已确诊冠心病患者脂质指标与完全闭塞的相关性：一项横断面研究。
Associations of lipid measures with total occlusion in patients with established coronary artery disease: a cross-sectional study.
作者信息
Li Tianyu, Yuan Deshan, Wang Peizhi, Jia Sida, Zhang Ce, Zhu Pei, Song Ying, Tang Xiaofang, Zhao Xueyan, Gao Zhan, Yang Yuejin, Gao Runlin, Xu Bo, Yuan Jinqing
机构信息
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, North Lishi Road, Xicheng District, Beijing, 100037, China.
Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167, North Lishi Road, Xicheng District, Beijing, 100037, China.
出版信息
Lipids Health Dis. 2022 Nov 11;21(1):118. doi: 10.1186/s12944-022-01733-8.
BACKGROUND
Total occlusion is the most severe coronary lesion, indicating heavy ischemic burden and poor prognosis. The lipid profile is central to the development of atherosclerotic coronary lesions. Evidence on the optimal lipid measure to be monitored and managed in patients with established coronary artery disease (CAD) is inconclusive.
METHODS
Total cholesterol (TC), total triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), nonhigh-density lipoprotein cholesterol (non-HDL-c), lipoprotein (a) [Lp(a)], apolipoprotein B (apoB), non-HDL-c/HDL-c, and apoB/apoA-1 were analyzed in quintiles and as continuous variables. The associations of lipid measures with total occlusion were tested using logistic regression models, visualized with restricted cubic splines, and compared by areas under the receiver operating characteristic curves (AUROC). Discordance analysis was performed when apoB/apoA-1 and non-HDL-c/HDL-c were not in concordance.
RESULTS
The prospective cohort study included 10,003 patients (mean age: 58 years; women: 22.96%), with 1879 patients having total occlusion. The risks of total occlusion significantly increased with quintiles of Lp(a), non-HDL-c/HDL-c, and apoB/apoA-1 (all p for trend < 0.001). TG had no association with total occlusion. Restricted cubic splines indicate significant positive linear relations between the two ratios and total occlusion [odds ratio per 1-standard deviation increase (95% confidence interval): non-HDL-c/HDL-c: 1.135 (1.095-1.176), p < 0.001; apoB/apoA-1: 2.590 (2.049-3.274), p < 0.001]. The AUROCs of apoB/apoA-1 and non-HDL-c/HDL-c were significantly greater than those of single lipid measures. Elevation in the apoB/apoA-1 tertile significantly increased the risk of total occlusion at a given non-HDL-c/HDL-c tertile but not vice versa.
CONCLUSION
ApoB/apoA-1 confers better predictive power for total occlusion than non-HDL-c/HDL-c and single lipid measures in established CAD patients.
背景
完全闭塞是最严重的冠状动脉病变，提示缺血负担重且预后差。血脂谱在动脉粥样硬化性冠状动脉病变的发生发展中起核心作用。关于已确诊冠心病（CAD）患者中应监测和管理的最佳血脂指标的证据尚无定论。
方法
对总胆固醇（TC）、总甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-c）、非高密度脂蛋白胆固醇（non-HDL-c）、脂蛋白（a）[Lp（a）]、载脂蛋白B（apoB）、非HDL-c/HDL-c和apoB/apoA-1进行五分位数分析并作为连续变量分析。使用逻辑回归模型检验血脂指标与完全闭塞之间的关联，用受限立方样条进行可视化，并通过受试者工作特征曲线下面积（AUROC）进行比较。当apoB/apoA-1和非HDL-c/HDL-c不一致时进行不一致性分析。
结果
前瞻性队列研究纳入10003例患者（平均年龄：58岁；女性：22.96%），其中1879例患者存在完全闭塞。Lp（a）、非HDL-c/HDL-c和apoB/apoA-1五分位数的完全闭塞风险显著增加（所有趋势p<0.001）。TG与完全闭塞无关联。受限立方样条显示这两个比值与完全闭塞之间存在显著的正线性关系[每增加1个标准差的比值比（95%置信区间）：非HDL-c/HDL-c：1.135（1.095-1.176），p<0.001；apoB/apoA-1：2.590（2.049-3.274），p<0.001]。apoB/apoA-1和非HDL-c/HDL-c的AUROC显著大于单一血脂指标。在给定的非HDL-c/HDL-c三分位数水平下，apoB/apoA-1三分位数升高显著增加完全闭塞风险，但反之则不然。
结论
在已确诊的CAD患者中，apoB/apoA-1对完全闭塞的预测能力优于非HDL-c/HDL-c和单一血脂指标。
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