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冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)是常见的心血管疾病(cardiovascular diseases, CVD)之一,急性冠状动脉综合征(acute coronary syndrome, ACS)是CHD的一种,包括急性心肌梗死(acute myocardial infarction, AMI)和不稳定型心绞痛(unstable angina pectoris, UAP)。《中国心血管报告2016年》[1]指出:我国CVD占居民疾病死亡比例的40%以上,高于肿瘤疾病居于首位,其病死率和患病率在今后10年内仍将升高,而CHD现患人数估计为1 100万。因此,积极寻找CHD相关危险因素及预测指标,对降低病死率、改善预后具有十分重要的临床价值。CHD传统危险因素包括糖尿病、高血压、低密度脂蛋白(low density lipoprotein,LDL)、吸烟等。近年来大量相关研究发现, 小而密低密度脂蛋白(small dense low density lipoprotein, sdLDL)、游离脂肪酸(free fatty acids, FFA)是CHD新的危险因素, 而sdLDL、FFA与冠状动脉狭窄程度的研究较少,并且尚未达成共识。本研究以ACS病人作为研究对象,以冠状动脉造影作为诊断ACS的金标准,检测研究对象sdLDL和FFA水平,探讨上述指标与ACS的相关性。
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各组年龄差异无统计学意义(P>0.05)。与健康对照组比较,AMI组和UAP组TC、TG、LDL、sdLDL和FFA水平均显著升高(P < 0.05~P < 0.01)。AMI组FFA水平高于UAP组(P < 0.01),其余指标2组间差异均无统计学意义(P>0.05)。冠状动脉硬化组和冠状动脉正常组TG、FFA均显著高于健康对照组(P < 0.01和P < 0.05),2组间各指标差异均无统计学意义(P>0.05)。健康对照组HDL水平明显高于各疾病组(P < 0.01),各疾病组间差异无统计学意义(P>0.05)(见表 1)。
分组 n 年龄/岁 TC TG HDL LDL sdLDL FFA 健康对照组 100 59.42±11.07 4.16±0.51 1.05±0.28 1.38±0.26 2.46±0.44 0.64±0.16 0.61±0.24 冠状动脉正常组 50 58.34±8.77 3.92±0.85 1.55±0.84** 1.07±0.38** 2.28±0.48 0.67±0.27 0.83±0.30* 冠状动脉硬化组 30 58.13±10.14 4.14±1.06 1.73±0.82** 1.01±0.25** 2.47±0.77 0.75±0.38 0.82±0.37* UAP组 110 61.91±9.41 4.66±1.04**## 2.01±1.25**# 1.05±0.28** 2.84±0.83**##▲ 0.87±0.37**## 1.03±0.50**#▲ AMI组 92 60.82±12.82 4.63±1.08**##▲ 1.92±1.33** 1.01±0.28** 2.71±0.78*## 0.89±0.38**##▲ 1.41±0.79**##▲▲■■ F — 1.39 9.51 13.99 26.05 7.83 10.78 31.90 P — >0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 114.261 0.845 1.037 0.083 0.472 0.102 0.262 q检验:与健康对照组比较*P < 0.05,** P < 0.01;与冠状动脉正常组比较#P < 0.05,##P < 0.01;与冠状动脉硬化组比较▲P < 0.05,▲▲P < 0.01;与UAP组比较■■P < 0.01 表 1 各组相关指标水平的比较(x±s;mmol/L)
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3组冠状动脉异常者FFA水平随着Gensini评分的升高而升高,差异有统计学意义(P < 0.05~P < 0.01);各组间sdLDL、TC、TG、HDL、LDL水平差异均无统计学意义(P>0.05)(见表 2)。
分组 n TC TG HDL LDL sdLDL FFA ≤20分 81 4.41±1.04 1.99±1.13 1.04±0.28 2.62±0.82 0.82±0.38 0.92±0.38 21~50分 71 4.59±1.05 1.79±1.02 1.04±0.28 2.80±0.82 0.88±0.35 1.12±0.55* >50分 80 4.75±1.10 2.02±1.48 1.00±0.27 2.81±0.79 0.86±0.40 1.35±0.78**# F — 1.97 0.76 0.56 1.47 0.82 10.96 P — >0.05 >0.05 >0.05 >0.05 >0.05 < 0.01 MS组内 — 1.136 1.520 0.077 0.649 0.142 0.348 q检验:与≤20分组比较*P < 0.05,** P < 0.01;与21~50分组比较#P < 0.05 表 2 不同Gensini评分组的相关指标水平的比较(x±s;mmol/L)
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不同ACS病人各Gensini评分组间FFA、sdLDL、TC、TG、HDL、LDL水平差异均无统计学意义(P>0.05)(见表 3)。
