探討脂蛋白a等危險(xiǎn)因素與冠脈病變的相關(guān)性
發(fā)布時(shí)間：2019-06-12 12:05
【摘要】：目的:分析冠心病人群中各項(xiàng)血脂水平與冠狀動(dòng)脈病變程度的相關(guān)性,討論其對(duì)冠狀動(dòng)脈病變的評(píng)估價(jià)值。方法:采用回顧性病例分析,選取中國(guó)武裝警察部隊(duì)后勤學(xué)院附屬醫(yī)院心臟醫(yī)院2013年11月至2014年11月以冠狀動(dòng)脈粥樣硬化性心臟病(coronary heart disease,CHD)或可疑冠心病入院的患者1437例,依據(jù)冠狀動(dòng)脈造影檢查(coronary angiography,CAG)結(jié)果將入選受試者分為冠心病組(990例)和對(duì)照組(447例),采集入選患者相關(guān)臨床資料和血清血脂水平,算出非高密度脂蛋白膽固醇水平及血脂比值指標(biāo)。冠脈病變的程度分別用冠脈受累的血管支數(shù)及冠脈Gensini評(píng)分表示。分析對(duì)照組與冠心病組的基本臨床資料,包括性別、年齡、吸煙人群的比例、糖尿病人群的比例、高血壓人群的比例有無(wú)差異。分析對(duì)照組與冠心病組血清血脂及血脂比值水平,包括總膽固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白膽固醇(low density lipoprotein cholesterol,LDL-c)、高密度脂蛋白膽固醇(high density lipoprotein cholesterol,HDL-c)、非高密度脂蛋白膽固醇(non high density lipoprotein cholesterol,Non-HDL-c)、總膽固醇/高密度脂蛋白膽固醇(TC/HDL-c)、甘油三酯/高密度脂蛋白膽固醇(TG/HDL-c)、低密度脂蛋白膽固醇/高密度脂蛋白膽固醇(LDL-c/HDL-c)有無(wú)差異。在1437例患者中有417例患者的血脂測(cè)定含載脂蛋白A1(apolipoprotein A1,Apo A1)、載脂蛋白B(apolipoprotein B,Apo B)和脂蛋白a(lipoprotein(a),Lp(a)),同樣分為冠心病組(287例)和對(duì)照組(130例),分析冠心病組及對(duì)照組中Apo A1、Apo B、Apo B/Apo A1、Lp(a)水平有無(wú)差異。另外分析冠心病組不同冠脈病變支數(shù)及不同Gensini積分組間血脂水平、血脂比值有無(wú)差異。分析相關(guān)危險(xiǎn)因素、血清血脂及血脂比值與冠脈病變的關(guān)系。多元logistics回歸分析冠心病的危險(xiǎn)因素。用ROC曲線評(píng)價(jià)脂蛋白a在冠心病診斷中的意義。對(duì)脂蛋白a與其他脂類關(guān)系進(jìn)行分析。低密度脂蛋白膽固醇水平不同分層時(shí)血脂因素與冠脈病變的關(guān)系。隨著Lp(a)水平的升高,分析冠脈病變有何變化。結(jié)果:冠心病組與對(duì)照組基本臨床資料比較,其年齡、男性所占比例、吸煙人群所占比例、高血壓人群所占比例、糖尿病人群所占比例均明顯升高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。冠心病組與對(duì)照組血清血脂及血脂比值水平的比較,差異均有統(tǒng)計(jì)學(xué)意義,冠心病組血清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)水平顯著高于對(duì)照組(P0.05),冠心病組血清HDL-c、Apo A1水平顯著低于對(duì)照組(P0.05)。冠心病組不同冠脈病變支數(shù)組間血脂水平及血脂比值的比較,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)水平隨冠脈病變支數(shù)的增加而逐漸升高,Apo A1水平隨冠脈病變支數(shù)的增加而逐漸降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。血清HDL-c水平在組間比較無(wú)顯著差異。