TG/HDL-C和HDL-C对不同体型冠心病患者的诊断价值

摘要

目的 探讨三酰甘油/高密度脂蛋白胆固醇(TG/HDL-C)和HDL-C对不同体型冠状动脉粥样硬化性心脏病(冠心病)患者的诊断价值.方法 入选2008年8月~2009年8月于西安交通大学第一附属医院心血管内科住院治疗的急性冠脉综合征患者212例.同时选取年龄、性别匹配的健康对照者174例.按照体质指数(BMI)和是否发生急性冠脉综合征分为:正常组(99例,BMI 18.5~23.9 kg/m2)、肥胖组(75例,≥28 kg/m2)、冠心病组(79例)、肥胖冠心病组(133例).入选者检测总胆固醇(TC)、TG、HDL-C、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(apoA)和载脂蛋白B(apoB),并计算TG/HDL-C比值.结果 肥胖冠心病组男性、高血压病史、糖尿病史和吸烟比例明显高于其他3组,TG和TG/HDL-C明显高于其他3组,差异有统计学意义(P均<0.05).以是否发生冠心病为因变量,以TG/HDL-C为自变量,经多因素Logistic回归分析,TG/HDL-C是肥胖者发生冠心病的危险因素(OR=1.825,95%CI:1.294~2.573);校正年龄、性别、TC、TG、HDL-C、LDL-C、apoA和apoB后,TG/HDL-C对于肥胖者冠心病发病无影响.以是否发生冠心病为因变量,以TG/HDL-C为自变量,经多因素Logistic回归分析,TG/HDL-C是非肥胖者发生冠心病的危险因素(OR=1.952,95%CI:1.323~2.878);校正年龄、性别、TC、TG、HDL-C、LDL-C、apoA和apoB后,TG/HDL-C对于非肥胖者冠心病发病无影响.TG/HDL-C诊断肥胖冠心病ROC曲线下面积为0.726,HDL-C为0.794;TG/HDL-C诊断体型正常冠心病的ROC曲线下面积为0.751,HDL-C为0.779.结论 TG/HDL-C不是冠心病发病的独立危险因素,TG/HDL-C和HDL-C诊断不同体型冠心病患者的效能较好.%Objective To discuss the diagnostic values of ratio of triglyceride to high-density lipoprotein-cholesterol (TG/HDL-C) and high-density lipoprotein-cholesterol (HDL-C) to patients with coronary heart disease (CHD) in different body types. Methods The patients with acute coronary syndrome (ACS, n=212) and health controls with matched age and sex (n=174) were chosen from the Department of Cardiovascular Medicine of the First Affiliated Hospital of Xi'an Jiaotong University Health Science Center from Aug. 2008 to Aug. 2009. All subjects were divided, according to body mass index (BMI) and whether ACS onset or not, into normal group (n=99, BMI=18.5 kg/m2-23.9 kg/m2), obesity group (n=75, weight≥28 kg/m2), CHD group (n=79) and obesity CHD group (n=133). The levels of total cholesterol (TC), TG, HDL-C, low-density lipoprotein-cholesterol (LDL-C), apolipoprotein A (apoA) and apolipoprotein B (apoB) were detected and TG/HDL-C was calculated in all groups. Results The percentages of the male, patients with hypertension and diabetes history and smoking cases, and TG and TG/HDL-C were significantly higher in obesity CHD group than those in other 3 groups (all P<0.05). Taken whether CHD onset or not as dependent variable and TG/HDL-C as independent variable, the multi-factor Logistic regression analysis showed that TG/HDL-C was the risk factor of CHD in obesity patients (OR=1.825, 95%CI: 1.294~2.573). After corrected age, sex, TC, TG, HDL-C, LDL-C, apoA and apoB, TG/HDL-C had no effect on CHD onset in obesity patients. Taken whether CHD onset or not as dependent variable and TG/HDL-C as independent variable, the multi-factor Logistic regression analysis showed that TG/HDL-C was the risk factor of CHD in non-obesity patients (OR=1.952, 95%CI: 1.323~2.878). After corrected age, sex, TC, TG, HDL-C, LDL-C, apoA and apoB, TG/HDL-C had no effect on CHD onset in non-obesity patients. The receiver operating characteristic curve (ROC) showed that the area under curve (AUC) of TG/HDL-C was 0.726 and AUC of HDL-C was 0.794 in diagnosis of obesity CHD, and AUC of TG/HDL-C was 0.751 and AUC of HDL-C was 0.779 in diagnosis of non-obesity CHD. Conclusion TG/HDL-C is not independent risk factor of CHD onset, and TG/HDL-C and HDL-C have higher efficacy in CHD diagnosis in patients in different body types.