探讨脂蛋白a等危险因素与冠脉病变的相关性
发布时间：2019-06-12 12:05
【摘要】：目的:分析冠心病人群中各项血脂水平与冠状动脉病变程度的相关性,讨论其对冠状动脉病变的评估价值。方法:采用回顾性病例分析,选取中国武装警察部队后勤学院附属医院心脏医院2013年11月至2014年11月以冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)或可疑冠心病入院的患者1437例,依据冠状动脉造影检查(coronary angiography,CAG)结果将入选受试者分为冠心病组(990例)和对照组(447例),采集入选患者相关临床资料和血清血脂水平,算出非高密度脂蛋白胆固醇水平及血脂比值指标。冠脉病变的程度分别用冠脉受累的血管支数及冠脉Gensini评分表示。分析对照组与冠心病组的基本临床资料,包括性别、年龄、吸烟人群的比例、糖尿病人群的比例、高血压人群的比例有无差异。分析对照组与冠心病组血清血脂及血脂比值水平,包括总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-c)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-c)、非高密度脂蛋白胆固醇(non high density lipoprotein cholesterol,Non-HDL-c)、总胆固醇/高密度脂蛋白胆固醇(TC/HDL-c)、甘油三酯/高密度脂蛋白胆固醇(TG/HDL-c)、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇(LDL-c/HDL-c)有无差异。在1437例患者中有417例患者的血脂测定含载脂蛋白A1(apolipoprotein A1,Apo A1)、载脂蛋白B(apolipoprotein B,Apo B)和脂蛋白a(lipoprotein(a),Lp(a)),同样分为冠心病组(287例)和对照组(130例),分析冠心病组及对照组中Apo A1、Apo B、Apo B/Apo A1、Lp(a)水平有无差异。另外分析冠心病组不同冠脉病变支数及不同Gensini积分组间血脂水平、血脂比值有无差异。分析相关危险因素、血清血脂及血脂比值与冠脉病变的关系。多元logistics回归分析冠心病的危险因素。用ROC曲线评价脂蛋白a在冠心病诊断中的意义。对脂蛋白a与其他脂类关系进行分析。低密度脂蛋白胆固醇水平不同分层时血脂因素与冠脉病变的关系。随着Lp(a)水平的升高,分析冠脉病变有何变化。结果:冠心病组与对照组基本临床资料比较,其年龄、男性所占比例、吸烟人群所占比例、高血压人群所占比例、糖尿病人群所占比例均明显升高,差异均有统计学意义(P0.05)。冠心病组与对照组血清血脂及血脂比值水平的比较,差异均有统计学意义,冠心病组血清TC、TG、LDL-c、Non-HDL-c、TC/HDL-c、TG/HDL-c、LDL-c/HDL-c、Apo B、Apo B/Apo A1、Lp(a)水平显著高于对照组(P0.05),冠心病组血清HDL-c、Apo A1水平显著低于对照组(P0.05)。冠心病组不同冠脉病变支数组间血脂水平及血脂比值的比较,血清TC、TG、LDL-c、Non-HDL-c、TC/HDL-c、TG/HDL-c、LDL-c/HDL-c、Apo B、Apo B/Apo A1、Lp(a)水平随冠脉病变支数的增加而逐渐升高,Apo A1水平随冠脉病变支数的增加而逐渐降低,差异均有统计学意义(P0.05)。血清HDL-c水平在组间比较无显著差异。冠心病组不同Gensini积分组间血脂水平及血脂比值的比较,血清TC、TG、LDL-c、Non-HDL-c、TC/HDL-c、TG/HDL-c、LDL-c/HDL-c、Apo B、Apo B/Apo A1、Lp(a)水平随Gensini积分增加而逐渐升高,Apo A1的水平随Gensini积分的增加而逐步降低,差异均有统计学意义(P0.05)。血清HDL-c水平在组间比较无显著差异。多元线性回归分析显示性别、年龄、高血压、脂蛋白a与冠脉病变支数及冠脉Gensini积分有相关性。多元logistic回归分析提示,男性、年龄增加、高血压、吸烟、脂蛋白a是冠心病的独立危险因素(P0.05),提示为冠心病的致病因素。脂蛋白a与血脂指标的相关性分析发现除HDL-c外,脂蛋白a与TC、TG、LDL-c、Apo A1、Apo B均存在相关性,其中与Apo A1存在负相关,其余为正相关,其中与Apo B的相关性最强。脂蛋白a的ROC曲线下面积是0.594,提示对冠心病有预测意义。当LDL-C2.6mmol/L,脂蛋白a与冠状动脉Gensini评分呈正相关;当LDL-c≥2.6mmol/L时,LDL-c、non-HDL-c、LDL-c/HDL-c、Apo B、Apo B/Apo A1、Lp(a)均为冠脉gensini积分的独立相关因素,LDL-c、non-HDL-c、LDL-c/HDL-c、TC/HDL-c、Apo B/Apo A1、Lp(a)均为冠心病的独立相关危险因素,LDL-c的相关性最强,HDL-c为冠心病的保护因素。随着脂蛋白a数值逐步升高,冠脉病变支数及gensini积分呈上升的趋势。结论:1、性别、年龄、高血压、糖尿病、吸烟与冠心病患病存在一定的关系。2、血清TC、TG、LDL-c、Non-HDL-c、TC/HDL-c、TG/HDL-c、LDL-c/HDL-c、Apo B、Apo B/Apo A1、LP(a)水平在冠心病组明显高于对照组,有统计学意义,提示各项血脂指标的检测,可能为致动脉粥样硬化的血脂指标。在冠心病组血清HDL-c及Apo A1水平明显低于对照组,这表明它可能是一种抗动脉粥样硬化指数。3、冠心病组血清TC、TG、LDL-c、Non-HDL-c、TC/HDL-c、LDL-c/HDL-c、TG/HDL-c、Apo B、Apo B/Apo A1、LP(a)水平随冠脉病变支数增加而逐渐升高,随Gensini积分的升高而逐渐升高,差异均有统计学意义。4、在血脂因素中仅脂蛋白a与冠脉病变存在相关性,在冠心病中具有重要意义。5、低密度脂蛋白胆固醇进行分层分析,当LDL-c水平处于理想水平时仅LP(a)为冠脉病变程度的相关因素,当LDL-c高于理想水平时,LDL-c、non-HDL-c、LDL-c/HDL-c、TC/HDL-c、Apo B/Apo A1、Lp(a)均为冠心病的独立相关危险因素,提示冠脉病变是多种因素作用的结果,无论有无血脂升高脂蛋白a始终为致冠脉疾病危险因素。随着低密度脂蛋白胆固醇水平的升高多种危险因素暴露出来,故控制血脂应为预防及治疗冠脉疾病必然措施。6、脂蛋白a数值逐渐升高可加重冠状动脉的损害。
[Abstract]:Objective: To study the correlation between the level of blood lipid and the degree of coronary artery disease in the coronary heart disease (CHD) population, and to discuss its evaluation value for coronary artery disease. Methods: A retrospective case study was used to select 1437 patients with coronary atherosclerotic heart disease (CHD) or suspected coronary heart disease (CHD) from November 2013 to November 2014. According to the results of coronary angiography (CAG), the subjects were divided into coronary heart disease group (990 cases) and control group (447 cases), and the relevant clinical data and serum lipid level of the patients were collected, and the non-high-density lipoprotein cholesterol level and the blood lipid ratio index were calculated. The degree of coronary artery disease was expressed by the number of vessels involved in the coronary artery and the Gensini score of the coronary artery, respectively. The basic clinical data of the control group and the coronary heart disease group were analyzed, including the proportion of the sex, the age, the smoking population, the proportion of the diabetic population and the proportion of the hypertension group. The levels of serum lipid and blood lipid in the control group and the coronary heart disease group were analyzed, including total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c) and high density lipoprotein cholesterol (HDL-c). The non-high density lipoprotein cholesterol (Non-HDL-c), total cholesterol/ high-density lipoprotein cholesterol (TC/ HDL-c), triglyceride/ high-density