more detailed illustration of cholesterol transport process, as well as the development of therapies to prevent CVD, here we review the functional mechanism and structural basis of lipoproteins in cholesterol transport, as well as their structural dynamics in the plasma lipoprotein （HDL and LDL） elevations, in order to obtain better quantitative understandings on structure-function relationship of lipoproteins. Finally, we also provide an approach for further research on the lipoprotein in cholesterol transport.

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.

高尿酸血症相关肾损害的危险因素分析

目的分析高尿酸血症(HUA)相关肾损害的危险因素。方法选取2021年4月至2023年3月本院收治的HUA患者132例,根据是否发生肾功能损伤分为肾功能损伤组54例及肾功能正常组78例。采用Logistic回归模型分析HUA肾功能损伤的影响因素,采用ROC曲线分析临床指标评估肾功能损伤的价值,采用Pearson相关性分析临床指标与肾功能损伤指标的相关性。结果肾功能损伤组患者病程、收缩压、TG、LDL-C、SUA、BUN、Scr水平明显高于肾功能正常组(P<0.05),eGFR水平明显低于肾功能正常组(P<0.05);Logistic回归分析显示,病程、收缩压、TG、LDL-C、SUA是影响HUA肾功能损伤的主要因素(P<0.05);病程、收缩压、TG、LDL-C、SUA评估HUA肾功能损伤的AUC分别为0.596、0.545、0.746、0.651、0.724;Pearson相关性分析显示,病程、收缩压、TG、LDL-C、SUA与Scr呈正相关,与eGFR呈负相关。结论病程、血压、SUA、LDL-C、TG是HUA肾功能损伤的独立危险因素,定期监测有助于早期筛查肾功能损伤。

血浆致动脉粥样硬化指数轨迹与动脉粥样硬化性心血管疾病的关联

目的:探讨血浆致动脉粥样硬化指数(AIP)轨迹与动脉粥样硬化性心血管疾病(ASCVD)的关联。方法:选择2006~2010年期间连续3次参加开滦集团健康体检的51831名在职及离退休员工作为研究对象。通过SAS Proc Traj程序拟合AIP(甘油三酯/高密度脂蛋白胆固醇比值的对数值)轨迹模型,并根据AIP轨迹将研究对象分为低稳定组(n=11114)、低中稳定组(n=21647)、中高稳定组(n=13659)、高稳定组(n=5411)。采用Kaplan-Meier法计算四组的ASCVD累积发病率,并通过log-rank检验进行比较。采用Cox比例风险回归模型分析四组的ASCVD发病风险,并进行分层分析。结果:平均随访(10.19±2.22)年期间,5142例(9.92%)研究对象发生ASCVD,4013例(7.74%)研究对象死亡。校正混杂因素后,Cox回归分析显示:与低稳定组相比,低中稳定组、中高稳定组、高稳定组的ASCVD发病风险分别增加13%(HR=1.13,95%CI:1.04~1.23,P=0.003)、20%(HR=1.20,95%CI:1.10~1.31,P<0.001)和41%(HR=1.41,95%CI:1.27~1.57,P<0.001),且风险呈逐渐增加趋势(P_(trend)<0.001)。分层分析显示,在AIP长期处于高水平的人群中,年龄<65岁者和低密度脂蛋白胆固醇(LDL-C)<3.4 mmol/L者的ASCVD发病风险分别高于年龄≥65岁者和LDL-C≥3.4 mmol/L者(P_(interaction)均<0.01)。结论:在开滦研究队列中,AIP长期处于高水平的人群发生ASCVD的风险更高,且发病风险随着AIP升高而逐步增加。另外,在AIP长期处于高水平的人群中,年龄<65岁者的ASCVD发病风险高于年龄≥65岁者,LDL-C<3.4 mmol/L者的ASCVD发病风险高于LDL-C≥3.4 mmol/L者。

两样本孟德尔随机化分析血脂与肌肉减少症的因果关系

背景:骨质疏松常伴有肌肉减少症的发生并增加摔倒骨折的风险。近年来的研究表明,脂质代谢与肌肉减少症之间存在密切关系。异常的脂质代谢可能对肌肉的生理功能和代谢产生直接的影响。目的:探究脂质代谢与肌肉减少症之间的关系,并使用孟德尔随机化方法来评估其因果关系。方法:使用孟德尔随机化方法探究低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和三酰甘油与肌肉量之间的因果关系;采用了全基因组关联研究的研究数据,并进行敏感性分析来验证结果的可靠性;采用肌肉量的近似指标作为结局指标,包括四肢瘦体质量和躯干瘦体质量。结果与结论:①结果发现,肌肉量与低密度脂蛋白胆固醇和三酰甘油存在负相关关系,而高密度脂蛋白胆固醇与肌肉量之间未发现相关性;②敏感性分析结果表明因果关系稳健;③通过孟德尔随机化方法,此次研究提供了低密度脂蛋白胆固醇和三酰甘油与肌肉量之间存在因果关系的证据,这一发现深化了脂质对肌肉减少症影响的理解,对于预防及治疗肌肉减少症和骨质疏松症具有重要的临床意义。

