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小而密低密度脂蛋白胆固醇预测老年冠心病患者主要不良心血管事件的价值

Value of small dense low density lipoprotein cholesterol in predicting major adverse cardiovascular events of elderly patients with coronary heart disease

    摘要
  • 摘要:
      目的  探讨小而密低密度脂蛋白胆固醇(sdLDL-C)与老年冠心病患者预后的关系。
      方法  选取新疆医科大学第二附属医院2019年10月—2020年10月收治的冠心病患者80例，分为服用他汀组(n=40)和未服用他汀组(n=40); 另选取同期体检的老年非冠心病患者40例为对照组。检测3组受试者血清sdLDL-C、脂蛋白相关磷脂酶A2(Lp-PLA2)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白(a)Lp(a)、中性粒细胞与淋巴细胞比值(NLR), 记录冠心病患者发生主要不良心血管事件(MACE)情况，分析冠心病患者发生MACE的危险因素。
      结果  未服用他汀组与服用他汀组、对照组的sdLDL-C、Lp-PLA2、TG、TC、HDL-C、LDL-C、Lp(a)的水平差异有统计学意义(P<0.05)。Pearson相关性分析显示，所有冠心病患者血清sdLDL-C水平与LDL-C、TG、TC均呈正相关(P<0.05); 服用他汀类药物者血清sdLDL-C水平与TC、LDL-C均呈正相关(P<0.05); 未服用他汀类药物者血清sdLDL-C水平与TC、LDL-C均呈正相关(P<0.05); 对照人群血清sdLDL-C水平与LDL-C、TG、TC均呈正相关(P<0.05)。在校正了年龄、性别、TC、TG、LDL-C等指标的影响后，冠心病患者血清sdLDL-C(OR=5.677, 95%CI=1.008~31.983，P=0.049)、Lp(a)(OR=1.007, 95%CI=1.001~1.013, P=0.015)水平是发生MACE的独立危险因素。
      结论  长期规律服用他汀类药物可有效降低冠心病患者血清sdLDL-C、Lp-PLA2、TG、TC、LDL-C、Lp(a)水平，提高HDL-C水平，其中sdLDL-C、Lp(a)水平可作为评估冠心病患者发生MACE的独立危险因素。

     

    Abstract:
      Objective  To investigate the relationship between small dense low density lipoprotein cholesterol (sdLDL-C) and prognosis of elderly patients with coronary heart disease.
      Methods  A total of 80 patients with coronary heart disease from October 2019 to October 2020 in the Second Affiliated Hospital of Xinjiang Medical University were selected and divided into statin group (n=40) and non-statin group (n=40). In addition, 40 non-coronary heart disease elderly patients with physical examination at the same time were selected as control group. Serum sdLDL-C, lipoprotein associated phospholipase A2 (Lp-PLA2), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), lipoprotein (a)Lp(a)and neutrophil to lymphocyte ratio (NLR) of the three groups were measured, the occurrence of major adverse cardiovascular events (MACE) in patients with coronary heart disease was recorded, and the risk factors of MACE in patients with coronary heart disease were analyzed.
      Results  There were significant differences in the levels of sdLDL-C, Lp-PLA2, TG, TC, HDL-C, LDL-C and Lp(a) among the statin group, the control group and non-statin group (P<0.05). Pearson correlation analysis showed that the level of serum sdLDL-C in all patients with coronary heart disease was positively correlated with LDL-C, TG and TC (P<0.05); the level of serum sdLDL-C in patients with statins was positively correlated with TC and LDL-C (P<0.05); serum sdLDL-C level was positively correlated with TC and LDL-C in patients without statins (P<0.05); the level of serum sdLDL-C in the controls was positively correlated with LDL-C, TG and TC (P<0.05). After adjusting for the effects of age, gender, TC, TG and LDL-C, the levels of serum sdLDL-C (OR=5.677, 95%CI, 1.008~31.983, P=0.049) and Lp(a) (OR=1.007, 95%CI, 1.001~1.013, P=0.015) were independent risk factors for MACE in patients with coronary heart disease.
      Conclusion  Regular administration of statins for a long time can effectively reduce the levels of serum sdLDL-C, Lp-PLA2, TG, TC, LDL-C and Lp(a) and increase the level of HDL-C in patients with coronary heart disease, in which the levels of sdLDL-C and Lp(a) can be used as independent risk factors for MACE in patients with coronary heart disease.

     

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