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[冠心病患者血脂亚组与冠状动脉狭窄程度的相关性研究]

[Study on the correlation between subgroup of blood lipid with degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease].

作者信息

Wang X Y, Peng Y J, Han X J, Jia K G

机构信息

Clinical School of Cardiovascular Diseases, Tianjin Medical University, Tianjin 300457, China.

Department of Clinical Laboratory, Second People's Hospital of Yuhang District, Hangzhou 211121, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Dec 6;55(12):1435-1441. doi: 10.3760/cma.j.cn112150-20210519-00486.

Abstract

To study the correlation between low-density lipoprotein particles (LDL-P) with other lipoprotein indexes. To explore the correlation between LDL-P and its subgroup particles(LDL1-P-LDL6-P) with the degree of coronary artery stenosis in patients with coronary atherosclerotic heart disease(CHD) combining with the result of coronary arteriography. To explore the value of lipoprotein subgroup granules in preventing the severity of coronary artery stenosis in CHD patients. Cross-sectional study. A total of 259 patients without lipid-lowering drugs for coronary angiography in the department of cardiology of TEDA International Cardiovascular Hospital during 3 months from August 2019 to December 2019 were collected, and 52 healthy subjects were recruited during the same period. The level of high sensitivity C-reactive protein (hs-CRP) and other biochemical indexes were detected by automatic biochemical analyzer. The level of LDL-P and other biochemical indexes were detected by nuclear magnetic resonance spectroscopy(NMRS). The relation between various biomarkers levels with coronary artery stenosis degree was analyzed. Analysis of variance and nonparametric tests were used to compare the differences of indexes among each group. Pearson correlation analysis was used to determine the correlation among the measured indexes. Logistic regression was used for multi-factor analysis, ROC curve was used to evaluate the diagnostic value of related indexes. LDL-P was highly correlated with low-density lipoprotein cholesterol (LDL-C),apolipoprotein B (ApoB) and total cholesterol (TC) (= 0.927, <0.001; =0.921, <0.001; =0.844, <0.001). LDL-P, LDL4-P, LDL5-P and LDL6-P in patients with severe coronary stenosis were higher than those in patients with mild coronary stenosis(=4 172.000, =4.256, <0.001; =2.573, =0.011; =3 995.000, =4.621, <0.001;=5.223, <0.001), LDL-P and LDL6-P were higher than those of patients with moderate coronary stenosis (=1 159.000, =2.294, =0.022; =2.075, =0.041). High levels of hs-CRP, LDL5-P and LDL6-P were risk factors for the degree of coronary stenosis(=1.095, =0.036;=1.015, =0.046;=1.012, =0.039). ROC analysis showed that the AUC of LDL-P, LDL5-P and LDL6-P on coronary stenosis was 0.67, 0.68 and 0.69, respectively. Hs-CRP combined with LDL5-P and LDL6-P had the greatest effect on the degree of coronary stenosis (AUC= 0.70). LDL-P is highly correlated with LDL-C. The levels of LDL-P and LDL6-P were significantly higher in patients with severe stenosis than in patients with mild and moderate stenosis. hs-CRP, LDL5-P and LDL6-P can be used as new risk factors for the degree of coronary stenosis and may be further used as risk predictors. The combined detection of hs-CRP, LDL5-P and LDL6-P is helpful for the diagnosis of the severity of coronary stenosis, and may further become risk predictors.

摘要

研究低密度脂蛋白颗粒(LDL-P)与其他脂蛋白指标之间的相关性。结合冠状动脉造影结果,探讨LDL-P及其亚组颗粒(LDL1-P-LDL6-P)与冠状动脉粥样硬化性心脏病(CHD)患者冠状动脉狭窄程度之间的相关性。探讨脂蛋白亚组颗粒在预防CHD患者冠状动脉狭窄严重程度方面的价值。横断面研究。收集2019年8月至2019年12月3个月期间泰达国际心血管病医院心内科259例未服用降脂药物行冠状动脉造影的患者,并同期招募52例健康受试者。采用自动生化分析仪检测高敏C反应蛋白(hs-CRP)等生化指标水平。采用核磁共振波谱法(NMRS)检测LDL-P等生化指标水平。分析各生物标志物水平与冠状动脉狭窄程度的关系。采用方差分析和非参数检验比较各组指标差异。采用Pearson相关分析确定各测量指标之间的相关性。采用Logistic回归进行多因素分析,采用ROC曲线评估相关指标的诊断价值。LDL-P与低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)和总胆固醇(TC)高度相关(r = 0.927,P < 0.001;r = 0.921,P < 0.001;r = 0.844,P < 0.001)。重度冠状动脉狭窄患者的LDL-P、LDL4-P、LDL5-P和LDL6-P高于轻度冠状动脉狭窄患者(F = 4172.000,P = 4.256,P < 0.001;t = 2.573,P = 0.011;F = 3995.000,P = 4.621,P < 0.001;t = 5.223,P < 0.001),LDL-P和LDL6-P高于中度冠状动脉狭窄患者(t = 1159.000,P = 2.294,P = 0.022;t = 2.075,P = 0.041)。hs-CRP、LDL5-P和LDL6-P水平升高是冠状动脉狭窄程度的危险因素(β = 1.095,P = 0.036;β = 1.015,P = 0.046;β = 1.012,P = 0.039)。ROC分析显示,LDL-P、LDL5-P和LDL6-P对冠状动脉狭窄的AUC分别为0.67·、0.68和0.69。Hs-CRP联合LDL5-P和LDL6-P对冠状动脉狭窄程度的影响最大(AUC = 0.70)。LDL-P与LDL-C高度相关。重度狭窄患者的LDL-P和LDL6-P水平显著高于轻度和中度狭窄患者。Hs-CRP、LDL5-P和LDL6-P可作为冠状动脉狭窄程度的新危险因素,可能进一步用作风险预测指标。Hs-CRP、LDL5-P和LDL6-P联合检测有助于诊断冠状动脉狭窄的严重程度,并可能进一步成为风险预测指标。

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