摘要
目的:探讨血脂基础水平尤其是LDL-C与冠状动脉狭窄程度相关性,明确动脉粥硬化患者血脂基础水平,为冠心病的降脂治疗提供证据依据。方法:收集2011年1月至2014年12月就诊于首都医科大学附属北京安贞医院,行冠状动脉造影且12周内无他汀等降脂类药物用药史的患者434例,根据造影结果分为病例组(有冠状动脉狭窄,n=285),对照组(无冠状动脉狭窄,n=149)。对比分析两组人口学基本资料、血脂各项基础水平、血压、血糖水平及其与冠状动脉狭窄程度的相关性。结果:与对照组比较,病例组患者年龄较大,男性所占比例及吸烟史患者所占比例较高,糖尿病患者所占比例较高,病例组患者的空腹血糖(GLU)及糖化血红蛋白水平(HAB1AC)均显著高于对照组,病例组患者的TC、LDL-C、non-HDL-C及HCRP水平显著高于对照组,HDL-C显著低于对照组(P<0.05)。两组间,体质量指数(BMI)、心率、高血压患者所占比例及TG水平,差异无统计学意义(P>0.05)。Logistic回归分析,经校正体质量指数(BMI)、心率、TC、HDL-C、TG、non-HDL-C及HAB1AC等因素之后,年龄、吸烟、LDLC、HCRP及GLU是冠状动脉狭窄的相关危险因素(P<0.05)。经相关性分析得出LDL-C、GLU及HAB1AC与冠状动脉狭窄程度呈正相关(P<0.05)。经分层比较,不同LDL-C分层冠状动脉狭窄程度,差异无统计学意义(P>0.05)。结论:研究表明中国冠心病患者血脂基础水平并不是很高,冠心病的危险因素除了血脂水平,还有吸烟史、糖尿病、年龄及炎症因子CRP等。LDL-C虽与冠状动脉狭窄程度呈正相关,但并非LDL-C越低冠状动脉狭窄程度越小。因此,强化降脂治疗可能并不适合中国冠心病人群,具体的降脂治疗方案应根据不同患者的血脂基础水平进行个体化治疗。
Objective： To investigate the correlation of the blood lipid baseline especially LDL-C and coronary artery stenosis degree, thereby determining the baseline lipid levels of patients with coronary atheroscle- rosis and providing evidence for the lipid-lowering therapy of coronary heart disease. Methods： A total of 434 patients with coronary angiography and without statins lipid-lowering drugs for 12 weekswere included in this study. Patients were divided into two groups according to the results of the coronary angiography, the case group （ coronary stenosis, n = 285）, the control group （ without coronary stenosis, n = 149）. Analysis the correlation of the basic data, baseline lipid levels, blood pressure and blood glucose levels with coronary stenosis degree of the two groups. Results： Compared with control group, the age of case group were older, the ratio of male, smoker and diabetes were higher, the fasting blood glucose （GLU）, glycosylated hemoglobin levels （HAB1AC）, TC,LDL-C, non-HDL-C and high-sensitivity c-reactive protein （HCRP） baseline of case groupwere significantly higher than that of control group, while HDL-C was significantly lower than that of control group （P 〈 0. 05）. Between the two groups, body mass index （BMI）, heart rate, blood pressure proportion and TG baseline levels had no significant difference （P 〉 0. 05 ）. Logistic regression analysis, the correction of BMI, heart rate, TG, TC, HDL-C, non-HDL-C, HAB1AC factors, such as age, smoking, LDL-C, HCRP, GLU were independent risk factors for coronary artery stenosis. Withthe correlation analysis, LDL-C, GLU, HAB I AC was positively correlated with the extent of coronary stenosis （P 〈 0. 05 ）. Comparison of layered, dif- ferent levels of LDL-C layered coronary stenosis had no significant difference （ P 〉 0.05 ）. Conclusion： The study showed that the baseline lipid level of patients with coronary heart disease in China is not high. In addition to lipid levels, risk factors for coronary heart disease also included smoking history, diabetes, age, proinflam- matory factor such as CRP, etc. LDLD-C is positively correlated with the extent of coronary stenosis, but not the lower LDL-C the less extent of coronary stenosis. Therefore, strengthen the lipid-lowering therapy may not be suitable for coronary heart disease in China, specific lipid-lowering therapy should be individualized according to different baseline lipid levels in patients with treatment.
作者
任新宇
周玉杰
刘宇扬
周扬威
孙岩
REN Xinyu ZHOU Yufie LIU Yuyang ZHOU Yangwei SUN Yan(Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beifing 100029, China)
出处
《心肺血管病杂志》
2016年第10期821-824,828,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
北京市医院管理局临床医学发展专项经费资助(编号:ZYLX201303)
北京市医院管理局"登峰"计划专项经费资助(编号:DFL20150601)
国家临床重点专科建设项目经费资助(2013-2014年度)
关键词
血脂
冠心病
低密度脂蛋白
冠状动脉狭窄
SYNTAX评分
他汀强化治疗
Lipid
Coronary heart disease
Low density lipoprotein cholesterol
Coronary artery steno- sis
The syntax score
Strengthen the lipid-lowering therapy