糖尿病患者血脂管理及干预策略研究进展

糖尿病(DM)患者常伴有血脂异常,这将增加心血管疾病的发病风险。降脂治疗、生活方式干预等能够显著改善DM患者的血脂异常状况,降低心血管事件的发生风险,从而让DM患者在临床上受益。本研究查阅相关文献,阐述了血脂管理及其干预策略的研究进展,旨在为临床治疗提供参考。

甲状腺结节发生与糖脂代谢水平的相关性分析

目的分析甲状腺结节发生与糖脂代谢水平的相关性。方法选取厦门弘爱医院(2022年1—12月)接受甲状腺检查者100例,根据患者的检查结果不同分组,其中检查结果为甲状腺结节的患者50例为研究组,检查结果为未发生甲状腺结节的患者50例为对照组。分析患者的基础资料,明确甲状腺结节发生与糖脂代谢水平[空腹血糖(fasting plasma glucose,FPG)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)及高密度脂蛋白胆固醇(high density lipid-cholesterol,HDL-C)]的相关性。结果研究组FPG、TC、TG和LDL-C水平较对照组更高,差异有统计学意义(P<0.05)。而在HDL-C指标相比之下,差异无统计学意义(P>0.05)。因FT3、FT4、TSH均有不确定值为等级资料行Spearman秩相关分析。TSH与FPG、TC、LDL-C、HDL-C均呈正相关(r值分别为0.105、0.635、0.143、0.704、0.619,P<0.01),而FT3与FPG、TC、LDL-C、HDL-C均呈负相关(r值分别为-0.568、-0.676、-0.352、-0.702、-0.764,P<0.01),FT4与FPG、TC、LDL-C、HDL-C均呈负相关(r值分别为-0.401、-0.547、-0.425、-0.639、-0.493,P<0.01)。结论血清FPG、TC、TG、LDL-C升高,HDL-C降低,为甲状腺结节诱发因素。

残余胆固醇与动脉粥样硬化性心血管疾病风险的研究

动脉粥样硬化性心血管疾病是全球最主要的死亡原因。低密度脂蛋白胆固醇水平低的患者也可复发动脉粥样硬化性心血管疾病事件,残余胆固醇可能是主要残余心血管风险的重要因素。本文对残余胆固醇的定义、定量方法、代谢、致动脉粥样硬化性心血管疾病的机制、证据、治疗等进行综述。

妊娠早期TG/HDL-C与妊娠期糖尿病发生风险:大样本回顾性队列研究

目的 探究妊娠早期甘油三酯(triglyceride, TG)/高密度脂蛋白胆固醇(high density lipoprotein-cholesterol, HDL-C)与妊娠期糖尿病(gestational diabetes mellitus, GDM)发生风险的关系。方法 回顾性收集2020年7月—2022年6月北京协和医院规律产检并分娩的单胎妊娠孕妇临床资料,并根据妊娠24~28周75 g口服葡萄糖耐量试验结果将孕妇分为GDM组和正常糖耐量组。采用多因素Logistic回归法评估妊娠早期(8~12^(+6)周)TG/HDL-C与GDM的相关性,并以甘油三酯-葡萄糖(triglyceride-glucose, TyG)指数为参照,评估妊娠早期TG/HDL-C预测GDM的临床价值。结果共入选符合纳入与排除标准的单胎妊娠孕妇1617名,其中GDM组372例(23.01%)、正常糖耐量组1245名(76.99%)。多因素Logistic回归分析校正年龄、民族、孕前体质量指数、GDM史等混杂因素后发现,妊娠早期TG/HDL-C最高四分位数孕妇GDM发生风险是最低四分位数孕妇的2.46倍(OR=2.46,95%CI:1.73~3.51),TyG指数最高四分位数孕妇GDM发生风险是最低四分位数孕妇的2.36倍(OR=2.36,95%CI:1.67~3.37)。妊娠早期TG/HDL-C预测GDM的效能(曲线下面积:0.607比0.608)、对GDM基础风险模型的改善程度(净重新分类指数:0.240比0.270;综合判别改善指数:0.022比0.024)均与TyG指数较为接近。结论 妊娠早期TG/HDL-C显著升高与GDM发生风险增加具有一定相关性,且其对GDM的预测价值与TyG指数相当。

