Objective To investigate the relation between high density lipoprotein cholesterol (HDL-C)and coronary atherosclerotic heart disease(CHD) with multi-vessel lesions.Methods A total of 943 patients with uncertain diagnosis of CHD admitted to Beijing Anzhen Hospital,Capital Medical University from January to June 2018 were included;846 patients were diagnosed of CHD by coronary angiography (CHD group);97 patients without CHD were control group.There were 371 cases of single coronary disease,273 cases of double-vessel disease and 202 cases of triple-vessel disease.Baseline data,laboratory indices and Gensini score were compared among control group and CHD patients with different numbers of lesions.Related factors of CHD and multi-vessel lesions were analyzed.Results Ratios of male,smoking history,diabetes history,levels of white blood cell count,serum creatinine,C-reactive protein,B-type brain natriuretic peptide and Gensini score in CHD group were higher than those in control group;the level of HDL-C in CHD group was lower than that in control group [(1.05 ± 0.29) mmol/L vs (1.16 ± 0.27) mmol/L] and the differences were statistically significant (all P ＜ 0.05).Logistic regression showed that Gensini score and diabetes history were risk factors and HDL-C was a protective factor of CHD (odds ratio =0.276,95％ confidence interval:0.102-0.749,P =0.012).In double-vessel and triple-vessel disease groups,age and Gensini score were higher than those in single-vessel disease group;HDL-C level was lower than that in single-vessel disease group [(1.03 ± 0.25),(1.02 ± 0.35) mmol/L vs (1.07 ± 0.27) mmol/L] (all P ＜ 0.05).In triple-vessel disease group,systolic blood pressure and serum B-type brain natriuretic peptide level were higher than those in single-vessel disease group;Gensini score was higher than that in double-vessel disease group;ratios of diabetes history and hypertension history and serum creatinine level were higher than those in single vessel and double-vessel disease groups(all P ＜ 0.05).Logistic regression showed that age,male,Gensini score,diabetes history and hypertension history were risk factors of multi-vessel lesions;HDL-C was a protective factor of multi-vessel lesions(odds ratio =0.299,95％ confidence interval:0.118-0.754,P =0.011).Conclusions Increased HDL-C level suggests low risk of CHD and multi-vessel coronary artery disease.Low HDL-C level is an independent risk factor of CHD and multi-vessel lesions.%目的 探讨高密度脂蛋白胆固醇(HDL-C)对冠状动脉粥样硬化性心脏病(冠心病)及冠状动脉多支病变发病的影响.方法 选取2018年1-6月首都医科大学附属北京安贞医院收治的疑似冠心病患者共943例,其中经冠状动脉造影明确冠心病诊断846例(冠心病组),除外冠心病诊断97例(对照组),冠心病组包括单支病变371例、双支病变273例、三支病变202例.比较冠心病组与对照组以及冠心病不同病变支数患者基线资料、各实验室检测指标和Gensini积分的差异,分析冠心病以及冠状动脉多支病变的相关因素.结果 冠心病组男性比例、吸烟史、糖尿病史和白细胞计数、血肌酐、C反应蛋白、B型脑钠肽水平以及Gensini积分均高于对照组,HDL-C水平低于对照组[(1.05±0.29) mmol/L比(1.16±0.27) mmol/L],差异均有统计学意义(均P＜0.05).Logistic回归分析结果显示,Gensini积分和糖尿病史为冠心病发病的危险因素,HDL-C为冠心病发病的保护因素(比值比=0.276,95％置信区间:0.102 ～0.749,P=0.012).双支病变组和三支病变组年龄和Gensini积分均高于单支病变组,HDL-C均低于单支病变组[(1.03±0.25)、(1.02±0.35) mmol/L比(1.07 ±0.27) mmol/L];三支病变组收缩压和B型脑钠肽高于单支病变组,Gensini积分高于双支病变组,糖尿病史、高血压史和血肌酐水平均高于单支、双支病变组,差异均有统计学意义(均P＜0.05).Logistic回归分析结果显示,年龄、男性、Gensini积分、糖尿病史、高血压史为冠心病患者多支病变的危险因素,HDL-C为冠心病患者多支病变的保护因素(比值比=0.299,95％置信区间:0.118 ～0.754,P=0.011).结论 随着HDL-C的增高,发生冠心病及冠状动脉多支病变的风险降低,低HDL-C是冠心病、冠状动脉多支病变的独立危险因素.
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