分组 n TC TG HDL LDL sdLDL FFA AMI ≤20分 3 4.99±1.50 2.51±1..22 0.89±0.16 2.82±1.36 0.98±0.72 0.99±0.09 21~50分 35 4.48±1.01 1.77±1.07 1.04±0.31 2.63±0.73 0.86±0.30 1.23±0.60 >50分 54 4.71±1.11 1.98±1.48 1.00±0.27 2.76±0.78 0.90±0.41 1.51±0.85 F — 0.63 0.59 0.46 0.29 0.22 1.96 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 MS组内 — 1.180 1.776 0.0.080 0.612 0.148 0.564 UAP ≤20分 48 4.45±0.98 2.11±1.27 1.07±0.31 2.70±0.82 0.85±0.36 0.98±0.38 21~50分 35 4.66±1.09 1.80±1.00 1.04±0.25 2.95±0.85 0.89±0.38 1.00±0.47 >50分 27 4.87±1.10 2.10±1.47 1.02±0.27 2.94±0.81 0.88±0.38 1.04±0.46 F — 0.78 0.73 0.39 1.26 0.11 0.17 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 MS组内 — 1.092 1.558 0.079 0.684 0.140 0.187 表 3 不同ACS病人各Gensini评分组的相关指标水平的比较(x±s;mmol/L)
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sdLDL水平与Gensini评分无相关性(r=0.117, P>0.05)。FFA水平与Gensini评分呈弱正相关(r=0.232, P < 0.05)。
急性冠状动脉综合征病人小而密低密度脂蛋白、游离脂肪酸与Gensini评分的相关性研究
Relationship between small dense low-density lipoprotein, free fatty acid and Gensini score in patients with acute coronary syndrome
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摘要:
目的探讨血浆小而密低密度脂蛋白(sdLDL)、游离脂肪酸(FFA)水平与急性冠状动脉综合征(ACS)的关系,评估sdLDL、FFA与Gensini评分的关系。 方法选取282例疑似ACS病人,经冠状动脉造影确诊,分为急性心肌梗死(AMI)组92例,不稳定心绞痛(UAP)组110例、冠状动脉硬化组30例和冠状动脉正常组50例;择同期100名健康体检者作为健康对照组;并根据Gensini评分将冠状动脉异常者分为≤ 20分组81例、21~50分组71例和>50分组80例。测定各组血浆sdLDL、FFA、血清总胆固醇、三酰甘油、高密度脂蛋白和低密度脂蛋白水平,并进行统计分析。 结果AMI组和UAP组sdLDL水平明显升高(P < 0.05~P < 0.01),2组间差异无统计学意义(P>0.05);健康对照组、冠状动脉正常组、冠状动脉硬化组、UAP组及AMI组FFA水平逐渐升高,差异有统计学意义(P < 0.05~P < 0.01);ACS病人sdLDL水平与Gensini评分无相关性(r=0.117,P>0.05);ACS病人FFA水平与Gensini评分呈弱正相关(P < 0.05);冠状动脉异常者FFA水平随着Gensini评分的升高而升高,差异有统计学意义(P < 0.05~P < 0.01);AMI组和UAP组各Gensini组间FFA水平差异无统计学意义(P>0.05)。 结论sdLDL与FFA与ACS的发生密切相关,FFA可能是一个判断冠状动脉狭窄程度潜在指标。 Abstract:ObjectiveTo investigate the relationship between the levels of small dense low-density lipoprotein (sdLDL), free fatty acid (FFA) and acute coronary syndrome (ACS), and evaluate the correlation of sdLDL, FFA with Gensini score. MethodsAmong 282 patients suspected by ACS, 92 cases with acute myocardial infarction (AMI), 110 cases with unstable angina pectoris (UAP), 30 case with coronary sclerosis, and 50 cases with normal coronary were divided into the AMI group, UAP group, coronary sclerosis group and normal coronary group according to the results of coronary angiography, respectively.One hundred healthy people were set as the healthy control group.According to the results of Gensini score, the score for ≤ 20 in 81 cases, score for 21-50 in 71 cases and score for>50 in 80 cases were found.The plasma levels of sdLDL, FFA, TC, TG, HDL and LDL in all groups were analyzed. ResultsThe levels of sdLDL in AMI group and UAP group significantly increased (P < 0.05 to P < 0.01), and the difference of which was not statistically significant between two groups (P>0.05).The levels of FFA in healthy control group, normal coronary group, coronary sclerosis group, UAP group and AMI group gradually increased in turn, and the difference of which was statistically significant (P < 0.05 to P < 0.01).The level of sdLDL was not correlated with Gensini