TG/HDL-C、TyG及其衍生指数与白蛋白尿异常的相关性研究

目的:探讨体检人群甘油三酯/高密度脂蛋白胆固醇(triglyceride/high density lipoprotein cholesterol ratio,TG/HDL-C)、甘油三酯-葡萄糖乘积(riglyceride-glucose index,TyG)指数及其衍生指数水平与白蛋白尿异常的相关性,同时分析TG/HDL-C、TyG以及TyG-BMI(riglyceride-glucose index-body mass index,TyG-BMI)预测白蛋白尿的能力。方法:获取2022年1月至12月体检中心年龄在18岁以上3739例受检者进行回顾性分析,将研究对象分为白蛋白尿异常组(n=841)和对照人群(n=2898),将TG/HDL-C、TyG以及TyG-BMI按四分位数进行分组,采用logistic回归模型分析与体检人群白蛋白尿异常风险之间的关系。采用限制性立方样条回归模型分析不同水平TG/HDL-C、BMI、TyG以及TyG-BMI与白蛋白尿的剂量反应关系。通过受试者工作特征曲线分析单一指标与联合指标对白蛋白尿的预测价值。结果:除平均血红蛋白浓度、高密度脂蛋白胆固醇外,异常组年龄、中性粒细胞、单核细胞、血小板、血白细胞计数、平均红细胞体积、红细胞分布宽度SD、红细胞分布宽度、血小板压积、总蛋白、白蛋白、谷氨酰转肽酶、空腹血糖、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇、甘油三酯(triglyceride,TG)、体质指数(body mass index,BMI)、收缩压、舒张压、脉率、碱性磷酸酶、TyG指数、TyG-BMI、TG/HDL-C均高于对照组。调整混杂因素后,逻辑回归结果显示,与第2、第3分位数相比,TG/HDL-C、TyG、TyG-BMI指数第4四分位数组发生风险最高,其分别为1.895倍(95%CI=1.355~2.653)、2.377倍(95%CI=1.657~3.417)、2.319(95%CI=1.666~3.237)。BMI、TyG-BMI指数与白蛋白尿异常呈明显的非线性剂量反应关系,曲线呈近似“U”型,TyG、TG/HDL-C与白蛋白尿异常之间的剂量反应关系呈逐渐递增趋势,曲线呈近似“J”型。受试者工作特征(receiver operating characteristic,ROC)曲线结果显示,TyG-BMI预测能力优于其他3个指标,其AUC值为0.640。除TyG-BMI+TG/HDL-C之外,其余联合预测能力均优于单一预测指标,TyG-BMI+TG/HDL-C+TyG指数预测白蛋白尿的能力最优,AUC为0.6504。结论:TyG指数、TG/HDL-C比值升高与白蛋白尿异常密切相关,均对白蛋白尿具有一定的预测价值。综合考虑,TyG-BMI+TG/HDL-C+TyG指数是较佳白蛋白尿预测联合指标。

基于列线图模型评估TG/HDL-C和非HDL-C/HDL-C对腹膜透析患者预后的预测价值

目的探讨血清甘油三酯/高密度脂蛋白胆固醇(TG/HDL-C)和非HDL-C/HDL-C与腹膜透析患者5年全因死亡风险的关系。方法选取医院2016年4月至2020年6月行腹膜透析的慢性肾脏病患者200例,通过受试者工作特征曲线(ROC曲线)确定基线TG/HDL-C和非HDL-C/HDL-C的最佳截断值,以对5年全因死亡风险进行预测。采用Kaplan-Meier生存曲线和COX比例风险回归模型评估TG/HDL-C和非HDL-C/HDL-C的预测价值,并建立列线图模型。结果TG/HDL-C和非HDL-C/HDL-C预测腹膜透析患者死亡风险的最佳截断值分别为1.92和2.78。完成随访200例,死亡52例。其中,TG/HDL-C<1.92组142例,TG/HDL-C≥1.92组58例,非HDL-C/HDL-C<2.78组101例,非HDL-C/HDL-C≥2.78组99例。与TG/HDL-C<1.92组比较,TG/HDL-C≥1.92组患者年龄、白细胞计数、总胆固醇、TG、非HDL-C、使用调脂药例数均显著升高(P<0.05),HDL-C显著降低(P<0.05);与非HDL-C/HDL-C<2.78组比较,非HDL-C/HDL-C≥2.78组患者年龄、白细胞计数、总胆固醇、TG、低密度脂蛋白胆固醇、非HDL-C、使用调脂药例数均显著升高(P<0.05),HDL-C显著降低(P<0.05)。单因素和多因素COX比例风险回归模型分析结果显示,TG/HDL-C≥1.92[HR=4.16,95%CI(2.14,7.12),P<0.001]和非HDL-C/HDL-C≥2.78[HR=2.16,95%CI(1.29,4.53),P<0.001]与腹膜透析患者5年全因死亡风险增加独立相关。腹膜透析患者死亡风险列线图模型ROC曲线下面积(AUC)为0.817[95%CI(0.752,0.881),P<0.001]。结论TG/HDL-C和非HDL-C/HDL-C可有效预测腹膜透析患者的5年全因死亡风险。