lipoprotein cholesterol (TG/ HDL-c), low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol (LDL-c/ HDL-c) are different. Among the 1437 patients, the blood lipids of 417 patients were determined to include Apolipoprotein A1 (Apo A1), Apolipoprotein B (Apo B) and lipoprotein (a), Lp (a)), and were also divided into coronary heart disease group (287 cases) and control group (130 cases), and then Apo A1, Apo B, Apo B/ Apo A1 in coronary heart disease group and control group were analyzed. There is no difference in the level of Lp (a). In addition, that blood lipid level and the blood lipid ratio of different coronary artery lesion in the coronary heart disease group and the different Gensini integral group were analyzed. The relationship between the relative risk factors, the serum lipid and the blood lipid ratio and the coronary artery disease was analyzed. Multivariate logistic regression analysis of the risk factors of coronary heart disease. The significance of lipoprotein a in the diagnosis of coronary heart disease was assessed by ROC curve. The relationship between lipoprotein a and other lipids is analyzed. The relationship between dyslipidemia and coronary artery disease in different levels of low-density lipoprotein cholesterol. With the increase of Lp (a), the changes of coronary artery disease were analyzed. Results: Compared with the basic clinical data of the control group, the proportion of the age, the proportion of the male, the proportion of the smoking population, the proportion of the hypertension group and the proportion of the diabetic population increased significantly (P0.05). The levels of serum lipid and blood lipid in the coronary heart disease group and the control group were statistically significant, and the levels of TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1 and Lp (a) in the coronary heart disease group were significantly higher than that in the control group (P0.05), and the serum HDL-c in the coronary heart disease group. The level of Apo A1 was significantly lower than that in the control group (P0.05). Serum TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1 and Lp (a) were gradually increased with the increase of the number of coronary artery lesions, and the level of Apo A1 gradually decreased with the increase of the number of coronary artery lesions. The difference was significant (P0.05). Serum HDL-c levels were not significantly different between groups. The serum TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1, Lp (a) levels were gradually increased with the increase of the Gensini integral, and the level of Apo A1 was gradually decreased with the increase of the Gensini integral. The difference was significant (P0.05). Serum HDL-c levels were not significantly different between groups. Multiple linear regression analysis showed that sex, age, hypertension, lipoprotein a and coronary artery lesion count and coronary heart disease were related. Multivariate logistic regression analysis indicated that male, age, hypertension, smoking, lipoprotein a were the independent risk factors of coronary heart disease (P0.05). The correlation between lipoprotein a and blood lipid index showed that, in addition to HDL-c, lipoprotein a had a correlation with TC, TG, LDL-c, Apo A1 and Apo B, among which there was a negative correlation with Apo A1, and the balance was positive correlation, among which the correlation with Apo B was the strongest. The area of the ROC curve of the lipoprotein a was 0.594, suggesting a predictive value for coronary heart disease. When LDL-c is 2.6 mmol/ L, LDL-c, non-HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1, and Lp (a) are independent related factors of coronary ensini integration, and LDL-c, non-HDL-c, LDL-c/ HDL-c, TC/ HDL-c, Apo B/ Apo A1 and Lp (a) are independent risk factors of coronary heart disease, The correlation of LDL-c is the strongest, and HDL-c is the protective factor of coronary heart disease. With the increase of the value of lipoprotein a, the number of coronary artery lesions and the increase of the Gensini score. Conclusion:1. The relationship between serum TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1 and LP (a) in the coronary heart disease group was significantly higher than that in the control group. It is suggested that the detection of blood lipid index may be a blood lipid index for atherosclerosis. The levels of serum HDL-c and Apo A1 in the coronary heart