摘要
目的：
通过对高甘油三脂腰围表型(HTWP)的冠心病(CHD)患者冠脉病变积分(CAS)及其与CHD危险因素的相关性分析,探讨HTWP的CHD患者临床特征。
方法：
经选择性冠状动脉造影术确诊的CHD患者198人,其中男性151人,女性47人,年龄32～85岁(平均57.34±10.56岁)。所有患者均于入院3日内完成生化指标、炎症指标及体质指标等的采集,并计算体质指数(BMI)和腰围甘油三酯乘积指数(WTindex);计算CAS。根据患者是否同时存在腰围(WC)>90cm(男性)、85cm(女性)和血清甘油三酯水平(TG)≥1.7mmol/L将患者分为HTWP表型者(A组)共126例和非HTWP者(B组)共72例。对两组患者的相关指标进行对比分析,并对所有患者的CAS及各危险因素指标进行相关回归分析。
结果：
1、A组CAS显著高于B组(P<0.01)。
2、与B组比较,A组患者的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),人纤维酶原激活物抑制物-1(PAI-1)、白细胞介素-6(IL-6)、收缩压(SBP)、舒张压(DBP)、 BMI、空腹血糖(FPG)、游离脂肪酸(FFA)、纤维蛋白原(Fib)、肿瘤坏死因子-a(TNF-a)和高敏C反应蛋白(hsCRP)的水平显著增高(P<0.05),而脂联素(APN)、高密度脂蛋白胆固醇(HDL-C)的水平明显降低(P<0.01)。
3、所有入选的CHD患者的CAS与各危险因素相关及多元线性回归分析显示： CAS与WTindex、 hsCRP、 PAI-1、 TC呈显著正相关,与HDL-C、 APN呈显著负相关。
4、 WTindex与FFA、 SBP呈显著正相关。
结论：
1、合并HTWP的CHD患者多个危险因素水平(如CAS、TC、 LDL-C、 PAI-1、 IL-6、 SBP、 DBP、 BMI、 FPG、 Fib、 TNF-α、 hsCRP和FFA等)均显著高于非HTWP的CHD患者,同时前者冠脉病变程度较后者严重。
2、综合反映腹型肥胖和TG升高的新指标WTindex与冠状动脉病变的严重程度及部分CHD传统危险因素关系密切,因此WTindex可能是判断CHD风险的一个有用的指标,同时也可能成为CHD危险人群早期干预的靶点。
Objective:To investigate the relationship of abdominal obesity and coronary heart disease (CHD) by analyzing the hypertriglyceridemic waist phenotype, the risk factors of coronary heart disease and the conclusion of coronary angiography.
Methods:We collected198CHD patients(male151and female47), aged from thirty two to eighty-five (mean age57.34-10.56years) in the hospital with suspected coronary heart disease during August2010to December2011. All patients'total cholesterol (TC), total triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein—cholesterol (LDL-C), interleukin-6(IL6), hsCRP, fasting plasma glucose(FPG)and blood pressure were detected by the standard methods in3days after hospitalization. Body surveying index consisting of the patients'height, weight and waist circumference Was measured, waist circumferencextriglyceride index(WT index) and body mass index (BMI) were computed. According to the hypertriglyceridemic waist phenotype cut-off point, we enroll whose as abnormal hypertriglyceridemic waist phenotype group (n=126), the others normal hypertriglyceridemic waist phenotype group (n=72). Selected coronary angiography Was completed by special cardiac catheterization doctor to gain various vascular picture of the heart. All patients were calculated the coronary artery score (CAS). Date were pooled to analyze the level of blood lipids, inflammatory markers, FBG, blood pressure in normal hypertriglyceridemic waist phenotype group Versus (VS) hypertriglyceridemic waist phenotype group. Multiple linear correlation and regression analysis were applied to assess the correlationship between WT index, BMI and the aforementioned biochemical indicators, CAS.
Results：
1、group A of CAS was significantly higher than group B (P<00.1).
2、 Compared with group B, group A patients with total cholesterol (TC)、low density lipoprotein cholesterol (LDL-C)、human plasminogen activation inhibitor1(PAI-1)、interleukin-6(IL-6)、systolic blood pressure (SBP)、diastolic blood pressure (DBP)、 BMI、 fasting plasma glucose (FPG)、free fatty acid (FFA) fibrinogen (Fib)、tumor necrosis factor-alpha (TNF-a) and high-sensitivity C-reactive protein (hsCRP) levels were significantly higher (P<0.05); adiponectin (APN)、high density lipoprotein cholesterol (HDL-C) levels were significantly lower (P <0.01).
3、CAS of all selected patients with CHD and multiple linear regression correlation analysis of the risk factors:WTindex、hsCRP、PAI-1and TC was significantly positively correlated with the CAS; HDL-C、 APN was significantly negatively correlated.
4、WTindex with FFA、SBP was significantly positively related.
Conclusion:
1、Combined high triglycerides waist phenotype (HTWP) in patients with CHD risk factors levels (such as the CAS, the TC, LDL-C, PAI-1, IL-6, the SBP, DBP, and BMI, and of FPG, Fib, TNF-alpha, hsCRP and FFA etc.) were significantly higher than normal triglyceride waist phenotype in patients with CHD, while the former severe coronary lesions than the latter.
2、Comprehensive report of abdominal obesity and elevated TG new index WTindex and the severity of coronary lesions and CHD traditional risk factors are closely related, so WTindex may be judged CHD risk is a useful indicator, also may be CHD populations at risk for early intervention targets.
引文
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