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。

术前血清PCSK9检测联合甘油三酯-葡萄糖指数、甘油三酯-高密度脂蛋白胆固醇比值对乳腺癌患者的临床应用价值

目的:探讨术前血清前蛋白转化酶枯草溶菌素9(PCSK9)检测联合甘油三酯-葡萄糖指数(TyG)、甘油三酯-高密度脂蛋白胆固醇比值(TG/HDL-c)对乳腺癌患者的临床意义。方法:收集蚌埠医科大学第一附属医院经病理确诊并手术治疗的乳腺癌患者122例,行手术切除的乳腺良性肿瘤患者76例,健康体检者105例,统计分析各组患者完整的病历资料,利用ROC曲线确定血清PCSK9、TyG及TG/HDL-c的最佳临界值,并分析其对乳腺癌患者预后的临床价值。结果:良性肿瘤组和健康对照组血清PCSK9、TyG及TG/HDL-c水平低于乳腺癌组(P<0.05);矫正多因素Logistic回归分析显示,血清TyG(OR=2.766,95%CI:1.449~5.278)、TG/HDL-c(OR=28.624,95%CI:5.055~162.094)及PCSK9(OR=1.082,95%CI:1.060~1.105)水平升高均为乳腺癌发生的危险因素(P<0.001)。ROC曲线评估显示,血清PCSK9、TyG和TG/HDL-c联合分析(AUC=0.905)诊断效能高于TyG(AUC=0.797)和TG/HDL-c(AUC=0.713),P<0.01。结论:血清PCSK9、TyG和TG/HDL-c可作为乳腺癌患者辅助性诊断指标。

肾移植受者代谢标志物与血脂水平的相关性研究

目的分析肾移植受者血脂代谢、高脂血症、他克莫司药物代谢中共表达的基因及其与血脂水平的相关性。方法从比较毒理基因组学数据库(CTD)中筛选出共表达的基因。收集25例肾移植受者的一般资料,检测ATP结合盒亚家族A成员1(ABCA1)、过氧化物酶体增殖物激活受体γ(PPAR-γ)、糖基磷脂酰肌醇锚定高密度脂蛋白结合蛋白1(GPIHBP1)的表达情况。对肾移植受者进行跟踪随访,收集术后1、3、6、12个月空腹血糖、糖化血红蛋白、甘油三酯、总蛋白、白蛋白、球蛋白、胆固醇、高密度脂蛋白、低密度脂蛋白、他克莫司血药浓度,并分析受者高脂血症的发生情况。分析ABCA1、GPIHBP1、PPAR-γ与临床指标的相关性,及其与相关指标对肾移植术后高脂血症的诊断效能。结果共筛选出3个共表基因ABCA1、PPAR-γ、GPIHBP1。ABCA1与术后6个月胆固醇、术后3个月他克莫司血药浓度成正相关,与术后3个月空腹血糖呈负相关(均为P<0.05);GPIHBP1与术前胆固醇、术前甘油三酯呈负相关,与术后3个月他克莫司血药浓度呈正相关(均为P<0.05)。PPAR-γ与术前球蛋白、术前低密度脂蛋白呈负相关(均为P<0.05)。ABCA1、GPIHBP1、PPAR-γ联合术前球蛋白及术后1、6个月血糖水平诊断肾移植术后高甘油三酯血症的效果较好(AUC=0.900)。ABCA1、GPIHBP1、PPAR-γ联合术后1、6个月他克莫司血药浓度及术后6个月血糖水平诊断肾移植术后高胆固醇血症的效果较好(AUC=0.931)。结论ABCA1、GPIHBP1、PPAR-γ与肾移植术后血脂、他克莫司血药浓度等指标存在不同程度的相关关系,但用于预测肾移植术后高脂血症尚无确切依据。提升机体免疫力、规范的血糖管理可能是控制高脂血症的有益因素。