比较低密度脂蛋白胆固醇/高密度脂蛋白胆固醇及总胆固醇/高密度脂蛋白胆固醇用于预测经血管内光学相干断层扫描测定的薄帽纤维粥样斑块。
Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography.
作者信息
Wang Yao, Zhang Si-Si, Lv Qing-Bo, Li Ya, Zhao Jin, Han Jia, Fu Guo-Sheng, Zhang Wen-Bin
机构信息
Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Infection Control, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
出版信息
J Geriatr Cardiol. 2020 Nov 28;17(11):666-673. doi: 10.11909/j.issn.1671-5411.2020.11.003.
BACKGROUND
The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol (LDL-C/ HDL-C), total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and thin-cap fibroatheroma has not yet been established.
METHODS
It was a single center, retrospective observational study. In total, we recruited 421 patients (82.4% men; mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography (OCT). The thinnest-capped fibroatheroma (TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve (AUC) of receiver-operating characteristic (ROC) curve was assessed.
RESULTS
OCT was performed in 421 patients (TCFA group ( = 109), non-TCFA group ( = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group (2.95 ± 1.20 . 2.43 ± 0.92, < 0.05), as was TC/LDL in TCFA and non-TCFA group (4.57 ± 1.58 . 4.04 ± 1.13, < 0.05). Both LDL-C/HDL-C (OR: 1.002 (1.002-1.003), < 0.05) and TC/HDL-C (OR: 1.001 (1.001-1.004), < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/ HDL-C and TC/HDL-C had no significant difference statistically (LDL-C/HDL-C AUC: 0.63; TC/HDL-C AUC: 0.61; = 0.10) for the prediction of TCFA.
CONCLUSIONS
LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.
背景
低密度脂蛋白胆固醇/高密度脂蛋白胆固醇（LDL-C/HDL-C）、总胆固醇/高密度脂蛋白胆固醇（TC/HDL-C）比值与薄帽纤维粥样斑块之间的相关性尚未明确。
方法
这是一项单中心回顾性观察研究。我们共纳入421例患者（男性占82.4%；平均年龄65.73±10.44岁），这些患者均有一根罪犯血管，通过血管内光学相干断层扫描（OCT）确定。最薄帽纤维粥样斑块（TCFA）组定义为脂质含量在2个以上象限，最薄纤维帽厚度小于65μm。进行单因素和多因素逻辑回归分析，以探讨脂蛋白比值、TCFA与斑块其他特征之间的关系。为比较不同比值，评估了受试者操作特征（ROC）曲线的曲线下面积（AUC）。
结果
对421例患者进行了OCT检查（TCFA组（=109），非TCFA组（=312））。TCFA组的LDL-C/HDL-C显著高于非TCFA组（2.95±1.20. 2.43±0.92，<0.05），TCFA组和非TCFA组的TC/LDL也是如此（4.57±1.58. 4.04±1.13，<0.05）。根据逻辑回归分析，LDL-C/HDL-C（OR：1.002（1.002 - 1.003），<0.05）和TC/HDL-C（OR：1.001（1.001 - 1.004），<0.05）均被认为是预测TCFA的独立因素。基于AUC比较，LDL-C/HDL-C和TC/HDL-C在预测TCFA方面无统计学显著差异（LDL-C/HDL-C AUC：0.63；TC/HDL-C AUC：0.61；=0.10）。
结论
LDL-C/HDL-C和TC/HDL-C可能是预测TCFA存在的独立因素，提示冠心病患者冠状动脉斑块的易损性。此外，TC/HDL-C在预测TCFA方面与LDL-C/HDL-C表现相当。
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