低密度脂蛋白胆固醇达标的冠心病患者餐后残粒脂蛋白-胆固醇水平及与冠脉病变严重程度相关性的研究

摘要

Objective To investigate postprandial remnant-like particle cholesterol (RLP-C) level in coronary heart disease (CHD) patients with normal low density lipoprotein cholesterol (LDL-C), and the relationship between RLP-C and the severity of coronary artery lesion.Methods 42 CHD patients with normal LDL-C in Nanjing Chest Hospital were recruited from March 2015 to September 2015 and divided into CHD group and control group according to coronary angiography. The levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured 4 hours fasting and after breakfast. RLP-C level was calculated by the equation (RLP-C=TC-HDL-C-LDL-C). The Gensini score of coronary artery disease was calculated and the relationship with RLP-C was analyzed.Results There was no significant difference in TG, TC, LDL-C and RLP-C between the two groups (P>0.05). HDL-C in the control group was higher than that in the CHD group, the difference was statistically significant (P<0.05). There was no significant difference in TG, TC and LDL-C between the two groups at 4 hours postprandial (P>0.05). The level of RLP-C in CHD group was higher than that in control group, and HDL-C in control group was higher than that in CHD group (P<0.05). The increase of RLP-C in CHD group was significantly higher than that in control group, and the increase of HDL-C in control group was higher than that in CHD group (P<0.05). The postprandial increase of RLP-C was moderately correlated with the Gensini score (r=0.450,P<0.05).Conclusion RLP-C was a better index for the lipid level and the lipid-associated cardiovascular risk to CHD patients.%目的 观察低密度脂蛋白胆固醇(LDL-C)达标的冠状动脉粥样硬化性心脏病(冠心病)患者餐后残粒脂蛋白-胆固醇(RLP-C)水平,并探讨其与冠状动脉病变严重程度的关系.方法 连续入选2015年3月~2015年9月南京市胸科医院心内科收治的临床诊断为冠心病且低密度脂蛋白(LDL)达标的住院患者42例.按冠状动脉造影结果 分为冠心病组及对照组,入院第2 d检查空腹及早餐后4 h的血脂水平:总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、LDL-C,使用公式法(RLP-C=TC-HDL-C-LDL-C)计算得到RLP-C浓度,比较组间差异,并计算冠心病组冠状动脉病变Gensini评分,分析其与RLP-C的关系.结果 两组空腹情况下TG、TC、LDL-C、RLP-C比较差异无统计学意义(P均>0.05);对照组HDL-C高于冠心病组,差异具有统计学意义(P<0.05).两组餐后4 h情况下TG、TC、LDL-C比较差异无统计学意义(P均>0.05);冠心病组RLP-C高于对照组,对照组HDL-C仍高于冠心病组,差异均具有统计学意义(P<0.05).冠心病组RLP-C增幅明显高于对照组,对照组HDL-C增幅高于冠心病组,差异均具有统计学意义(P<0.05).分析空腹、餐后4 h各个血脂指标以及血脂指标增幅和Gensini评分之间的相关性,RLP-C的餐后增幅与Gensini评分具有中度相关性(r=0.450,P<0.05).结论 餐后RLP-C能够更好反应冠心病患者血脂水平及血脂相关性心血管剩留风险.