各血脂指标与高密度脂蛋白胆固醇比值对冠心病的诊断价值

摘要

目的 探讨各血脂指标与高密度脂蛋白胆固醇比值对冠心病诊断价值. 方法 选取急性冠状动脉综合征患者375例为研究组,随机抽取健康人群328例为对照组.抽取空腹静脉血,酶法检测总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白AⅠ(apoA-Ⅰ)和载脂蛋白B(apoB),并计算TGHDL-C、TC/HDL-C、LDL-C/HDL-C和apoBapoA-Ⅰ比值.通过Logistic回归分析和ROC分析各血脂指标与高密度脂蛋白胆固醇比值对冠心病的诊断价值. 结果 与正常健康人群相比,冠心病患者TG水平,TG/HDL-C、TC/HDL-C、LDL-C/HDL-C和apoB/apoA-Ⅰ比值显著升高(P＜0.05),而HDL-C和apoA-Ⅰ水平明显降低(P＜0.05).通过多变量Logistic回归分析发现TG/HDL-C、TC/HDL-C、LDL-C/HDL-C和apoB/apoA-Ⅰ的回归系数分别为0.272,0.256,0.669和1.595,提示血脂比值与冠心病的关系更密切.进一步经ROC分析,TG/HDL-C和TC/HDL-C比值的曲线下面积都为0.690(P ＜0.001),明显大于其他指标曲线下面积.结论 与单项血脂指标相比,血脂比值与冠心病的关系更密切,TG/HDL-C和TC/HDL-C对冠心病的诊断价值最大.%Objective To investigate the clinical value of the ratio between serum lipid and high density lipoprotein cholesterol in diagnosis of coronary heart disease(CHD).Methods Totally 375 patients with acute coronary syndrome were selected as CHD group,and 328 healthy subjects were randomly selected as control group.The fasting venous blood was taken to detect the levels of serum TC,TG,HDL-C,LDL-C,apoA-Ⅰ and apoB,and then the ratio of TG/HDL-C,TC/HDL-C,LDL-C/HDL-C,apoB/apoA-Ⅰ and apoA Ⅰ/HDL-C were calculated.The ratios of lipid indexes and high density lipoprotein cholesterol in the diagnosis of coronary heart disease were analyzed by Logistic regression analysis and ROC analysis.Results TG level,TG/HDL-C,TC/HDL-C,LDL-C/HDL-C and apoB/apoA-Ⅰ were significantly higher in patients with coronary heart disease than those in healthy subjects (P ＜ 0.05),and HDL-C and apoA-Ⅰ were significantly lower (P ＜ 0.05).By multivariate Logistic regression analysis,the regression coefficients of TG/HDL-C,TC/HDL-C,LDL-C/HDL-C and apoB/apoA-Ⅰ were 0.272,0.256,0.669 and 1.595,respectively.The areas under the curve of TG/HDL-C and TC/HDL-C were both 0.690,which was significantly higher than those of other indexes (P ＜ 0.001).Conclusion TG/HDL-C and TC/HDL-C may be more valuable in the diagnosis of coronary heart disease than that of the single lipid index.