Drexel H, Steurer J, Muntwyler J, Meienberg S, Schmid H R, Schneider E, Gröchenig E, Amann F W
Division of Cardiology, University Hospital Zurich, Switzerland.
Circulation. 1996 Nov 1;94(9 Suppl):II199-205.
Data relating lipids to the angiographic presence and extent of atherosclerosis, as reported for the coronary circulation, are lacking for the peripheral site.
This study comprised 102 patients with peripheral arterial occlusive disease (PAOD) referred for elective percutaneous transluminal angioplasty and 100 age-matched control subjects with normal coronary and peripheral angiograms. The presence of PAOD was defined as > or = 1 stenosis with > or = 50% narrowing, and the extent was defined as the total of > or = 50% lesions in the iliac, femoral, popliteal, and crural beds. The relation of lipids and nonlipid risk factors to the presence of PAOD was tested by stepwise logistic regression analysis; their relation to the extent of disease was analyzed by simple regression and stepwise discriminant analysis. The presence of PAOD was significantly and positively associated with LDL cholesterol (P = .0003), triglycerides (P = .0001), apolipoprotein B (P = .0073), and smoking (P = .005) and was significantly and negatively associated with HDL2 cholesterol (P = .0085) and apolipoprotein A-I (P = .021). In the logistic model, LDL cholesterol, triglycerides, smoking, and systolic blood pressure were selected as independent predictors of PAOD presence. The extent of PAOD was significantly and negatively correlated with HDL3 cholesterol (P = .005), HDL cholesterol (P = .013), and apolipoprotein A-I (P = .021) and was significantly and positively associated with smoking and fasting blood glucose. Age, smoking, and blood glucose were selected by the discriminant analysis as independent predictors of the extent of PAOD.
From this large case-control study, it is concluded that the presence of PAOD is predicted by parameters of LDL, triglyceride, and HDL2 metabolism, whereas the extent of PAOD is related to HDL3 and nonlipid risk factors.
关于脂质与动脉粥样硬化血管造影表现及范围之间的关系，冠状动脉循环方面已有报道，但外周部位的相关数据尚缺。
本研究纳入了102例因择期经皮腔内血管成形术而转诊的外周动脉闭塞性疾病（PAOD）患者，以及100例年龄匹配、冠状动脉和外周血管造影正常的对照者。PAOD的存在定义为一处及以上狭窄且狭窄程度≥50%，其范围定义为髂动脉、股动脉、腘动脉和小腿血管床中一处及以上病变且病变程度≥50%。通过逐步逻辑回归分析检验脂质和非脂质危险因素与PAOD存在之间的关系；通过简单回归和逐步判别分析分析它们与疾病范围的关系。PAOD的存在与低密度脂蛋白胆固醇（P = 0.0003）、甘油三酯（P = 0.0001）、载脂蛋白B（P = 0.0073）和吸烟（P = 0.005）显著正相关，与高密度脂蛋白2胆固醇（P = 0.0085）和载脂蛋白A-I（P = 0.021）显著负相关。在逻辑模型中，低密度脂蛋白胆固醇、甘油三酯、吸烟和收缩压被选为PAOD存在的独立预测因素。PAOD的范围与高密度脂蛋白3胆固醇（P = 0.005）、高密度脂蛋白胆固醇（P = 0.013）和载脂蛋白A-I（P = 0.021）显著负相关，与吸烟和空腹血糖显著正相关。判别分析选择年龄、吸烟和血糖作为PAOD范围的独立预测因素。
从这项大型病例对照研究得出结论，PAOD的存在可由低密度脂蛋白、甘油三酯和高密度脂蛋白2代谢参数预测，而PAOD的范围与高密度脂蛋白3和非脂质危险因素有关。
