小而密低密度脂蛋白胆固醇对中国老年糖尿病患者心血管事件的预测价值
Predictive value of small dense low-density lipoprotein cholesterol for cardiovascular events in Chinese elder diabetes mellitus patients.
作者信息
Xu Li, Chen Xu, Lu Jingfen, Xu Yan, Yang Honglin, Zhou Xuewen, Zhou Jun, Xu Jianhong, Shen Hao
机构信息
Department of General Surgery, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China.
Department of Blood Transfusion and Clinical Laboratory Medicine, Suzhou Ninth People's Hospital, Soochow University, Suzhou, China.
出版信息
Diabetol Metab Syndr. 2021 Apr 28;13(1):49. doi: 10.1186/s13098-021-00667-y.
BACKGROUND
As a subcomponent of low-density lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C) has been suggested to be a better predictor of cardiovascular diseases (CVD). The aim of this research was to evaluate the predictive value of the sdLDL-C in cardiovascular events (CVs) in Chinese elderly patients with type 2 diabetes mellitus (DM).
METHODS
A total of 386 consecutive type 2 DM patients were included into this study during December 2014 to December 2016. The serum sdLDL-C level of each subject was measured by homogeneous method. During a period of 48-month's follow-up, the occurrence of CVs and associated clinical information were recorded. Receiver operating characteristic (ROC) curves were used to assess the predictive value of serum sdLDL-C to occurrence of major CVs.
RESULTS
A total of 92 CVs occurred during the study period. The ROC curve analysis manifested that sdLDL-C in the study population had a matchable discriminatory power (AUC for sdLDL-C was 0.7366, P = 0.003). In addition, Kaplan-Meier event-free survival curves displayed an obvious increase of CVs risk for sdLDL-C ≧ 26 mg/dL (log-rank = 9.10, P = 0.003). This phenomenon had analogous results in patients who received statins at baseline (log rank = 7.336, P = 0.007). Cox regression analysis revealed that the increase in HbA1c, glucose, LDL-C, sdLDL-C, non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B (ApoB) and the decrease in apolipoprotein AI (ApoAI) were obviously interrelated with heightened CVs risk. Multiple Cox regression demonstrated that the increase of sdLDL-C and hemoglobin A1c (HbA1c) was significantly correlated with CVs. The results of the study indicated that high sdLDL-C level (> 10 mg/dL) was a risk factor for CVs in the multivariate model (HR 1.281, 95% CI 1.225-16.032; P < 0.01).
CONCLUSION
sdLDL-C level could be an effective predictor in predicting the future CVs for Chinese elderly patients with type 2 DM and dyslipidemia.
背景
作为低密度脂蛋白胆固醇（LDL-C）的一个亚组分，小而密低密度脂蛋白胆固醇（sdLDL-C）被认为是心血管疾病（CVD）更好的预测指标。本研究旨在评估sdLDL-C对中国老年2型糖尿病（DM）患者心血管事件（CVs）的预测价值。
方法
2014年12月至2016年12月期间，共纳入386例连续性2型DM患者。采用匀相法测定每位受试者的血清sdLDL-C水平。在48个月的随访期间，记录CVs的发生情况及相关临床信息。采用受试者工作特征（ROC）曲线评估血清sdLDL-C对主要CVs发生的预测价值。
结果
研究期间共发生92例CVs。ROC曲线分析表明，研究人群中的sdLDL-C具有相当的鉴别能力（sdLDL-C的AUC为0.7366，P = 0.003）。此外，Kaplan-Meier无事件生存曲线显示，sdLDL-C≥26mg/dL时CVs风险明显增加（对数秩检验= 9.10，P = 0.003）。在基线时接受他汀类药物治疗的患者中也有类似结果（对数秩检验= 7.336，P = 0.007）。Cox回归分析显示，糖化血红蛋白（HbA1c）、血糖、LDL-C、sdLDL-C、非高密度脂蛋白胆固醇（non-HDL-C）和载脂蛋白B（ApoB）升高以及载脂蛋白AI（ApoAI）降低与CVs风险升高明显相关。多重Cox回归表明，sdLDL-C和糖化血红蛋白（HbA1c）升高与CVs显著相关。研究结果表明，在多变量模型中，高sdLDL-C水平（>10mg/dL）是CVs的一个危险因素（HR 1.281，95%CI 1.225 - 16.032；P < 0.01）。
结论
sdLDL-C水平可能是预测中国老年2型DM和血脂异常患者未来CVs的有效指标。
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