冠心病患者血脂异常与冠状动脉病变的相关性分析

摘要

目的 探讨冠心病患者冠状动脉病变范围及狭窄程度与血脂的关系.方法 9847例疑诊冠心病并行诊断性冠状动脉造影的住院患者中,确诊冠心病6419例(65.2％),排除3428例(34.8％),以冠状动脉造影阳性(主要血管直径狭窄≥＞50％)作为诊断冠心病的标准.冠状动脉造影病变程度采用Gensini积分评价.术前进行甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)检查,对比分析冠心病组冠状动脉狭窄程度及范围与血脂的关系.结果 对6419例冠心病患者进行统计学分析显示TC、LDL-C随着冠状动脉病变支数及病变程度(冠状动脉病变Gensini积分)的增加而升高,并与之成明显的负相关(P＜0.001)；而高密度脂蛋白则随着病变支数和病变程度(冠状动脉病变Gensini积分)的增加而降低,呈明显的负相关(P＜0.001),进一步多元线性回归分析显示HDL-C(β=-0.075,OR值-5.580,95％ CI:-7.541 ～ -3.618,P＜0.001)与冠状动脉病变程度成独立正相关,低密度脂蛋白(β=0.067,OR值2.712,95％CI:0.943～4.481,P=0.003)与冠状动脉病变程度成独立正相关,而与TG(β=0.002,OR值0.067,95％ CI:-0.689～0.822,P=0.863)、TC(β=0.034,OR值1.080,95％ CI:-0.392～2.553,P=0.150)无独立相关性.结论 TG、TC、LDL-C可以作为冠心病的危险因素,而HDL-C与冠状动脉病变程度成独立负相关,LDL-C与冠状动脉病变程度成独立正相关.虽然TG和TC在本研究中末体现出与冠状动脉病变程度存在独立相关性,但因本研究为横断面研究,研究结果存在一定的局限性,应结合临床具体分析.所以积极控制血脂对防止冠心病有积极意义.%Objective To evaluate Coronary lesions in patients with coronary heart disease with dislipidemia. Methods 9847 consecutive patients underwent coronary angiography were selected, including 6419 (65. 2% ) with coronary artery disease. CAD severity was assessed by the Gensini score with > 50% stenosis in the angiography. Preoperative triglyceride (TG) , total cholesterol (TC) , high density lipoprotein cholesterol ( HDL-C) , low density lipoprotein cholesterol ( LDL-C) levels were measured. Comparative analysis of the coronary lesions and the extent of coronary stenosis with lipid levels was made. Results By analysis of 6419 cases of coronary heart disease, patients with lower HDL-C levels and higher TC, LDL-C levels were found to have more severe coronary lesions and the levels of TC and LDL-C were positively related with the severity of coronary artery stenosis and the Gensini score. Multiple liner regression analysis showed that Gensini score was independently negatively correlated with HDL-C (β= -0. 075,OR: -5. 580, 95%CI: -7.541 - - 3. 618,P < 0. 001 ) but independently positively correlated with LDL-C (/3=0.067, OR:2. 712,95%CI:0. 943 -4.481,P =0.003). TG (β = 0. OO2,OK:0. 067,95% CI: -0. 689 -0. 822,P =0.863) and TC (β = 0. 034, OR: 1. 080,95% CI: -0.392 -2.553,P=0. 150) showed no correlation with Gensini score. Conclusions TG, LDL-C, TC as an independent risk factor for coronary heart disease.Gensini score was independently negatively correlated with HDL-C, but was positively related with LDL-C. TG and TC were not correlated with Gensini score. Control of blood lipids to prevent coronary heart disease showed positive significance.