2019 年第 7 期 第 14 卷

高密度脂蛋白胆固醇与冠状动脉粥样硬化性心脏病及冠状动脉多支病变的相关性研究

Relation between high density lipoprotein cholesterol and coronary atherosclerotic heart disease with multi-vessel lesions

作者：张宁刘文娴

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏内科监护室

英文单位：

关键词：冠状动脉粥样硬化性心脏病；高密度脂蛋白胆固醇；冠状动脉病变

英文关键词：

• 摘要：

• 【摘要】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。

• 【Abstract】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.