摘要
目的对男性冠心病(coronary heart disease,CHD)患者胱抑素C(Cys C)、血脂水平进行相关性分析。方法选择在解放军总医院心内科经冠状动脉造影术确诊为CHD的男性患者348例,其中稳定型心绞痛(stable angina pectoris,SAP)113例,不稳定型心绞痛(unstable angina pectoris,UAP)145例,急性心肌梗死(acute myocardial infarction,AMI)90例。并设同期经冠状动脉造影排除CHD诊断的男性对照组134例。测定不同组别和不同病变支数的Cys C、同型半胱氨酸、肌酐、尿素氮和血脂水平,分析男性CHD患者生化指标的变化特点。结果与对照组比较,男性CHD患者的总胆固醇(TC)(4.15±0.83)mmol/L vs(4.33±0.88)mmol/L、低密度脂蛋白胆固醇(LDL-C)(2.29±0.71)mmol/L vs(2.54±0.72)mmol/L、载脂蛋白B(apoB)(0.76±0.20)g/L vs(0.86±0.20)g/L、血清脂蛋白a[Lp(a)](121.03±101.30)mg/L vs(206.60±189.26)mg/L、Cys C(0.99±0.18)mg/L vs(1.09±0.24)mg/L水平增高。CHD患者与对照组比较,高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A-Ⅰ(apoA-Ⅰ)水平降低,(1.16±0.37)mmol/L vs(1.05±0.28)mmol/L,(1.27±0.28)g/L vs(1.19±0.22)g/L(均P<0.01)。随冠状动脉病变支数增加,血清TC、Lp(a)、Cys C水平有升高趋势,HDL-C、apoA-Ⅰ水平降低,3病变组与其他组的差异性有统计学意义(P<0.05或<0.01)。应用二元logistic回归分析发现TC、LP(a)、Cys C是男性发生CHD的危险因素(P<0.05或<0.01)。对冠状动脉病变支数进行有序logistic回归分析显示,TC、LP(a)、Cys C水平增高,apoA-Ⅰ水平降低,冠状动脉病变支数增加的风险升高(P≤0.01)。结论男性CHD患者存在多项血脂指标异常和胱抑素C水平升高,在AMI组和多支病变组更为明显,且这些指标是CHD和病变程度的危险因素。注重胱抑素C和血脂指标的联合检测有助于男性CHD的诊断和评价。
Objective To analyze cystatin C（Cys C） and lipid levels in male patients with coronary heart disease （CHD）. Methods A total of 348 male patients with CHD diagnosed by coronary arteriography in PLA General Hospital were enrolled into CHD group, and 134 subjects without CHD comprised the control group. The patients in C HD group were divided into three groups：stable angina pectoris（SAP, n ; 113）, unstable angina pectoris（UAP, n = 145） and acute myocardial infarction（AMI, n = 90）. We measured plasma Cys C levels, homocysteine（Hcy）, creatinine （Cr）,blood urea nitrogen（BUN） and serum lipid levels of different groups and different quantitative coronary artery lesions at the same time. Results Compared with the patients in control group, the levels of total cholesterol（TC） （4.15 ±0. 83） mmol/L vs （4. 33±0.88） mmol/L,low density lipoprotein eholesterol（LDL-C） （2.29±0.71） mmol/L vs （2.54±0.72） mmol/L, apolipoprotein（apo） B （0.76±0.20 ） g/L vs （0.86±0.20） g/L, lipoprotein （a） [Lp （a）; （ 121.03±101.30） mg/L vs （206.60±189.26） mg/L and Cys C（0.99±0.18） mg/L vs （1.09±0.24） mg/L were significantly higher in CHD group. The levels of high density lipoprotein cholesterol（HDL-C） and apolipoprotein（apo）A-I in CHD group were significantly lower compared with those of control group, （1.16±0.37） mmol vs （1.05!0.28） mmol/L, （1.27±0. 28） g/L vs （1. 19±0. 22） g/L（both P 〈0.01）. Binary logistic regression analysis found that higher concentration of TC,LP（a） and Cys C,and lower levels of HDL-C and apoA- I were demonstrated risk factors in male patients with CHD （ P 〈0.05 or 〈0.01） ,as well as the ordinal logistic regression analysis showed that TC,apoA- I , LP （a） ,Cys C finally entered into the regression equation（ P〈0.01）. Conclusion Multiple lipid metabolic disorders and Cys C elevation present in male patients with CHD especially in those of AMI and three-vessel coronary lesions. More attention should fOCUS at the union detection of serum Cys C level and lipid indexes, which is helpful to the diagnosis and evaluation of CHD in male patients.
出处
《临床荟萃》
CAS
2013年第6期626-629,632,共5页
Clinical Focus