score (P>0.05), and the level of FFA was weakly positively correlated with Gensini score in patients with ACS (P < 0.05).The level of FFA in abnormal coronary patients increased with the increasing of Gensini score, and the difference of which was statistically significant (P < 0.05 to P < 0.01).There was no statistical significance in the level of FFA among Gensini groups in AMI group and UAP group (P>0.05). ConclusionsThe sdLDL and FFA are closely related to the occurrence of ACS, and FFA may be a potential indicator to judge the severity of coronary artery disease. -
表 1 各组相关指标水平的比较(x±s;mmol/L)
分组 n 年龄/岁 TC TG HDL LDL sdLDL FFA 健康对照组 100 59.42±11.07 4.16±0.51 1.05±0.28 1.38±0.26 2.46±0.44 0.64±0.16 0.61±0.24 冠状动脉正常组 50 58.34±8.77 3.92±0.85 1.55±0.84** 1.07±0.38** 2.28±0.48 0.67±0.27 0.83±0.30* 冠状动脉硬化组 30 58.13±10.14 4.14±1.06 1.73±0.82** 1.01±0.25** 2.47±0.77 0.75±0.38 0.82±0.37* UAP组 110 61.91±9.41 4.66±1.04**## 2.01±1.25**# 1.05±0.28** 2.84±0.83**##▲ 0.87±0.37**## 1.03±0.50**#▲ AMI组 92 60.82±12.82 4.63±1.08**##▲ 1.92±1.33** 1.01±0.28** 2.71±0.78*## 0.89±0.38**##▲ 1.41±0.79**##▲▲■■ F — 1.39 9.51 13.99 26.05 7.83 10.78 31.90 P — >0.05 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 114.261 0.845 1.037 0.083 0.472 0.102 0.262 q检验:与健康对照组比较*P < 0.05,** P < 0.01;与冠状动脉正常组比较#P < 0.05,##P < 0.01;与冠状动脉硬化组比较▲P < 0.05,▲▲P < 0.01;与UAP组比较■■P < 0.01 表 2 不同Gensini评分组的相关指标水平的比较(x±s;mmol/L)
分组 n TC TG HDL LDL sdLDL FFA ≤20分 81 4.41±1.04 1.99±1.13 1.04±0.28 2.62±0.82 0.82±0.38 0.92±0.38 21~50分 71 4.59±1.05 1.79±1.02 1.04±0.28 2.80±0.82 0.88±0.35 1.12±0.55* >50分 80 4.75±1.10 2.02±1.48 1.00±0.27 2.81±0.79 0.86±0.40 1.35±0.78**# F — 1.97 0.76 0.56 1.47 0.82 10.96 P — >0.05 >0.05 >0.05 >0.05 >0.05 < 0.01 MS组内 — 1.136 1.520 0.077 0.649 0.142 0.348 q检验:与≤20分组比较*P < 0.05,** P < 0.01;与21~50分组比较#P < 0.05 表 3 不同ACS病人各Gensini评分组的相关指标水平的比较(x±s;mmol/L)
分组 n TC TG HDL LDL sdLDL FFA AMI ≤20分 3 4.99±1.50 2.51±1..22 0.89±0.16 2.82±1.36 0.98±0.72 0.99±0.09 21~50分 35 4.48±1.01 1.77±1.07 1.04±0.31 2.63±0.73 0.86±0.30 1.23±0.60 >50分 54 4.71±1.11 1.98±1.48 1.00±0.27 2.76±0.78 0.90±0.41 1.51±0.85 F — 0.63 0.59 0.46 0.29 0.22 1.96 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 MS组内 — 1.180 1.776 0.0.080 0.612 0.148 0.564 UAP ≤20分 48 4.45±0.98 2.11±1.27 1.07±0.31 2.70±0.82 0.85±0.36 0.98±0.38 21~50分 35 4.66±1.09 1.80±1.00 1.04±0.25 2.95±0.85 0.89±0.38 1.00±0.47 >50分 27 4.87±1.10 2.10±1.47 1.02±0.27 2.94±0.81 0.88±0.38 1.04±0.46 F — 0.78 0.73 0.39 1.26 0.11 0.17 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 MS组内 — 1.092 1.558 0.079 0.684 0.140 0.187 -
