餐后血脂水平及其波动性与冠状动脉病变程度的相关性研究
|
摘要
目的:分析空腹、餐后血脂水平及其波动性(餐后-空腹血脂差值绝对值)与冠脉病变程度的相关性。方法:选择在我院行冠脉造影术患者264例进行横断面研究,根据冠脉造影结果及是否行介入治疗分为斑块组(128例)和介入组(136例)。采用Gensini评分反映冠状动脉病变程度。比较两组间血脂水平及血脂波动性,并分析冠脉病变程度与血脂水平及血脂波动性的相关性。结果:与斑块组比较,介入组男性比例、吸烟比例及腰围均显著增加,餐后-空腹血清LDL-C差值(ΔLDL-C)和餐后-空腹血浆载脂蛋白B差值(ΔApoB)水平均显著升高,餐后-空腹血浆载脂蛋白A1差值(ΔApoA1)水平显著降低,P<0.05或<0.01。Pearson相关分析显示,空腹及餐后血清HDL-C、血浆ApoA1、ΔApoA1水平与Gensini评分呈显著负相关(r=-0.130～-0.218,P<0.05或<0.01),空腹血浆脂蛋白a (Lp a)、空腹及餐后血清游离脂肪酸(FFA)、血清游离脂肪酸差值(ΔFFA)与Gensini评分呈显著正相关(r=0.139～0.176,P<0.05或<0.01)。多元线性回归分析提示餐后血清HDL-C是Gensini评分的保护因素(B=-22.274,P=0.002),餐后血清FFA、ΔFFA、腰围和高脂血症史是Gensini评分的影响因素(B=0.388～24.135,P<0.05或<0.01)。结论:检测冠脉病变患者餐前、餐后血脂水平及其波动性有助于全面、客观地评估血脂和冠脉病变程度的相关性。
Objective:To analyze correlation among fasting(FBL)and postprandial blood lipids(PBL),blood lipid fluctuation(absolute value of PBL-FBL)and severity of coronary artery disease.Methods:Cross-sectional study was performed among 264 patients undergoing coronary angiography(CAG)in our hospital.According to percutaneous coronary intervention(PCI)or not based on CAG results,patients were divided into plaque group(n=128)and PCI group(n=136).Gensini score was used to assess severity of coronary artery disease.Blood lipid levels and its fluctuation were compared between two groups.Correlation among blood lipid levels,blood lipid fluctuation and severity of coronary artery disease were analyzed.Results:Compared with plaque group,there were significant rise in percentages of men and smokers,waist circumference,levels of postprandial-fasting(P-F)serum LDL-C(ΔLDL-C)and P-F plasma apolipoprotein B(ΔApoB),and significant reduction in plasma level of P-F apolipoprotein A1(ΔApoA1)in PCI group,P<0.05 or<0.01.Pearson correlation analysis indicated that serum fasting and postprandial HDL-C levels,plasma fasting and postprandial levels of ApoA1 andΔApoA1 were significant inversely correlated with Gensini score(r=-0.130～-0.218,P<0.05 or<0.01),and levels of plasma fasting lipoprotein a(Lp(a)),serum fasting and postprandial levels of free fatty acid(FFA),serum P-F FFA(ΔFFA)were significant positively correlated with Gensini score(r=0.139-0.176,P<0.05 or<0.01).Multifactor linear regression analysis indicated that postprandial serum HDL-C was protective factor for Gensini score(B=-22.274,P=0.002),while postprandial serum FFA,ΔFFA,waist circumference and hyperlipidemia history were its influencing factors(B=0.388～24.135,P<0.05 or<0.01).Conclusion:Measurements of fasting and postprandial blood lipid levels and their fluctuation contribute to more comprehensively and objectively assessing blood lipid levels and severity of coronary disease in patients with coronary artery disease.
