小而密低密度脂蛋白膽固醇與冠狀動脈粥樣硬化特征的相關性分析

王愷雋，李鐵威，藺亞暉，李陽，周洲，陳曦，康金鎖

(中國醫學科學院 北京協和醫學院 阜外醫院a.實驗診斷中心，b.心血管疾病國家重點實驗室，北京 100037)

·臨床實驗研究·

小而密低密度脂蛋白膽固醇與冠狀動脈粥樣硬化特征的相關性分析

王愷雋a，李鐵威b，藺亞暉a，李陽a，周洲a，陳曦a，康金鎖a

(中國醫學科學院 北京協和醫學院 阜外醫院a.實驗診斷中心，b.心血管疾病國家重點實驗室，北京 100037)

目的結合影像學評價小而密低密度脂蛋白膽固醇(sdLDL-C)與冠狀動脈(以下簡稱“冠脈”)粥樣硬化病變嚴重程度的關系。方法連續選取2015年7月至2016年3月阜外醫院436例門診初診懷疑冠脈粥樣硬化性心臟病(CAD)并行冠脈計算機斷層攝影術檢查(CT)的患者，從斑塊性質、病變支數及狹窄程度3個方面分析sdLDL-C與冠脈粥樣硬化嚴重程度的相關性。結果sdLDL-C與載脂蛋白B(apoB)、三酰甘油(TG)、總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)、血糖(Glu)呈正相關(r依次為0.644、0.631、0.558、0.434、0.145，P均<0.01)，與高密度脂蛋白膽固醇(HDL-C)呈負相關(r=-0.241，P<0.01)； sdLDL-C、apoB可作為嚴重CAD(三支病變及重度狹窄>75%)發生的危險因素，且獨立于傳統風險因素(年齡、性別、高血壓史、糖尿病史、吸煙史、飲酒史)及他汀類降脂藥的應用；對于三支病變，LDL-C、sdLDL-C、apoB預測價值依次增強(OR依次為1.936、2.673、31.707);對于重度狹窄，LDL-C非獨立危險因素，sdLDL-C、apoB有預測價值(OR分別為2.000、9.457)。結論sdLDL-C可作為獨立于傳統風險因素的嚴重CAD預測指標，預測價值優于LDL-C，有可能作為進一步的風險控制指標。

小而密低密度脂蛋白膽固醇；冠狀動脈粥樣硬化；計算機斷層攝影術

Abstract：ObjectiveTo evaluate the association between small, dense low-density lipoprotein cholesterol (sdLDL-C)and severity of coronary atherosclerosis disease (CAD).MethodsA total of 436 outpatients with suspected coronary atherosclerotic heart disease(CAD)and underwent coronary computed tomography (CT)were consecutively enrolled from July 2015 to March 2016 in Fuwai Hospital. Correlations between serum sdLDL-C and the severity of CAD including characteristics of plaque, the number of stenosed coronary vessels, the degree of stenosis were analyzed.ResultssdLDL-C was positively correlated with apolipoprotein B (apoB), triglyceride(TG), total cholesterol(TC), low-density lipoprotein cholesterol (LDL-C), blood glucose(Glu)with the coefficient correlation 0.644, 0.631, 0.558, 0.434 and 0.145 successively(P<0.01), and negatively correlated with high-density lipoprotein cholesterol (HDL-C)(r=-0.241，P<0.01). sdLDL-C and apoB were the risk factors for severe CAD (triple-vessel disease and severe stenosis), independent of traditional risk factors (age, gender, hypertension, diabetes, smoking, alcohol consumption)and the use of lipid-lowering agents. For the patients with triple-vessel disease, odds ratio of LDL-C, sdLDL-C and apoB were 1.936, 2.673 and 31.707 respectively . For the patients with severe stenosis, LDL-C was not an independent factor, while sdLDL-C and apoB still had predictive value (odds ratio were 2.000 and 9.457 respectively).ConclusionsdLDL-C should be a predictor of severe CAD independent of traditional risk factors that may be useful for further risk stratification in the patients with CAD.

Keywords: small dense low-density lipoprotein cholesterol; atherosclerosis; computer tomography

心腦血管疾病是目前國內外人口死亡的主要原因[1-2]。血脂異常尤其是低密度脂蛋白膽固醇(low-density lipoprotein cholesterol，LDL-C)被認為是動脈粥樣硬化發生發展的獨立危險因素。……