血清sdLDL-C、ApoAⅠ和ApoB水平与急性冠状动脉综合征的关系研究-现代医学

血清sdLDL-C、ApoAⅠ和ApoB水平与急性冠状动脉综合征的关系研究

单位：中国人民解放军西部战区总医院心血管内科, 四川成都 610000

关键词：小而密低密度脂蛋白胆固醇载脂蛋白AⅠ 载脂蛋白B 冠心病急性冠状动脉综合征

分类号：R541.4

出版年·卷·期（页码）：2022·50·第十一期（1407-1412）

摘要：

目的：探讨血清小而密低密度脂蛋白胆固醇(sdLDL-C)、载脂蛋白AⅠ(ApoAⅠ)和载脂蛋白B (ApoB)水平与急性冠状动脉综合征(ACS)的关系。方法：选取2018年5月至2021年11月我院收治的279例冠心病患者为研究对象，根据冠心病临床分类将其分为ACS组(116例)与稳定性冠心病组(163例)。患者均行血清sdLDL-C、ApoAⅠ、ApoB水平检测。比较ACS组与稳定性冠心病组血清sdLDL-C、ApoAⅠ、ApoB水平，采用多因素Logistic回归行分析法ACS的影响因素，并采用受试者工作特征(ROC)曲线分析三者联合对ACS的评估价值。结果：ACS组血清sdLDL-C、ApoB水平均高于稳定性冠心病组(P＜0.05)，ApoAⅠ水平低于稳定性冠心病组(P＜0.05)；经多因素Logistic回归性分析，体质量指数(BMI)、白细胞计数(WBC)、高血压史、糖尿病史、吸烟史、饮酒史、血清超敏C反应蛋白(hs-CRP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、sdLDL-C、ApoB水平均是ACS的危险因素(P＜0.05)，高密度脂蛋白胆固醇(HDL-C)、ApoAⅠ是其保护因素(P＜0.05)。根据ROC曲线分析，血清sdLDL-C、ApoAⅠ、ApoB单项及联合评估ACS的灵敏度分别为79.31%、75.86%、77.59%、94.83%，特异度分别为81.60%、83.44%、82.82%、79.75%，曲线下面积(AUC)分别为0.854、0.853、0.868、0.927，三者联合评估的灵敏度与AUC均高于各项指标单独评估(P＜0.05)。结论：血清sdLDL-C、ApoB水平在ACS患者中明显升高，而ApoAⅠ水平明显降低，上述指标均是ACS发生的影响因素，且可作为该疾病的评估指标，但此三者联合评估的临床应用价值更高。

Objective: To investigate the relationship between serum small and dense low density lipoprotein cholesterol(sdLDL-C), apolipoprotein AⅠ(ApoAⅠ), apolipoprotein B(ApoB) levels and acute coronary syndrome(ACS). Methods: 279 patients with coronary heart disease treated in our hospital from May 2018 to November 2021 were selected as the research objects, and they were divided into ACS group(116 cases) and stable coronary heart disease group(163 cases) according to the clinical classification of coronary heart disease. The serum levels of sdLDL-C, ApoAⅠ and ApoB levels of all patients were detected. The serum levels of sdLDL-C, ApoAⅠ and ApoB were compared between ACS group and stable coronary heart disease group, and the influencing factors of ACS was analyzed by multivariate Logistic regression, and the evaluation value of the combination of them for ACS was analyzed by receiver operating characteristic(ROC) curve. Results: The serum levels of sdLDL-C and ApoB in the ACS group were higher than those in the stable coronary heart disease group(P<0.05), while the level of ApoAⅠ was lower(P<0.05). Multivariate logistic regression analysis showed that body mass index(BMI), white blood cell count(WBC), with hypertension,with diabetes mellitus, smoking history, drinking history and serum high sensitivity C-reactive protein(hs-CRP), total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), sdLDL-C and ApoB levels were all risk factors for ACS(P < 0.05), but high density lipoprotein cholesterol(HDL-C) and ApoAⅠ were the protective factors(P< 0.05). According to ROC curve analysis, the sensitivity of serum sdLDL-C, ApoAⅠ, ApoB of in single and combined evaluating ACS was 79.31%, 75.86%, 77.59% and 94.83% respectively, and the specificity was 81.60%, 83.44%, 82.82% and 79.75% respectively, and the area under curve(AUC) was 0.854, 0.853, 0.868 and 0.927 respectively, and the sensitivity and AUC of joint evaluation of the three indexes were higher than those of the single evaluation(P<0.05). Conclusion: The levels of serum sdLDL-C and ApoB are significantly increased in patients with ACS, while the level of ApoAⅠ is significantly decreased, and the above indicators are the influencing factors of ACS and can be used as the evaluation indicators of the disease, but the combined evaluation of the three has higher clinical application value.

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