Kim Se Won, Jee Jae Hwan, Kim Hye Jeong, Jin Sang-Man, Suh Sunghwan, Bae Ji Cheol, Kim Sun Wook, Chung Jae Hoon, Min Yong-Ki, Lee Myung-Shik, Lee Moon-Kyu, Kim Kwang-Won, Kim Jae Hyeon
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Cardiol. 2013 Oct 3;168(3):2678-83. doi: 10.1016/j.ijcard.2013.03.027. Epub 2013 Mar 29.
The ratio of apolipoprotein B (apoB) to apolipoprotein A1 (apoA1) has been reported to be associated with metabolic syndrome (MetS) and insulin resistance (IR). Non-HDL-C is regarded as a surrogate marker for apoB in routine clinical practice. However, it is unclear whether the ratio of non-HDL-C to HDL-C is an equal or a better predictor than the apoB/apoA1 ratio for the identification of MetS and IR.
We performed a retrospective study of 41,821 Korean adults who participated in a routine health screening examination. Anthropometry, fasting glucose, fasting insulin, HOMA-IR, CRP, lipid profiles, apoB, and apoA1 were measured.
To compare the predictive value for MetS between different lipid ratios, we analyzed the ROC curves of apoB/apoA1 and non-HDL-C/HDL-C ratios. ROC analysis showed that the AUCs of non-HDL-C/HDL-C (0.75 [95% CI=0.74-0.76] in men and 0.84 [95% CI=0.83-0.85] in women) were significantly higher than those of apoB/apoA1 (0.66 [95% CI=0.65-0.67] in men and 0.77 [95% CI=0.76-0.78] in women). The non-HDL-C/HDL-C ratio also showed a significantly stronger association with HOMA-IR than the apoB/apoA1 ratio. The optimal cutoff value of the non-HDL-C/HDL-C ratio for detection of MetS in men was 3.39, with a sensitivity of 66.7% and a specificity of 71.8%, whereas the optimal ratio cutoff value in women was 2.89, with a sensitivity of 75.7% and a specificity of 78.1%.
Our findings indicate that the non-HDL-C/HDL-C ratio is a better marker than the apoB/apoA1 ratio for identifying IR and MetS in Koreans.
据报道，载脂蛋白B（apoB）与载脂蛋白A1（apoA1）的比值与代谢综合征（MetS）和胰岛素抵抗（IR）相关。在常规临床实践中，非高密度脂蛋白胆固醇（Non-HDL-C）被视为apoB的替代标志物。然而，尚不清楚Non-HDL-C与高密度脂蛋白胆固醇（HDL-C）的比值在识别MetS和IR方面是否与apoB/apoA1比值一样或更具预测性。
我们对41821名参加常规健康筛查检查的韩国成年人进行了一项回顾性研究。测量了人体测量学指标、空腹血糖、空腹胰岛素、稳态模型评估胰岛素抵抗（HOMA-IR）、C反应蛋白（CRP）、血脂谱、apoB和apoA1。
为了比较不同血脂比值对MetS的预测价值，我们分析了apoB/apoA1和Non-HDL-C/HDL-C比值的ROC曲线。ROC分析显示，Non-HDL-C/HDL-C的曲线下面积（AUC）在男性中为0.75（95%CI=0.74-0.76），在女性中为0.84（95%CI=0.83-0.85），显著高于apoB/apoA1的曲线下面积（男性为0.66[95%CI=0.65-0.67]，女性为0.77[95%CI=0.76-0.78]）。Non-HDL-C/HDL-C比值与HOMA-IR的相关性也显著强于apoB/apoA1比值。男性检测MetS的Non-HDL-C/HDL-C比值的最佳截断值为3.39，敏感性为66.7%，特异性为71.8%；而女性的最佳比值截断值为2.89，敏感性为75.7%，特异性为78.1%。
我们的研究结果表明，在韩国人中，Non-HDL-C/HDL-C比值在识别IR和MetS方面比apoB/apoA1比值是更好的标志物。
