冠状动脉微血管功能障碍患者中丙二醛修饰的低密度脂蛋白循环水平升高。
Increased circulating levels of malondialdehyde-modified low-density lipoprotein in patients with coronary microvascular dysfunction.
作者信息
Ito Tsuyoshi, Yokoi Masashi, Kitada Shuichi, Kawada Yu, Mizoguchi Tatsuya, Kikuchi Shohei, Goto Toshihiko, Seo Yoshihiro
机构信息
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (Drs Ito, Yokoi, Kitada, Kawada, Mizoguchi, Kikuchi, Goto, and Seo).
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan (Drs Ito, Yokoi, Kitada, Kawada, Mizoguchi, Kikuchi, Goto, and Seo).
出版信息
J Clin Lipidol. 2024 Sep-Oct;18(5):e756-e763. doi: 10.1016/j.jacl.2024.08.002. Epub 2024 Aug 14.
BACKGROUND
Coronary microvascular dysfunction (CMD) is associated with angina symptoms and adverse clinical outcomes in patients without obstructive coronary artery disease (CAD). Malondialdehyde-modified low-density lipoprotein (MDA-LDL) is reportedly a marker of the initiation and acceleration of epicardial coronary atherosclerosis. However, its impact on CMD remains unclear.
OBJECTIVE
We aimed to investigate the relationship between CMD and MDA-LDL levels.
METHODS
This study included 95 patients who did not receive lipid-lowering medications and had no obstructive CAD. Obstructive CAD was defined as >50% diameter reduction on coronary angiography or fractional flow reserve of ≤0.80. We retrospectively analyzed coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and MDA-LDL levels. CMD was defined as either CFR <2.0 or IMR ≥25.
RESULTS
CMD was observed in 29 (31%) patients. MDA-LDL levels were significantly higher in patients with CMD than in those without CMD (124.8 ± 37.6 vs. 95.3 ± 29.5 U/L; p < 0.01). Univariable logistic regression analysis indicated a significant relationship between CMD and MDA-LDL levels (odds ratio (OR): 1.03; p < 0.01). In the multivariable model, MDA-LDL levels were significantly associated with CMD (OR: 1.02; p < 0.01). Regression analysis showed a significant correlation between MDA-LDL levels and CFR (r = -0.42, p < 0.01) and IMR (r = 0.35, p < 0.01). In the multiple regression analysis, MDA-LDL levels were independently associated with CFR (β = -0.30, p < 0.01) and IMR (β = 0.26, p = 0.02).
CONCLUSION
MDA-LDL levels were associated with CMD in patients without obstructive CAD.
背景
冠状动脉微血管功能障碍（CMD）与无阻塞性冠状动脉疾病（CAD）患者的心绞痛症状及不良临床结局相关。据报道，丙二醛修饰的低密度脂蛋白（MDA-LDL）是心外膜冠状动脉粥样硬化起始和加速的标志物。然而，其对CMD的影响仍不明确。
目的
我们旨在研究CMD与MDA-LDL水平之间的关系。
方法
本研究纳入了95例未服用降脂药物且无阻塞性CAD的患者。阻塞性CAD定义为冠状动脉造影显示直径减少>50%或血流储备分数≤0.80。我们回顾性分析了冠状动脉血流储备（CFR）、微循环阻力指数（IMR）和MDA-LDL水平。CMD定义为CFR<2.0或IMR≥25。
结果
29例（31%）患者存在CMD。CMD患者的MDA-LDL水平显著高于无CMD患者（124.8±37.6 vs. 95.3±29.5 U/L；p<0.01）。单因素逻辑回归分析表明CMD与MDA-LDL水平之间存在显著关系（比值比（OR）：1.03；p<0.01）。在多变量模型中，MDA-LDL水平与CMD显著相关（OR：1.02；p<0.01）。回归分析显示MDA-LDL水平与CFR（r = -0.42，p<0.01）和IMR（r = 0.35，p<0.01）之间存在显著相关性。在多元回归分析中，MDA-LDL水平与CFR（β = -0.30，p<0.01）和IMR（β = 0.26，p = 0.02）独立相关。
结论
在无阻塞性CAD的患者中，MDA-LDL水平与CMD相关。
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