[1] 陈伟伟, 高润霖, 刘力生, 等.《中国心血管病报告2016》概要[J].中国循环杂志, 2017, 32(06):521. doi: 10.3969/j.issn.1000-3614.2017.06.001 [2] GENSINI GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol, 1983, 51(3):606. doi: 10.1016/S0002-9149(83)80105-2 [3] FUKUSHIMA Y, HIRAYAMA S, UENO T, et al.Small dense LDL cholesterol is a robust therapeutic marker of statin treatment in patients with acute coronary syndrome and metabolic syndrome[J].Clin Chim Acta, 2011, 412(15/16):1423. [4] ORAVEC S, DUKAT A, GAVORNIK P, et al.Contribution of atherogenic lipoprotein profile to development of arterial hypertension[J].Bratisl Lek Listy, 2011, 112(1):4. [5] NISHIKURA T, KOBA S, YOKOTA Y, et al.Elevated small dense low-density lipoprotein cholesterol as a predictor for future cardiovascular events in patients with stable coronary artery disease[J].J Atheroscler Thromb, 2014, 21(8):755. doi: 10.5551/jat.23465 [6] BANSAL SK, YADAV R.A Study of the extended lipid profile including oxidized LDL, small dense LDL, lipoprotein(a) and apolipoproteins in the assessment of cardiovascular risk in hypothyroid patients[J].J Clin Diagn Res, 2016, 10(6):BC04. [7] BARBALHO SM, TOFANO RJ, Bechara MD, et al.Castelli Index and estimative of LDL-c particle size may still help in the clinical practice[J].J Cardiovasc Dis Res, 2016, 7(2):86. [8] TSAI MY, STEFFEN BT, GUAN W, et al.New automated assay of small dense low-density lipoprotein cholesterol identifies risk of coronary heart disease:the Multi-ethnic Study of Atherosclerosis[J].Arterioscler Thromb Vasc Biol, 2014, 34(1):196. doi: 10.1161/ATVBAHA.113.302401 [9] 翟菊萍, 黄惠芳, 顾国浩, 等.小而密低密度脂蛋白与冠心病的相关性研究[J].中国现代医学杂志, 2011, 21(27):3376. doi: 10.3969/j.issn.1005-8982.2011.27.012 [10] 戴雯, 李艳.冠心病患者血清sd-LDL和hs-CRP与冠状动脉狭窄程度的相关性研究[J].海南医学, 2017, 28(7):1045. doi: 10.3969/j.issn.1003-6350.2017.07.005 [11] KOBA S, HIRANO T, KONDO T, et al.Significance of small dense low-density lipoproteins and other risk factors in patients with various types of coronary heart disease[J].Am Heart J, 2002, 144(6):1026. doi: 10.1067/mhj.2002.126119 [12] LEGRAND-POELS S, ESSER N, L'HOMME L, et al.Free fatty acids as modulators of the NLRP3 inflammasome in obesity/type 2 diabetes[J].Biochem Pharmacol, 2014, 92(1):131. [13] MA P, HAN L, LV Z, et al.In-hospital free fatty acids levels predict the severity of myocardial ischemia of acute coronary syndrome[J].BMC Cardiovasc Disord, 2016, 16(1):29. doi: 10.1186/s12872-016-0199-1 [14] 刘畅, 王秋丽.血清HDL-C、SOD及游离脂肪酸水平与急性冠脉综合征的相关性[J].中国老年学杂志, 2015, 35(11):2975. doi: 10.3969/j.issn.1005-9202.2015.11.042 [15] GRUZDEVA O, UCHASOVA E, DYLEVA Y, et al.Multivessel coronary artery disease, free fatty acids, oxidized LDL and its antibody in myocardial infarction[J].Lipids Health Dis, 2014, 13(1):111. doi: 10.1186/1476-511X-13-111 [16] HE LY, ZHAO JF, Han JL, et al.Correlation between serum free fatty acids levels and Gensini score in elderly patients with coronary heart disease[J].J Geriatr Cardiol, 2014, 11(1):57. [17] 王白石, 李东阳, 陈兴国, 等.游离脂肪酸与冠心病患者冠脉病变严重程度的相关性[J].中国老年学杂志, 2017, 37(6):1352. doi: 10.3969/j.issn.1005-9202.2017.06.020