摘要
目的 分析非传统血脂参数在预测老年冠状动脉粥样硬化性心脏病(冠心病,CHD)患者冠状动脉(冠脉)病变程度中的临床价值.方法 选取2021年3月至2023年3月于河北大学附属医院老年医学科行冠脉造影检查的老年患者185例,根据冠脉造影检查结果 分为CHD组(104例)、非CHD组(81例),根据Gensini评分结果将CHD组分为轻度病变组(≤24分,34例)、中度病变组(25～49分,37例)、重度病变组(≥50分,33例).采集所有老年患者血液标本,测定小而密低密度脂蛋白胆固醇(sdLDL-C)、载脂蛋白B(ApoB)、非高密度脂蛋白胆固醇(non-HDL-C)、脂蛋白a[Lp(a)]等非传统血脂参数,比较CHD组、非CHD组非传统血脂参数水平,分析其与冠脉病变程度的关系,以受试者工作特征(ROC)曲线分析非传统血脂参数对CHD的诊断价值.结果与非CHD组比较,CHD组sdLDL-C、ApoB、Lp(a)、non-HDL-C 水平均较高(P＜0.05).不同病情程度 CHD 患者 sdLDL-C、ApoB、Lp(a)、non-HDL-C水平比较,差异具有统计学意义(P＜0.05),且重度病变组高于中度病变组、轻度病变组(P＜0.05).相关性分析发现,sdLDL-C、ApoB、Lp(a)、non-HDL-C水平与病情程度均呈正相关性关系(P＜0.05).ROC曲线结果显示,sdLDL-C(AUC=0.835,95％CI:0.733～0.936,P＜0.001)、ApoB(AUC=0.754,95％CI:0.651～0.857,P＜0.001)、Lp(a)(AUC=0.949,95％CI:0.911～0.987,P＜0.001)、non-HDL-C(AUC=0.879,95％CI:0.814～0.943,P＜0.001)预测重度CHD的价值良好.结论 SdLDL-C、ApoB、Lp(a)、non-HDL-C与老年CHD患者紧密相关,对临床预测冠脉病变程度具有良好价值.
Abstract
Objective To analyze the clinical predictive value of non-traditional blood lipid parameters toseverity of coronary artery lesions in elderly patients with coronary heart disease(CHD).Methods Elderly patients(n=185)received coronary angiography(CAG)were chosen from Department of Geriatrics in the Affiliated Hospital of Hebei University from Mar.2021 to Mar.2023.The patients were divided,according to CAG results,into CHD group(n=104)and non-CHD group(n=81),and CHD group was divided,according to Gensini scores,into mild lesion subgroup(scores ≤24,n=34),moderate lesion subgroup(scores=25-49,n=37)and severe lesion subgroup(scores≥50,n=33).The blood samples were collected to detect non-traditional blood lipid parameters including small and dense low-density lipoprotein cholesterol(sdLDL-C),apolipoprotein B(ApoB),non-high-density lipoprotein-cholesterol(non-HDL-C)and lipoproteina(Lpa)in all groups.The levels of non-traditional blood lipid parameters were compared between non-CHD group and CHD group,and relationship among the parameters and severity of coronary artery lesions was analyzed.The diagnostic value of non-traditional blood lipid parameters to CHD was analyzed by using ROC curve.Results The levels of sdLDL-C,ApoB,Lp a and non-HDL-C were higher in CHD group than those in non-CHD group(P＜0.05).The differences in levels of sdLDL-C,ApoB,Lp a and non-HDL-C had statistical significance among subgroups(P＜0.05),and the levels were higher in severe lesion subgroup than those in mild lesion subgroup and moderate lesion subgroup(P＜0.05).The results of correlation analysis showed that the levels of sdLDL-C,ApoB,Lp a and non-HDL-C were positively correlated to severity of coronary artery lesions(P＜0.05).The results of ROC curve analysis showed that sdLDL-C(AUC=0.835,95％CI:0.733～0.936,P＜0.001),ApoB(AUC=0.754,95％CI:0.651～0.857,P＜0.001),Lp a(AUC=0.949,95％CI:0.911～0.987,P＜0.001)and non-HDL-C(AUC=0.879.95％CI:0.814～0.943,P＜0.001)had higher predictive value to severe CHD.Conclusion The levels of sdLDL-C,ApoB,Lp a and non-HDL-C are closely correlated to CHD in elderly patients,and they have higher predictive value to severity of coronary artery lesions.
维普
万方数据