中国心血管疾病住院患者一日内三餐后非空腹血脂的变化
Non-fasting Changes in Blood Lipids After Three Daily Meals Within a Day in Chinese Inpatients With Cardiovascular Diseases.
作者信息
Tan Yangrong, Lin Qiuzhen, Xu Jin, Zhu Liyuan, Guo Liling, Xie Yingying, Du Xiao, Zhang Shilan, Wen Tie, Liu Ling
机构信息
Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, China.
出版信息
Front Cardiovasc Med. 2022 Apr 12;9:799300. doi: 10.3389/fcvm.2022.799300. eCollection 2022.
BACKGROUND
Non-fasting (i.e., postprandial) lipid detection is recommended in clinical practice. However, the change in blood lipids in Chinese patients with cardiovascular diseases after three daily meals has never been reported yet.
METHODS
Serum levels of blood lipids were measured or calculated in 77 inpatients (48 men and 29 women) at high or very high risk of atherosclerotic cardiovascular disease (ASCVD) in the fasting state and at 4 h after three meals within a day according to their diet habits.
RESULTS
Female patients showed significantly higher level of high-density lipoprotein cholesterol (HDL-C) than male patients, and the gender difference in other lipid parameters did not reach statistical significance at any time-point. Levels of triglyceride (TG) and remnant cholesterol (RC) increased, while that of low-density lipoprotein cholesterol (LDL-C) decreased significantly after three meals ( < 0.05). Levels of HDL-C, total cholesterol (TC), and non-high-density lipoprotein cholesterol (non-HDL-C) showed smaller changes after three meals. Percent reductions in the non-fasting LDL-C levels after lunch and supper were around 20%, which were greater than that after breakfast. The percent reductions in the non-fasting non-HDL-C levels after three meals were smaller than those in the non-fasting LDL-C levels. Patients with TG level ≥ 2.0 mmol/L (177 mg/dL) after lunch had significantly greater absolute reduction of LDL-C level than those with TG level < 2.0 mmol/L (177 mg/dL) after lunch [-0.69 mmol/L (-27 mg/dL) vs. -0.36 mmol/L (-14 mg/dL), <0.01]. There was a significant and negative correlation between absolute change in LDL-C level and that in TG level ( = -0.32) or RC level ( = -0.67) after lunch (both <0.01).
CONCLUSION
LDL-C level decreased significantly after three daily meals in Chinese patients at high or very high risk of ASCVD, especially when TG level reached its peak after lunch. Relatively, non-HDL-C level was more stable than LDL-C level postprandially. Therefore, when LDL-C level was measured in the non-fasting state, non-HDL-C level could be evaluated simultaneously to reduce the interference of related factors, such as postprandial hypertriglyceridemia, on detection.
背景
临床实践中推荐进行非空腹（即餐后）血脂检测。然而，中国心血管疾病患者一日三餐后血脂的变化情况尚未见报道。
方法
根据饮食习惯，对77例处于动脉粥样硬化性心血管疾病（ASCVD）高风险或极高风险的住院患者（48例男性和29例女性）在空腹状态以及一日三餐后4小时测量或计算血脂水平。
结果
女性患者的高密度脂蛋白胆固醇（HDL-C）水平显著高于男性患者，其他血脂参数的性别差异在任何时间点均未达到统计学意义。三餐后甘油三酯（TG）和残粒胆固醇（RC）水平升高，而低密度脂蛋白胆固醇（LDL-C）水平显著降低（P<0.05）。HDL-C、总胆固醇（TC）和非高密度脂蛋白胆固醇（non-HDL-C）水平在三餐后变化较小。午餐和晚餐后非空腹LDL-C水平的降低百分比约为20%，高于早餐后。三餐后非空腹non-HDL-C水平的降低百分比低于非空腹LDL-C水平。午餐后TG水平≥2.0 mmol/L（177 mg/dL）的患者LDL-C水平的绝对降低幅度显著大于午餐后TG水平<2.0 mmol/L（177 mg/dL）的患者[-0.69 mmol/L（-27 mg/dL）对-0.36 mmol/L（-14 mg/dL），P<0.01]。午餐后LDL-C水平的绝对变化与TG水平（r=-0.32）或RC水平（r=-0.67）之间存在显著负相关（均P<0.01）。
结论
在中国处于ASCVD高风险或极高风险的患者中，一日三餐后LDL-C水平显著降低，尤其是午餐后TG水平达到峰值时。相对而言，餐后non-HDL-C水平比LDL-C水平更稳定。因此，在非空腹状态下测量LDL-C水平时，可同时评估non-HDL-C水平，以减少餐后高甘油三酯血症等相关因素对检测的干扰。
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