冠心病組不同Gensini積分組間血脂水平及血脂比值的比較,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)水平隨Gensini積分增加而逐漸升高,Apo A1的水平隨Gensini積分的增加而逐步降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。血清HDL-c水平在組間比較無(wú)顯著差異。多元線性回歸分析顯示性別、年齡、高血壓、脂蛋白a與冠脈病變支數(shù)及冠脈Gensini積分有相關(guān)性。多元logistic回歸分析提示,男性、年齡增加、高血壓、吸煙、脂蛋白a是冠心病的獨(dú)立危險(xiǎn)因素(P0.05),提示為冠心病的致病因素。脂蛋白a與血脂指標(biāo)的相關(guān)性分析發(fā)現(xiàn)除HDL-c外,脂蛋白a與TC、TG、LDL-c、Apo A1、Apo B均存在相關(guān)性,其中與Apo A1存在負(fù)相關(guān),其余為正相關(guān),其中與Apo B的相關(guān)性最強(qiáng)。脂蛋白a的ROC曲線下面積是0.594,提示對(duì)冠心病有預(yù)測(cè)意義。當(dāng)LDL-C2.6mmol/L,脂蛋白a與冠狀動(dòng)脈Gensini評(píng)分呈正相關(guān);當(dāng)LDL-c≥2.6mmol/L時(shí),LDL-c、non-HDL-c、LDL-c/HDL-c、Apo B、Apo B/Apo A1、Lp(a)均為冠脈gensini積分的獨(dú)立相關(guān)因素,LDL-c、non-HDL-c、LDL-c/HDL-c、TC/HDL-c、Apo B/Apo A1、Lp(a)均為冠心病的獨(dú)立相關(guān)危險(xiǎn)因素,LDL-c的相關(guān)性最強(qiáng),HDL-c為冠心病的保護(hù)因素。隨著脂蛋白a數(shù)值逐步升高,冠脈病變支數(shù)及gensini積分呈上升的趨勢(shì)。結(jié)論:1、性別、年齡、高血壓、糖尿病、吸煙與冠心病患病存在一定的關(guān)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)水平在冠心病組明顯高于對(duì)照組,有統(tǒng)計(jì)學(xué)意義,提示各項(xiàng)血脂指標(biāo)的檢測(cè),可能為致動(dòng)脈粥樣硬化的血脂指標(biāo)。在冠心病組血清HDL-c及Apo A1水平明顯低于對(duì)照組,這表明它可能是一種抗動(dòng)脈粥樣硬化指數(shù)。3、冠心病組血清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)水平隨冠脈病變支數(shù)增加而逐漸升高,隨Gensini積分的升高而逐漸升高,差異均有統(tǒng)計(jì)學(xué)意義。4、在血脂因素中僅脂蛋白a與冠脈病變存在相關(guān)性,在冠心病中具有重要意義。5、低密度脂蛋白膽固醇進(jìn)行分層分析,當(dāng)LDL-c水平處于理想水平時(shí)僅LP(a)為冠脈病變程度的相關(guān)因素,當(dāng)LDL-c高于理想水平時(shí),LDL-c、non-HDL-c、LDL-c/HDL-c、TC/HDL-c、Apo B/Apo A1、Lp(a)均為冠心病的獨(dú)立相關(guān)危險(xiǎn)因素,提示冠脈病變是多種因素作用的結(jié)果,無(wú)論有無(wú)血脂升高脂蛋白a始終為致冠脈疾病危險(xiǎn)因素。隨著低密度脂蛋白膽固醇水平的升高多種危險(xiǎn)因素暴露出來(lái),故控制血脂應(yīng)為預(yù)防及治療冠脈疾病必然措施。6、脂蛋白a數(shù)值逐漸升高可加重冠狀動(dòng)脈的損害。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
本文編號(hào)：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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
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