非高密度脂蛋白联合碱性磷酸酶在老年体检人群动脉粥样硬化风险评估的价值
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摘要
目的:探讨非高密度脂蛋白(non-HDL-C)联合碱性磷酸酶(ALP)在老年体检人群动脉粥样硬化风险评估的价值。方法:将本院体检中心2016年6月-2017年5月接收的老年体检人群346例作为研究对象,采用日本Colin公司生产的全自动动脉僵硬度自动测定仪测定ba PWV,以任一侧肢体ba PWV≥1737.50 cm/s定义为动脉粥样硬化,取空腹外周静脉血测定相关脂质水平、non-HDL-C及ALP水平。结果:动脉粥样硬化组的男性、糖尿病、高血压比例以及BMI、TC、TG、LDL-C、non-HDL-C、ba PWV、ALP水平均显著高于非动脉粥样硬化组(P<0.05)。non-HDL-C≥4 mmol/L与<2 mmol/L比较,模型1(未校正任何因素)、模型2(校正年龄、性别、BMI因素后)、模型3(校正年龄、性别、糖尿病、高血压、BMI、TC、TG、HDL-C、LDL-C因素,评价non-HDL-C与动脉粥样硬化则剔除ALP,评价ALP则剔除non-HDL-C,OR分别为2.286(1.308,3.128)、1.893(1.302,2.817)、1.682(1.249,2.685);ALP≥90 U/L与<60 U/L比较,在模型1、模型2、模型3下OR分别为2.985(2.182,4.620)、2.618(1.486,4.428)及1.796(1.281,4.022)。结论:血清non-HDL-C及ALP是老年体检人群动脉粥样硬化的独立危险因子。
Objective:To investigate the value of non-high density lipoprotein(non-HDL-C) combined with alkaline phosphatase(ALP) in the risk assessment of atherosclerosis in elderly patients.Method:A total of 346 cases of elderly physical examination were collected from June 2016 to May 2017 in our hospital,the ba PWV was measured by automatic arterial stiffness tester manufactured by Colin Company in Japan,ba PWV≥1737.50 cm/s was defined as atherosclerosis,and fasting peripheral venous blood was used to determine the level of lipid,nonHDL-C and ALP.Result:The proportion of men with diabetes mellitus,hypertension,atherosclerosis and the levels of BMI,TC,TG,LDL-C,non-HDL-C,ba PWV and ALP in atherosclerosis group were significantly higher than those in non-atherosclerosis group(P<0.05). non-HDL-C≥4 mmol/L and less than 2 mmol/L,model 1(not any correction factor),model 2(adjusted for age,gender,BMI factors),model 3(adjusted for age,sex,diabetes,hypertension,BMI,TC,TG,HDL-C,LDL-C,non-HDL-C and evaluation of atherosclerosis was eliminated ALP,the evaluation of ALP eliminates non-HDL-C,OR were 2.286(1.308,3.128),1.893(1.302,2.817),and 1.682(1.249,2.685);comparison of ALP≥90 U/L and in less than 60 U/L,model 1,model 2,model 3,OR were 2.985(2.182,4.620),2.618(1.486,4.428) and 1.796(1.281,4.022).Conclusion:Serum non-HDL-C and ALP are independent risk factors for atherosclerosis in elderly patients.
Objective:To investigate the value of non-high density lipoprotein(non-HDL-C) combined with alkaline phosphatase(ALP) in the risk assessment of atherosclerosis in elderly patients.Method:A total of 346 cases of elderly physical examination were collected from June 2016 to May 2017 in our hospital,the ba PWV was measured by automatic arterial stiffness tester manufactured by Colin Company in Japan,ba PWV≥1737.50 cm/s was defined as atherosclerosis,and fasting peripheral venous blood was used to determine the level of lipid,nonHDL-C and ALP.Result:The proportion of men with diabetes mellitus,hypertension,atherosclerosis and the levels of BMI,TC,TG,LDL-C,non-HDL-C,ba PWV and ALP in atherosclerosis group were significantly higher than those in non-atherosclerosis group(P<0.05). non-HDL-C≥4 mmol/L and less than 2 mmol/L,model 1(not any correction factor),model 2(adjusted for age,gender,BMI factors),model 3(adjusted for age,sex,diabetes,hypertension,BMI,TC,TG,HDL-C,LDL-C,non-HDL-C and evaluation of atherosclerosis was eliminated ALP,the evaluation of ALP eliminates non-HDL-C,OR were 2.286(1.308,3.128),1.893(1.302,2.817),and 1.682(1.249,2.685);comparison of ALP≥90 U/L and in less than 60 U/L,model 1,model 2,model 3,OR were 2.985(2.182,4.620),2.618(1.486,4.428) and 1.796(1.281,4.022).Conclusion:Serum non-HDL-C and ALP are independent risk factors for atherosclerosis in elderly patients.
引文
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[13]王伟,田慧军.脑梗死患者颈动脉内膜中层厚度与血清碱性磷酸酶水平的关系[J].山西医药杂志,2017,46(9):1074-1076.
[14]杨莉萍,杨国柱,陆幸妍,等.非高密度脂蛋白胆固醇与碱性磷酸酶水平的调查与分析[J].中国骨质疏松杂志,2013,19(6):572-575,579.
[15]Orimo H.The mechanism of mineralization and the role of alkaline phosphatase in health and disease[J].Journal of Nippon Medical School,2010,77(1):4-12.