disease group were significantly lower than that in the control group, which indicated that it could be an anti-atherosclerosis index.3. The levels of TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, LDL-c/ HDL-c, TG/ HDL-c, Apo B, Apo B/ Apo A1 and LP (a) in the coronary heart disease group were gradually increased with the increase of the number of coronary artery lesions. With the increase of Gensini's integral, the difference was significant.4. In the blood-lipid factor, only the lipoprotein a was associated with the coronary artery disease, and it was of great significance in the coronary heart disease. When LDL-c level is at the ideal level, only LP (a) is the relevant factor of the degree of coronary artery disease. When LDL-c is higher than the ideal level, LDL-c, non-HDL-c, LDL-c/ HDL-c, TC/ HDL-c, Apo B/ Apo A1 and Lp (a) are independent risk factors of coronary heart disease, and it is suggested that coronary artery disease is a result of various factors. The risk of coronary artery disease is always a risk factor for coronary artery disease, regardless of the presence or absence of lipid-elevated lipoprotein a. As the level of low-density lipoprotein cholesterol increases, the risk factors are exposed, so the control of blood fat should be a necessary measure to prevent and treat coronary artery disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：2498008
[Abstract]:Objective: To study the correlation between the level of blood lipid and the degree of coronary artery disease in the coronary heart disease (CHD) population, and to discuss its evaluation value for coronary artery disease. Methods: A retrospective case study was used to select 1437 patients with coronary atherosclerotic heart disease (CHD) or suspected coronary heart disease (CHD) from November 2013 to November 2014. According to the results of coronary angiography (CAG), the subjects were divided into coronary heart disease group (990 cases) and control group (447 cases), and the relevant clinical data and serum lipid level of the patients were collected, and the non-high-density lipoprotein cholesterol level and the blood lipid ratio index were calculated. The degree of coronary artery disease was expressed by the number of vessels involved in the coronary artery and the Gensini score of the coronary artery, respectively. The basic clinical data of the control group and the coronary heart disease group were analyzed, including the proportion of the sex, the age, the smoking population, the proportion of the diabetic population and the proportion of the hypertension group. The levels of serum lipid and blood lipid in the control group and the coronary heart disease group were analyzed, including total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-c) and high density lipoprotein cholesterol (HDL-c). The non-high density lipoprotein cholesterol (Non-HDL-c), total cholesterol/ high-density lipoprotein cholesterol (TC/ HDL-c), triglyceride/ high-density lipoprotein cholesterol (TG/ HDL-c), low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol (LDL-c/ HDL-c) are different. Among the 1437 patients, the blood lipids of 417 patients were determined to include Apolipoprotein A1 (Apo A1), Apolipoprotein B (Apo B) and lipoprotein (a), Lp (a)), and were also divided into coronary heart disease group (287 cases) and control group (130 cases), and then Apo A1, Apo B, Apo B/ Apo A1 in coronary heart disease group and control group were analyzed. There is no difference in the level of Lp (a). In addition, that blood lipid level and the blood lipid ratio of different coronary artery lesion in the coronary heart disease group and the different Gensini integral group were analyzed. The relationship between the relative risk factors, the serum lipid and the blood lipid ratio and the coronary artery disease was analyzed. Multivariate logistic regression analysis of the risk factors of coronary heart disease. The significance of lipoprotein a in the diagnosis of coronary heart disease was assessed by ROC curve. The relationship between lipoprotein a and other lipids is analyzed. The relationship between dyslipidemia and coronary artery disease in different levels of low-density lipoprotein cholesterol. With the increase of Lp (a), the changes of coronary artery disease were analyzed. Results: Compared with the basic clinical data of the control group, the proportion of the age, the proportion of the male, the proportion