Objective:To analyze correlation among fasting(FBL)and postprandial blood lipids(PBL),blood lipid fluctuation(absolute value of PBL-FBL)and severity of coronary artery disease.Methods:Cross-sectional study was performed among 264 patients undergoing coronary angiography(CAG)in our hospital.According to percutaneous coronary intervention(PCI)or not based on CAG results,patients were divided into plaque group(n=128)and PCI group(n=136).Gensini score was used to assess severity of coronary artery disease.Blood lipid levels and its fluctuation were compared between two groups.Correlation among blood lipid levels,blood lipid fluctuation and severity of coronary artery disease were analyzed.Results:Compared with plaque group,there were significant rise in percentages of men and smokers,waist circumference,levels of postprandial-fasting(P-F)serum LDL-C(ΔLDL-C)and P-F plasma apolipoprotein B(ΔApoB),and significant reduction in plasma level of P-F apolipoprotein A1(ΔApoA1)in PCI group,P<0.05 or<0.01.Pearson correlation analysis indicated that serum fasting and postprandial HDL-C levels,plasma fasting and postprandial levels of ApoA1 andΔApoA1 were significant inversely correlated with Gensini score(r=-0.130～-0.218,P<0.05 or<0.01),and levels of plasma fasting lipoprotein a(Lp(a)),serum fasting and postprandial levels of free fatty acid(FFA),serum P-F FFA(ΔFFA)were significant positively correlated with Gensini score(r=0.139-0.176,P<0.05 or<0.01).Multifactor linear regression analysis indicated that postprandial serum HDL-C was protective factor for Gensini score(B=-22.274,P=0.002),while postprandial serum FFA,ΔFFA,waist circumference and hyperlipidemia history were its influencing factors(B=0.388～24.135,P<0.05 or<0.01).Conclusion:Measurements of fasting and postprandial blood lipid levels and their fluctuation contribute to more comprehensively and objectively assessing blood lipid levels and severity of coronary disease in patients with coronary artery disease.
引文
[1]Farzadfar F,Finucane MM,Danaei G,et al.National,regional,and global trends in serum total cholesterol since 1980:Systematic analysis of health examinatlon surveys and epidemiological studies with untry-years and 3.0million articipants[J].Lancet,2011,377(9765):578-586.
[2]Pirillo A,Norata GD,Catapano AL.Postprandial lipemia as a cardiometabolic risk factor[J].Curr Med Res Opin,2014,30(8):1489-503.
[3]National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ).Third Report of the National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ)final report[J].Circulation,2002,106(25):3143-3421.
[4]Braschi S.Postprandial hyperlipidemia,small and dense LDL,HDL subfraction[J].Ann Med Intern,2001,152:162-168.
[5]Bansal S,Buring JE,Rifai N,et al.Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women[J].JAMA,2007,298(3):309-316.
[6]Nordestgaard BG,Benn M,Schnohr P,et al.Nonfasting triglycerides and risk of myocardial infarction,ischemic heart disease,and death in men and women[J].JAMA,2007,298(3):299-308.
[7]Mora S,Rifai N,Buring JE,et al.Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events[J].Circulation,2008,118(10):993-1001.
[8]Matsumoto S,Gotoh N,Hishinuma S,et al.The role of hypertriglyceridemia in the development of atherosclerosis and endothelial dysfunction[J].Nutrients,2014,6(3):1236-1250.
[9]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
[10]Teramoto T,Sasaki J,Ishibashi S,et al Executive summary of the Japan Atherosclerosis Society(JAS)guidelines for the diagnosis and prevention of atherosclerotic cardiovascular Dis in Japan-2012version[J].J Atheroscler Thromb,2013,20(4):517-523.
[11]Ooit C,Nordestgaard B G.Methods to study postprandial lipemia[J].Curr Vasc Pharmacol,2011,9(3):302-308.
[12]Iso H,Naito Y,Sato S,et al.Serum triglycerides and risk of coronary heart disease among Japanese men and women[J].Am J Epidemiol,2001,153(5):490-499.