[16]Tonelli M,Sacks F,Pfeffer M,et al.Relation between serum phosphate level and cardiovascular event rate in people with coronary disease[J].Circulation,2005,112(17):2627-2633.
[17]Hirschfield G M,Mason A,Luketic V,et al.Efficacy of Obeticholic Acid in Patients with Primary Biliary Cirrhosis and Inadequate Response to Ursodeoxycholic Acid[J].Gastroenterology,2015,148(4):751-761.
[18]Taylor J,Butcher M,Zeadin M,et al.Oxidized low-density lipoprotein promotes osteoblast differentiation in primary cultures of vascular smooth muscle cells by up-regulating Osterix expression in an Msx2-dependent manner[J].Journal of Cellular Biochemistry,2011,112(2):581-588.
[19]Yung L M,Sánchez-Duffhues G,ten Dijke P,et al.Bone morphogenetic protein 6 and oxidized low-density lipoprotein synergistically recruit osteogenic differentiation in endothelial cells[J].Cardiovascular Research,2015,108(2):278-287.
[20]Yahiro K,Satoh M,Nakano M,et al.Low-density lipoprotein receptor-related protein-1(LRP1)mediates autophagy and apoptosis caused by Helicobacter pylori Vac A[J].Journal of Biological Chemistry,2012,287(37):31 104-31 115.
[2]莫小丽,安巍,万国华,等.2型糖尿病患者动态动脉僵硬指数和24 h脉压的相关性研究[J].实用医学杂志,2012,28(16):2709-2711.
[3]Nauck M,Warnick G R,Rifai N.Methods for Measurement of LDL-Cholesterol:A Critical Assessment of Direct Measurement by Homogeneous Assays versus Calculation[J].Clinical Chemistry,2002,48(2):236.
[4]王凤清,徐美华,程祖建,等.非高密度脂蛋白胆固醇在冠状动脉病变时的临床价值[J].中国实验诊断学,2008,12(12):1552-1554.
[5]荆晶,韩运峰,李建涛,等.非高密度脂蛋白胆固醇在低密度脂蛋白胆固醇极低患者中对非罪犯冠状动脉病变进展的影响[J].疑难病杂志,2015,14(5):449-453.
[6]Hofbauer L C,Brueck C C,Shanahan C M,et al.Vascular calcification and osteoporosis-from clinical observation towards molecular understanding[J].Osteoporosis International,2007,18(3):251-259.
[7]邓欣如,王天歌,徐佰慧,等.上海市嘉定区社区人群血清碱性磷酸酶水平与动脉硬化的相关性[J].上海医学,2013,46(5):402-406.
[8]Expert Panel on Detection E.Executive summary of the 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)[J].JAMA,2001,285(19):2486.
[9]Natoinal Cholesterol Education Program Expert Panel.Executive summary of the third report of the National Cholestrol Education Program(NCEP)Expert panel ondetection,evaluation,and treatment of high blood cholesterol in adults(adult treatment paneⅣ)[J].JAMA,2001,285:2486.
[10]Orzkzai S H,Nasir K.Non-HDLC cholesterol is strongly associated with coronary artery calcification in asymptomatic[J].Individuals Atherosclerosis,2009,202(1):289-295.
[11]Abate N,Vega G L,Grundy S M.Variability in cholesterol content and physical properties of lipoproteins containing apolipoprotein B-100[J].Atherosclerosis,1993,104:159.
[12]侯建明,林庆明,李建卫,等.老年人骨质疏松与主动脉硬化的相关性研究[J].中华骨质疏松和骨矿盐疾病杂志,2009,2(2):79-82.
[13]王伟,田慧军.脑梗死患者颈动脉内膜中层厚度与血清碱性磷酸酶水平的关系[J].山西医药杂志,2017,46(9):1074-1076.
[14]杨莉萍,杨国柱,陆幸妍,等.非高密度脂蛋白胆固醇与碱性磷酸酶水平的调查与分析[J].中国骨质疏松杂志,2013,19(6):572-575,579.
[15]Orimo H.The mechanism of mineralization and the role of alkaline phosphatase in health and disease[J].Journal of Nippon Medical School,2010,77(1):4-12.
[16]Tonelli M,Sacks F,Pfeffer M,et al.Relation between serum phosphate level and cardiovascular event rate in people with coronary disease[J].Circulation,2005,112(17):2627-2633.
[17]Hirschfield G M,Mason A,Luketic V,et al.Efficacy of Obeticholic Acid in Patients with Primary Biliary Cirrhosis and Inadequate Response to Ursodeoxycholic Acid[J].Gastroenterology,2015,148(4):751-761.
[18]Taylor J,Butcher M,Zeadin M,et al.Oxidized low-density lipoprotein promotes osteoblast differentiation in primary cultures of vascular smooth muscle cells by up-regulating Osterix expression in an Msx2-dependent manner[J].Journal of Cellular Biochemistry,2011,112(2):581-588.
[19]Yung L M,Sánchez-Duffhues G,ten Dijke P,et al.Bone morphogenetic protein 6 and oxidized low-density lipoprotein synergistically recruit osteogenic differentiation in endothelial cells[J].Cardiovascular Research,2015,108(2):278-287.
[20]Yahiro K,Satoh M,Nakano M,et al.Low-density lipoprotein receptor-related protein-1(LRP1)mediates autophagy and apoptosis caused by Helicobacter pylori Vac A[J].Journal of Biological Chemistry,2012,287(37):31 104-31 115.