of the smoking population, the proportion of the hypertension group and the proportion of the diabetic population increased significantly (P0.05). The levels of serum lipid and blood lipid in the coronary heart disease group and the control group were statistically significant, and the levels of TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1 and Lp (a) in the coronary heart disease group were significantly higher than that in the control group (P0.05), and the serum HDL-c in the coronary heart disease group. The level of Apo A1 was significantly lower than that in the control group (P0.05). Serum TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1 and Lp (a) were gradually increased with the increase of the number of coronary artery lesions, and the level of Apo A1 gradually decreased with the increase of the number of coronary artery lesions. The difference was significant (P0.05). Serum HDL-c levels were not significantly different between groups. The serum TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1, Lp (a) levels were gradually increased with the increase of the Gensini integral, and the level of Apo A1 was gradually decreased with the increase of the Gensini integral. The difference was significant (P0.05). Serum HDL-c levels were not significantly different between groups. Multiple linear regression analysis showed that sex, age, hypertension, lipoprotein a and coronary artery lesion count and coronary heart disease were related. Multivariate logistic regression analysis indicated that male, age, hypertension, smoking, lipoprotein a were the independent risk factors of coronary heart disease (P0.05). The correlation between lipoprotein a and blood lipid index showed that, in addition to HDL-c, lipoprotein a had a correlation with TC, TG, LDL-c, Apo A1 and Apo B, among which there was a negative correlation with Apo A1, and the balance was positive correlation, among which the correlation with Apo B was the strongest. The area of the ROC curve of the lipoprotein a was 0.594, suggesting a predictive value for coronary heart disease. When LDL-c is 2.6 mmol/ L, LDL-c, non-HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1, and Lp (a) are independent related factors of coronary ensini integration, and LDL-c, non-HDL-c, LDL-c/ HDL-c, TC/ HDL-c, Apo B/ Apo A1 and Lp (a) are independent risk factors of coronary heart disease, The correlation of LDL-c is the strongest, and HDL-c is the protective factor of coronary heart disease. With the increase of the value of lipoprotein a, the number of coronary artery lesions and the increase of the Gensini score. Conclusion:1. The relationship between serum TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, TG/ HDL-c, LDL-c/ HDL-c, Apo B, Apo B/ Apo A1 and LP (a) in the coronary heart disease group was significantly higher than that in the control group. It is suggested that the detection of blood lipid index may be a blood lipid index for atherosclerosis. The levels of serum HDL-c and Apo A1 in the coronary heart disease group were significantly lower than that in the control group, which indicated that it could be an anti-atherosclerosis index.3. The levels of TC, TG, LDL-c, Non-HDL-c, TC/ HDL-c, LDL-c/ HDL-c, TG/ HDL-c, Apo B, Apo B/ Apo A1 and LP (a) in the coronary heart disease group were gradually increased with the increase of the number of coronary artery lesions. With the increase of Gensini's integral, the difference was significant.4. In the blood-lipid factor, only the lipoprotein a was associated with the coronary artery disease, and it was of great significance in the coronary heart disease. When LDL-c level is at the ideal level, only LP (a) is the relevant factor of the degree of coronary artery disease. When LDL-c is higher than the ideal level, LDL-c, non-HDL-c, LDL-c/ HDL-c, TC/ HDL-c, Apo B/ Apo A1 and Lp (a) are independent risk factors of coronary heart disease, and it is suggested that coronary artery disease is a result of various factors. The risk of coronary artery disease is always a risk factor for coronary artery disease, regardless of the presence or absence of lipid-elevated lipoprotein a. As the level of low-density lipoprotein cholesterol increases, the risk factors are exposed, so the control of blood fat should be a necessary measure to prevent and treat coronary artery disease.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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