[13]Nordestgaard BG,Benn M,Schnohr P,et al.Nonfasting triglycerides and risk of myocardial infarction,ischemic heart disease,and death in men and women[J].JAMA,2007,298(3):299-308.
[14]Freiberg JJ,Tybjaerg-Hansen A,Jensen JS,Nordestgaard BG.Nonfasting triglycerides and risk of ischemic stroke in the general population[J].JAMA,2008,300(8):2142-2152.
[15]Boey E,Cay GM,Poh KK,et al,Visit-to-visit variability in LDL-and HDL-cholesterol is associated with adverse events after ST-segment elevation myocardial infarction:A 5-year follow-up study[J].Atherosclerosis,2016,244:86-92.
[16]Smit RA,Trompet S,Sabayay B,et al,Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance,Lower Cerebral Blood Flow,and Greater White Matter Hyperintensity Load in Older SubjectsClin Perspective[J].Circulation,2016,134(3):212-221.
[2]Pirillo A,Norata GD,Catapano AL.Postprandial lipemia as a cardiometabolic risk factor[J].Curr Med Res Opin,2014,30(8):1489-503.
[3]National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ).Third Report of the National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ)final report[J].Circulation,2002,106(25):3143-3421.
[4]Braschi S.Postprandial hyperlipidemia,small and dense LDL,HDL subfraction[J].Ann Med Intern,2001,152:162-168.
[5]Bansal S,Buring JE,Rifai N,et al.Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women[J].JAMA,2007,298(3):309-316.
[6]Nordestgaard BG,Benn M,Schnohr P,et al.Nonfasting triglycerides and risk of myocardial infarction,ischemic heart disease,and death in men and women[J].JAMA,2007,298(3):299-308.
[7]Mora S,Rifai N,Buring JE,et al.Fasting compared with nonfasting lipids and apolipoproteins for predicting incident cardiovascular events[J].Circulation,2008,118(10):993-1001.
[8]Matsumoto S,Gotoh N,Hishinuma S,et al.The role of hypertriglyceridemia in the development of atherosclerosis and endothelial dysfunction[J].Nutrients,2014,6(3):1236-1250.
[9]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
[10]Teramoto T,Sasaki J,Ishibashi S,et al Executive summary of the Japan Atherosclerosis Society(JAS)guidelines for the diagnosis and prevention of atherosclerotic cardiovascular Dis in Japan-2012version[J].J Atheroscler Thromb,2013,20(4):517-523.
[11]Ooit C,Nordestgaard B G.Methods to study postprandial lipemia[J].Curr Vasc Pharmacol,2011,9(3):302-308.
[12]Iso H,Naito Y,Sato S,et al.Serum triglycerides and risk of coronary heart disease among Japanese men and women[J].Am J Epidemiol,2001,153(5):490-499.
[13]Nordestgaard BG,Benn M,Schnohr P,et al.Nonfasting triglycerides and risk of myocardial infarction,ischemic heart disease,and death in men and women[J].JAMA,2007,298(3):299-308.
[14]Freiberg JJ,Tybjaerg-Hansen A,Jensen JS,Nordestgaard BG.Nonfasting triglycerides and risk of ischemic stroke in the general population[J].JAMA,2008,300(8):2142-2152.
[15]Boey E,Cay GM,Poh KK,et al,Visit-to-visit variability in LDL-and HDL-cholesterol is associated with adverse events after ST-segment elevation myocardial infarction:A 5-year follow-up study[J].Atherosclerosis,2016,244:86-92.
[16]Smit RA,Trompet S,Sabayay B,et al,Higher Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is Associated With Lower Cognitive Performance,Lower Cerebral Blood Flow,and Greater White Matter Hyperintensity Load in Older SubjectsClin Perspective[J].Circulation,2016,134(3):212-221.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |