高密度脂蛋白胆固醇与冠心病的相关性研究
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摘要
目的通过对我科2002年4月~2007年12月连续5年诊断及疑诊CHD住院病例行冠状动脉造影和血脂检测资料进行回顾性分析,探讨高密度脂蛋白胆固醇水平与冠心病的相关性。
     方法所有对象均接受Judkins法冠状动脉造影检查,选择427例经冠状动脉造影证实的冠心病患者作为病例组,并选择同期住院的冠脉造影结果阴性的306例非冠心病患者作为对照组。冠心病组根据狭窄病变累及血管范围分为1支病变(单支病变组)、2支病变(双支病变组)和3支及以上病变(多支病变组)。分别对冠心病组和对照组、单支病变和双支、多支病变组进行血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、游离脂肪酸(FFA)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白LP(a)、空腹血糖(FBG)、餐后2小时血糖(2hPBG)、血清尿素氮(Bun)、尿酸(UA)、血肌酐(Cr)、纤维蛋白原(FIB)等指标进行比较分析。最后通过多元回归方法分析冠心病、冠脉病变程度与危险因素的相关关系。
     结果冠心病的总体患病率为58.25%(男68.84%,女49.20%)。冠心病组年龄、Cr、2hPBG水平明显高于对照组(P <0.01); Bun、FIB、HbA1C亦高于对照组(P <0.05)。冠心病组HDL-C、ApoA1较对照组显著降低(P<0.05),而TC和LDL-C显著增加(P<0.05,P<0.01);冠心病组TG、ApoB、Lp(a)、FFA较对照组升高,但无统计学意义。与单支病变组比较,双支及多支病变组的HDL-C水平明显降低(P<0.05, P<0.01),TC水平和TC/ HDL-C比值升高(P<0.05, P<0.01);与双支病变组比较,多支病变组的HDL-C水平亦降低(P<0.05),TC水平和TC/ HDL-C比值升高(P<0.05)。多元Logistic回归分析,低HDL-C水平为冠心病的独立危险因素。
     结论HDL-C与冠心病发生发展及冠脉病变程度呈显著负相关。TC/HDL-C可能对冠心病的诊断具有更好的预测价值。
OBJECTIVE
     To explore the relationship between high density lipoprotein cholesterol (HDL-C) and coronary heart disease(CHD).
     METHOD
     All objects are accepted Judkins of coronary angiography .427 CHD patients diagnosed by coronary angiography were selected as cases, and 306 non-CHD patients were selected as controls. Serum total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoproteinA1(ApoA1), apolipoprotein B (ApoB), lipoprotein (a)(LP (a)), free fatty acids (FFA) were compared with or without CHD, also these parameters were analyzed in 1-vesseal group, 2-vessel group and multi-vessel group of CHD patients. And finally through multiple regression analysis, the correlation of development and severity of coronary heart disease and risk factors was analiyzed.
     RESULTS
     The overall prevalence rate of coronary heart disease is 58.25% (male 68.84%, female 49.20%). Compared with non-CHD group, the level of age, Cr and 2hPBG of CHD group was significantly higher (P <0.01). The level of Bun, FIB and HbA1C in CHD group was also higher than that in non-CHD group (P <0.05). The level of HDL-C, ApoA1 of Coronary heart disease group was significantly lower than that in the control group (P <0.05), while TC and LDL-C increased significantly (P <0.05, P <0.01); The level of TG, ApoB, Lp (a), FFA in coronary heart disease group was also higher than that in the control group, but without statistical significance.The level of HDL-C in CHD group was significantly lower than that in non-CHD group(P<0.05). In CHD group, HDL-C decreased gradually with the increasing number of coronary artery disease branch(P<0.05). Logistic multiple regression analysis, low HDL-C level was an independent risk factor for coronary heart disease.
     CONCLUSION
     HDL-C was negatively correlated to the development and severity of coronary heart disease. TC / HDL-C may have a better predictive value in coronary heart disease.
引文
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