非高密度脂蛋白胆固醇和高密度脂蛋白胆固醇比值与冠脉病变的相关性研究

发布时间：2018-04-05 13:24

  本文选题：非高密度脂蛋白胆固醇　切入点：高密度脂蛋白胆固醇　出处：《青岛大学》2017年硕士论文

【摘要】：目的分析冠心病患者的血脂水平,探讨非高密度脂蛋白胆固醇和高密度脂蛋白胆固醇比值(non-HDL-C/HDL-C)与冠脉病变程度的相关性。方法入选267例在胜利石油管理局胜利医院心血管内科住院的患者,男性141例,女性126例,平均62.97±9.66岁。每位患者均记录性别、年龄、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)和有无吸烟史,口服药物如阿司匹林、β-受体阻滞剂、硝酸酯类、他汀类药物等。入选患者于入院后次日清晨空腹采血5ml,肝素抗凝,测定高敏C反应蛋白(Hs-CRP)、尿酸(UA)、脂蛋白-α(LP-α)、载脂蛋白A-1(APOA-1)、载脂蛋白B(APOB)、极低密度值蛋白胆固醇(VLDL-C)、总胆固醇(TC)、甘油三脂(TG)和高密度脂蛋白胆固醇(HDL-C),然后分别计算出非高密度脂蛋白胆固醇(non-HDL-C)、non-HDL-C/HDL-C。所有对象均采用经桡/股动脉行左右冠状动脉造影,左冠脉和右冠脉的主要分支依其主支进行统计。根据冠脉造影结果,按国际通用的冠状动脉直径法分为2组,冠状动脉造影至少一支冠脉血管管腔直径狭窄≥50%者确定为冠心病,即冠心病组(128例),冠脉造影各支冠脉管腔直径狭窄50%者为非冠心病患者,即对照组(139例)。依据冠脉病变支数将冠心病组分为单支、双支和多支病变组,单支病变组:左冠脉、右冠脉任意一支狭窄程度≥50%。双支病变组:左冠脉、右冠脉任意二支或左主干狭窄程度≥50%。多支病变组:左冠脉、右冠脉均有病变或左主干合并右冠脉病变。根据Gensini评分冠心病组分为轻度、中度和重度病变组,轻度病变组(1分≤Gensini评分23分);中度病变组(23分≤Gensini评分66分);重度病变组(Gensini评分≥66分)。入选患者均采集临床资料并测定TC、TG、LDL-C、HDL-C等生化指标,计算non-HDL-C/HDL-C,评价non-HDL-C/HDL-C与冠脉病变的相关性。采用SPSS20.0统计软件进行统计学分析,P0.05有统计学意义。结果1.两组患者血脂指标比较:2组患者TC、TG、LDL-C、VLDL-C、APOA1、LP-α无显著性差异(P0.05);HDL-C、APOB、Hs-CRP、UA、LDL-C/HDL-C、non-HDL-C、non-HDL-C/HDL-C、Gensini评分有显著性差异(P0.05)。2.各亚组non-HDL-C/HDL-C比值比较:亚组分析显示,non-HDL-C/HDL-C比值随着病变支数的增加而升高(P0.01)。3.non-HDL-C/HDL-C在不同冠脉病变组差异有显著性(P0.05)。4.non-HDL-C/HDL-C比值与Gensini评分的相关性分析:Spearman相关分析表明,冠心病组non-HDL-C/HDL-C比值与Gensini评分呈正相关(r=0.403,P0.01)。5.多元线性回归分析:以Gensini评分为应变量,以年龄、TC、apo B、Hs-CRP、GLU、UA、non-HDL-C/HDL-C比值为自变量,进行多元线性回归分析显示,冠心病患者non-HDL-C/HDL-C比值与Gensini评分密切相关(P0.01)。结论non-HDL-C/HDL-C与冠脉病变程度密切相关,是影响冠心病的最显著的危险因素。
[Abstract]:Objective to analyze the level of blood lipids in patients with coronary heart disease (CHD) and to investigate the relationship between non-HDL-C / HDL-C ratio and the severity of coronary artery disease.Methods A total of 267 patients (male 141, female 126, mean 62.97 卤9.66 years old) were enrolled in Department of Cardiovascular Medicine, Shengli Hospital, Shengli Petroleum Administration Bureau.Gender, age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), smoking history, oral drugs such as aspirin, 尾 -receptor blockers, nitrates and statins were recorded in each patient.Patients were enrolled in the morning after admission fasting blood collection of 5 ml, heparin anticoagulant,The C-reactive protein Hs-CRPU, UAA, LP- 伪, apolipoprotein A-1n APOA-1, apolipoprotein BUAPOB1, very low density protein cholesterol (VLDL-CU), total cholesterol TCU, triglyceride triglyceride (TGG) and high density lipoprotein cholesterol (HDL-CU) were measured, and the non-HDL-C non-HDL-CHDL-CHDL-C were calculated respectively.All subjects underwent left and right coronary angiography via radial / femoral artery, and the main branches of left and right coronary arteries were counted according to their main branches.According to the results of coronary angiography, the coronary artery diameter was divided into two groups according to the international common coronary artery diameter method. Coronary artery disease was determined as coronary artery disease with at least one coronary artery diameter stenosis 鈮，

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