Haemostasis Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Eur J Heart Fail. 2010 Mar;12(3):254-9. doi: 10.1093/eurjhf/hfp202. Epub 2010 Jan 19.
To compare the performance of apolipoproteins (Apo) and oxidized LDL against routine clinical lipid profiles in the discrimination of atherosclerotic burden and cardiac function in stable coronary artery disease (CAD) patients.
Using a cross-sectional approach, we measured oxidized LDL, Apo AI and B in 199 patients (34-81 years) with stable symptomatic CAD. The discrimination of (i) atherosclerotic burden (coronary atheroma scores, the number of diseased coronary vessels), and (ii) cardiac function [NYHA classification, left-ventricular systolic dysfunction (LVSD)] were judged using receiver operating characteristic (ROC) curves. The ratio of Apo AI to B was correlated to oxidized LDL (Spearman, r = 0.37, P < 0.001); however, oxidized LDL was unrelated to measures of cardiac function or CAD severity. Concentrations of Apo AI decreased from 1.38 to 1.20 g/L with increasing atheroma scores (P = 0.02), while triglyceride levels increased from 1.50 to 2.23 mmol/L (P = 0.016). High-density lipoprotein (HDL) cholesterol and Apo AI levels were higher among those with heart failure (P = 0.002), and increased ordinally with NYHA class (P = 0.005). On ROC analysis, reduced levels of Apo AI and HDL cholesterol were discriminators for patients in the upper quartile for atheroma score (P < 0.004). Raised indices of HDL were associated with heart failure (P < 0.002).
Apo AI levels are a consistent discriminator of atherosclerotic burden among patients with stable CAD. However, heart failure presents an element of confounding in the diagnostic and prognostic utility of Apo monitoring among these patients.
比较载脂蛋白（Apo）和氧化型低密度脂蛋白（LDL）在稳定型冠心病（CAD）患者中对动脉粥样硬化负担和心功能的区分能力，优于常规临床血脂谱。
我们采用横断面研究方法，测量了 199 例（年龄 34-81 岁）稳定型有症状 CAD 患者的氧化型 LDL、Apo AI 和 B。使用受试者工作特征（ROC）曲线判断（i）动脉粥样硬化负担（冠状动脉粥样斑块评分、病变冠状动脉血管数），以及（ii）心功能[纽约心脏协会（NYHA）分级、左心室收缩功能障碍（LVSD）]的区分能力。Apo AI 与 B 的比值与氧化型 LDL 相关（Spearman，r = 0.37，P < 0.001）；然而，氧化型 LDL 与心功能或 CAD 严重程度无关。随着动脉粥样斑块评分的增加，Apo AI 浓度从 1.38 降至 1.20 g/L（P = 0.02），而甘油三酯水平从 1.50 增至 2.23 mmol/L（P = 0.016）。心力衰竭患者的高密度脂蛋白（HDL）胆固醇和 Apo AI 水平更高（P = 0.002），并随 NYHA 分级有序增加（P = 0.005）。在 ROC 分析中，Apo AI 和 HDL 胆固醇水平降低是动脉粥样硬化斑块评分较高四分位数患者的鉴别因素（P < 0.004）。HDL 升高指数与心力衰竭相关（P < 0.002）。
Apo AI 水平是稳定型 CAD 患者动脉粥样硬化负担的一致鉴别指标。然而，心力衰竭对这些患者的 Apo 监测的诊断和预后价值产生了混杂因素。
