载脂蛋白A-I和B标志物在冠心病风险评估中的作用

Apolipoproteins A-I and B-markers in coronary risk evaluation.

作者信息

Agoston-Coldea Lucica, Zdrenghea D, Pop Dana, Crăciun Alexandra, Rusu M L, Mocan Teodora

机构信息

Department of Internal Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.

出版信息

Rom J Intern Med. 2007;45(3):251-8.

PMID:18333357

Abstract

OBJECTIVES

To investigate if apoB, apoA-I and apoB/apoA-I ratios are independent risk factors for coronary heart disease and to determine their value in relationship with serum lipid fractions in evaluating the risk of coronary events.

MATERIALS AND METHODS

We carried out a comparative observational study on 289 subjects divided into two groups: 144 subjects with old myocardial infarction, and 145 subjects without coronary heart disease, but with cardiovascular risk factors. None of the subjects received lipid-lowering drugs in the previous 3 months.

RESULTS

The mean values of lipid fractions were lower in subjects with myocardial infarction than in subjects without coronary heart disease: total cholesterol (186.06 +/- 48.11 vs. 206.93 +/- 42.28 mg/dl, p = 0.0001), LDL-cholesterol (118.57 +/- 42.95 vs. 129.53 +/- 39.75 mg/dl, p = 0.023), HDL-cholesterol (43.64 +/- 12.32 vs. 50.48 +/- 21.09 mg/dl, p = 0.0008) and triglycerides (145.38 +/- 62.74 vs. 167.56 +/- 82.11 mg/dl, p = 0.01). The plasmatic levels of apoB were higher in subjects with myocardial infarction (1.12 +/- 0.57 vs. 0.86 +/- 0.27 g/l, p = 0.0001), but the apoA-I was lower (1.31 +/- 0.47 vs. 1.40 +/- 0.39 g/l, p = 0.101). The multivariate analysis indicated that plasmatic concentrations of apoB over 1.7 g/l are closely correlated with myocardial infarction (OR 3.96; 95% CI 2.87-5.02, p = 0.001) independent of other covariables such as age, smoking, diabetes, hypertension, lipid CT/HDL-C and the LDL-C/HDL-C ratio. The protective effect of apolipoprotein A1 against cardiovascular events after the adjustment for other cardiovascular risk factors (OR 0.72; 95% CI 0.57-0.83, p = 0.004) was also independent in multivariate analysis.

CONCLUSION

These results highlight the significance of apoA-I and apoB in the evaluation of the cardiovascular risk. From this point of view, their predictive value is superior to that of serum lipid fractions. The data suggest that the determination of apoA-I and apoB is useful enough to be introduced in current clinical practice.

摘要

目的

研究载脂蛋白B（apoB）、载脂蛋白A-I（apoA-I）及apoB/apoA-I比值是否为冠心病的独立危险因素，并确定它们在评估冠心病事件风险中与血脂成分的关系。

材料与方法

我们对289名受试者进行了一项对比观察性研究，将其分为两组：144名陈旧性心肌梗死患者和145名无冠心病但有心血管危险因素的患者。在过去3个月内，所有受试者均未服用降脂药物。

结果

心肌梗死患者的血脂成分均值低于无冠心病患者：总胆固醇（186.06±48.11 vs. 206.93±42.28mg/dl，p = 0.0001）、低密度脂蛋白胆固醇（118.57±42.95 vs. 129.53±39.75mg/dl，p = 0.023）、高密度脂蛋白胆固醇（43.64±12.32 vs. 50.48±21.09mg/dl，p = 0.0008）和甘油三酯（145.38±62.74 vs. 167.56±82.11mg/dl，p = 0.01）。心肌梗死患者的血浆apoB水平较高（1.12±0.57 vs. 0.86±0.27g/l，p = 0.0001），但apoA-I水平较低（1.31±0.47 vs. 1.40±0.39g/l，p = 0.101）。多变量分析表明，血浆apoB浓度超过1.7g/l与心肌梗死密切相关（比值比3.96；95%可信区间2.87 - 5.02，p = 0.001），独立于其他协变量，如年龄、吸烟、糖尿病、高血压、血脂CT/HDL-C及LDL-C/HDL-C比值。在对其他心血管危险因素进行校正后，载脂蛋白A1对心血管事件的保护作用（比值比0.72；95%可信区间0.57 - 0.83，p = 0.004）在多变量分析中也具有独立性。