非高密度脂蛋白胆固醇水平与冠心病患者冠状动脉病变Gensini 评分的相关性研究

摘要

目的：探讨非高密度脂蛋白胆固醇水平(non-HDL-C)与冠心病(CHD)患者冠状动脉病变 Gensini 评分的关系及临床意义。方法对225例疑诊或既往临床诊断 CHD 患者予以冠状动脉造影(CAG),将造影阴性的39例作为对照组(HC 组),造影阳性的186例患者诊断为 CHD,结合临床特点分为心绞痛组(AP 组)122例和心肌梗死组(AMI 组)64例。采用 Gensini 评分对冠状动脉病变程度评分,测定患者全套血脂水平,探讨 non-HDL-C 及相关脂质成分与冠状动脉病变程度 Gensini 评分的相关性；同时对他汀类药物强化降脂达标,低密度脂蛋白胆固醇(LDL-C)<1．80 mmol/ L 的 AP 组患者进行 non-HDL-C 与冠状动脉病变程度 Gensini评分的亚组分析。结果 AMI 组 non-HDL-C 水平高于 AP 组及 HC 组,AP 组 non-HDL-C 水平高于 HC 组,差异均有统计学意义(P <0．05)；CHD 患者 non-HDL-C 水平与 Gensini 评分呈正相关(r =0．562,P <0．05)；LDL-C 控制达标的 AP 组患者,高 non-HDL-C 组(≥2．60 mmol/ L)比低 non-HDL-C 组(<2．60 mmol/ L)Gensini 评分明显升高,差异均有统计学意义(P <0．05)。结论 non-HDL-C 与冠状动脉病变程度密切相关,non-HDL-C 在评估 LDL-C 控制达标患者的冠状动脉病变程度及再发心血管事件风险上有一定价值,可作为 LDL-C 达标后心血管残余风险新的观察指标。%Objective o investigate the correlation between non-high-density lipoprotein cholesterol(non-HDL-C)level and Gensini score of coronary artery lesions in the patients with coronary heart disease(CHD)and its clinical significance. Methods 225 cases of suspec-ted or ever diagnosed CHD patients were examined by the coronary angiography( CAG),with 39 CAG-negative cases as controls( the HC group). 186 casesof CAG-positive patients were diagnosed as CHD,which were further divided into two groupsaccording to the clinical fea-tures:the angina pectoris group(the AP group,122 cases)and the myocardial infarction group(theAMI group,64 cases). Based on evaluation of severity of coronary artery lesions with Gensini scoresand detection of full blood lipid levels,the correlation between non-HDL-C levels and related lipid components and Gensini scores ofseverity of coronary artery lesions were analyzed. Furthermore,the subgroup relation analysis be-tween non-HDL-C levels and Gensini scores of coronary artery lesions inlow-density lipoprotein cholesterol(LDL-C)controlledpatients of the AP group(LDL-C < 1. 8mmol/ L),by intensive lipid-lowering treatmentwith statins,were conducted. Results The levels of non-HDL-C in theAMI group were higher than those in the other two groups,andthe levels of non-HDL-C in theAP group were higher than those in the HC group,both with significant differences(P < 0. 05). The non-HDL-C levels of CHD patients were positively correlated with theGensini scores(r= 0. 562,P < 0. 05). InLDL-C controlled patients of the AP group,patients with high non-HDL-C levels(≥2. 6 mmol/ L) hadsignificantly higher Gensini scores than those with low non-HDL-C levels( < 2. 6 mmol/ L)(P < 0. 05). Conclusion The non-HDL-C levelis closely asso-ciated with the severity of coronary artery lesionsand may be valuable on the assessment of severity of coronary artery lesions and recurrent risk of cardiovascular events in the patients,being available as a new indicator of cardiovascular residual risk under controlled LDL-C levels.