Rasouli Mehdi, Kiasari Asadollah Mohseni, Mokhberi Vahid
Department of Clinical Biochemistry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
Clin Chem Lab Med. 2006;44(8):1015-21. doi: 10.1515/CCLM.2006.163.
BACKGROUND: The ratio of low- to high-density lipoprotein-cholesterol (LDL-C/HDL-C) conventionally represents the balance of proatherogenic and anti-atherogenic lipids. However, growing evidence supports the idea that the ratio of apolipoprotein (apo) B/apoAI is a better index for risk assessment of coronary artery disease (CAD). The aim of this study was to evaluate the efficiency of advanced profile of serum (apo)lipoproteins for predicting stable CAD in secondary prevention. METHODS: The study subjects, 138 men and 126 women aged 40-70 years, were classified as CAD cases or controls, according to the results of coronary angiography. The severity of CAD was scored on the basis of the number and extent of lesions in coronary arteries. Serum (apo)lipoproteins were measured by immunoturbidometric and electrophoresis methods. RESULTS: Patients with CAD compared with controls had increased serum levels of triglycerides (2.6+/-2.0 vs. 2.0+/-1.2 mmol/L, p< or =0.005), apoB (1.36+/-0.31 vs. 1.19+/-0.24 g/L, p< or =0.0001), lipoprotein(a) [Lp(a)] (0.69+/-0.60 vs. 0.43+/-0.31 g/L, p< or =0.0001) and apoB/apoAI ratio (1.07+/-0.32 vs. 0.87+/-0.18, p< or =0.0001), and decreased serum levels of HDL-C (1.02+/-0.29 vs. 1.11+/-0.34 mmol/L, p< or =0.03), apoAI (1.32+/-0.22 vs. 1.37+/-0.19 g/L, p< or =0.04) and LDL-C/apoB ratio (0.91+/-0.32 vs. 1.02+/-0.25 mmol/g, p< or =0.01). Multiple logistic regression analysis after adjusting for major risk factors showed that the apoB/apoAI ratio, apoB and Lp(a) were among seven significant and independent determinants of CAD. The area under the receiver operating characteristic (ROC) curves (AUC) as a relative measure of test efficiency was highest and significant for the apoB/apoAI ratio (AUC=0.71, p< or =0.0001), apoB (0.67, p< or =0.0001), Lp(a) (0.63, p< or =0.001), the LDL-C/apoB ratio (0.62, p< or =0.006), triglycerides (0.62, p< or =0.004) and apoAI (0.58, p< or =0.05). ANOVA analysis showed significant association for the apoB/apoAI ratio, apoB, Lp(a) and triglycerides, and moderate association for total cholesterol and its subfractions, with the severity of CAD. CONCLUSIONS: The results indicate that the apoB/apoAI ratio, apoB and Lp(a) are independent risk factors for CAD and are superior to any of the cholesterol ratios. We suggest using the apoB/apoAI ratio as the best marker of CAD in clinical practice.
背景：传统上，低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值（LDL-C/HDL-C）代表致动脉粥样硬化和抗动脉粥样硬化脂质的平衡。然而，越来越多的证据支持载脂蛋白（apo）B/apoAI比值是评估冠状动脉疾病（CAD）风险的更好指标这一观点。本研究的目的是评估血清（apo）脂蛋白高级谱在二级预防中预测稳定型CAD的效能。 方法：根据冠状动脉造影结果，将138名年龄在40 - 70岁的男性和126名女性研究对象分为CAD病例组或对照组。根据冠状动脉病变的数量和范围对CAD的严重程度进行评分。采用免疫比浊法和电泳法测定血清（apo）脂蛋白。 结果：与对照组相比，CAD患者血清甘油三酯水平升高（2.6±2.0 vs. 2.0±1.2 mmol/L，p≤0.005），apoB升高（1.36±0.31 vs. 1.19±0.24 g/L，p≤0.0001），脂蛋白（a）[Lp（a）]升高（0.69±0.60 vs. 0.43±0.31 g/L，p≤0.0001），apoB/apoAI比值升高（1.07±0.32 vs. 0.87±0.18，p≤0.0001），而血清HDL-C水平降低（1.02±0.29 vs. 1.11±0.34 mmol/L，p≤0.03），apoAI降低（1.32±0.22 vs. 1.37±0.19 g/L，p≤0.04），LDL-C/apoB比值降低（0.91±0.32 vs. 1.02±0.25 mmol/g，p≤0.01）。在对主要危险因素进行校正后的多因素logistic回归分析显示，apoB/apoAI比值、apoB和Lp（a）是CAD的七个重要且独立的决定因素。作为检测效能相对指标的受试者工作特征（ROC）曲线下面积（AUC），对于apoB/apoAI比值（AUC = 0.71，p≤·0001）、apoB（0.67，p≤0.0001）、Lp（a）（0.63，p≤0.001）、LDL-C/apoB比值（0.62，p≤0.006）、甘油三酯（0.62，p≤0.004）和apoAI（0.5
Zhonghua Xin Xue Guan Bing Za Zhi. 2010-7
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