血清小而密低密度脂蛋白胆固醇水平对冠心病患者心血管不良事件的预测价值

目的分析冠心病(CAD)患者血清小而密低密度脂蛋白胆固醇(sdLDL-C)的水平,并评估sdLDL-C对CAD患者主要心血管不良事件(MACE)发生风险的预测价值。方法检测93例急性冠状动脉综合征(ACS)、48例稳定性CAD(SCAD)患者和123例健康对照者的血清sdLDL-C水平。计算CAD患者的Gensini积分,随访CAD患者1年内MACE的发生情况。采用Spearman相关和多元线性回归分析CAD患者血清sdLDL-C水平与Gensini积分的关系。采用多元Logistic回归分析血清sdLDL-C评估CAD发生风险的预测价值。采用Cox回归分析血清sdLDL-C评估CAD患者MACE发生风险的预测价值。结果ACS组血清sdLDL-C水平高于对照组(P<0.001)和SCAD组(P=0.038)。CAD患者血清sdLDL-C水平与Gensini积分独立相关(β=0.315,P=0.017,校正R^2=0.083)。多因素Logisitic回归分析显示,血清高sdLDL-C水平与ACS发生风险密切相关(OR=7.895,95%CI:2.344~26.589,P=0.001),且对ACS和SCAD的区分具有统计学意义(OR=5.948,95%CI:1.158~30.558,P=0.033)。随访1年内,CAD患者的MACE发生率为22.70%;发生MACE的CAD患者血清sdLDL-C水平高于未发生MACE的CAD患者(P=0.001)。多因素Cox回归分析显示,血清高sdLDL-C水平与CAD患者MACE的发生风险密切相关(HR=5.326,95%CI:1.623~17.483,P=0.006)。结论ACS患者血清sdLDL-C水平升高;血清sdLDL-C可望作为评估CAD患者MACE发生风险的预测指标。

Predictive values of serum small, dense low-density lipoprotein cholesterol levels for cardiovascular adverse events in patients with coronary artery disease

Objective To analyze the serum levels of small,dense low-density lipoprotein cholesterol(sdLDL-C)in patients with coronary artery disease(CAD)and evaluate their predictive values for the risk of major cardiovascular adverse events(MACE).Methods Serum sdLDL-C levels were measured in 93 patients with acute coronary syndrome(ACS),48 patients with stable CAD(SCAD)and 123 healthy controls.The Gensini scores of CAD patients were calculated.The incidence of MACE in the CAD patients was followed up for 1 year.Spearman correlation and multiple linear regression analyses were performed to investigate the association of serum sdLDL-C with Gensini scores in CAD patients.The predictive values of serum sdLDL-C for CAD risk were explored by multivariate Logistic regression analyses and their predictive values for the occurrence of MACE in CAD patients was investigated by Cox regression analyses.Results The serum sdLDL-C levels in ACS patients were significantly increased compared with SCAD patients(P=0.038)and controls(P<0.001).The serum sdLDL-C levels were independently correlated with Gensini scores in CAD patients(β=0.315,P=0.017,adjusted R^2=0.083).Multi-factor logistic regression analyses revealed that high sdLDL-C levels were closely associated with ACS risk(OR=7.895,95%CI:2.344-26.589,P=0.001)and they could discriminate between ACS and SCAD(OR=5.948,95%CI:1.158-30.558,P=0.033).During 1 year of follow-up,the incidence of MACE in the CAD patients was 22.70%.The serum sdLDL-C level of the CAD patients with MACE was significantly higher than that of CAD patients without MACE(P=0.001).Multi-factor Cox regression analyses indicated that high sdLDL-C levels were closely associated with MACE risk in CAD patients(HR=5.326,95%CI:1.623-17.483,P=0.006).Conclusion Serum sdLDL-C levels were significantly elevated in ACS patients.Serum sdLDL-C may function as a predictor for assessing the risk of MACE in CAD patients.