冠心病家族史儿童脂质三角的研究

目的：了解有冠心病(CHD)家族史儿童脂质三角［低密度脂蛋白-胆固醇(LDL-C)，高密度脂蛋白-胆固醇(HDL-C)和甘油三脂(TG)］有无异常。方法：对83例有冠心病家族史的儿童检测血浆TG，LDL-C和HDL-C浓度，计算LDL-C/HDL-C，以无CHD家族史的健康儿童作为对照。结果：与对照组比较，有CHD家族史的儿童血TG，LDL-C浓度明显增高［(1.46±0.63) mmol/L vs (0.84±0.43) mmol/L，(2.09±1.13) mmol/L vs (0.96±0.87) mmol/L］，HDL-C水平降低［(1.48±0.48) mmol/L vs (1.72±0.53) mmol/L］，LDL-C/HDL-C升高(1.71±1.29 vs 0.96±0.68)(P1.7 mmol/L及LDL-C/HDL-C>2.5的发生率明显增高(20.5% vs 1.2%)(P均0.05)。有早发CHD家族史的儿童血TG，LDL-C水平［(1.86±0.63)，(3.12±1.32) mmol/L］高于无早发CHD家族史儿童［(1.34±0.58)，(1.79±0.87) mmol/L］及对照组［(0.84±0.43)，(0.96±0.87) mmol/L］。有早发CHD家族史者LDL-C/HDL-C(2.85±1.21)高于无早发家族史组(1.37±1.11)和对照组(0.96±0.68)(P均<0.01)，HDL-C水平［(1.11±0.26) mmol/L］低于无早发家族史者［(1.59±0.47) mmol/L］和对照组［(1.72±0.53) mmol/L］。脂质三角异常发生率(52.6%)高于无早发家族史组(10.9%)和对照组(1.2%)(P<0.01)。结论：有CHD家族史的儿童存在脂质三角异常，以有早发CHD家族史儿童明显。提示儿童期脂质三角异常与CHD家族史关系密切，有CHD家族史儿童成年后发生CHD的危险性显著增高。

Changes of Lipid Trigone in Children with a Family History of Coronary Heart Disease

OBJECTIVE: To study the changes of lipid trigone in children with a family history of coronary heart disease (CHD). METHODS: The concentrations of plasma low density lipoprotein cholesterol (LDL C), high density lipoprotein cholesterol (HDL C) and triglyceride (TG) were determined in 83 children with a family history of CHD and 83 normal controls. RESULTS: Compared with the controls, the levels of TG and LDL C, and the ratio of LDL C/HDL C were higher [( 1.46 ± 0.63 ) mmol/L vs ( 0.84 ± 0.43 ) mmol/L; ( 2.09 ± 1.13 ) mmol/L vs ( 0.96 ± 0.87 ) mmol/L; ( 1.71 ± 1.29 ) vs ( 0.96 ± 0.68 )], and the HDL C level was lower [( 1.48 ± 0.48 ) mmol/L vs ( 1.72 ± 0.53 ) mmol/L]in children with a family history of CHD (all P< 0.01 ). There was no difference in blood lipid trigone between boys and girls with a family history of CHD. The levels of TG and LDL C [( 1.86 ± 0.63 ) and ( 3.12 ± 1.32 ) mmol/L], and the ratio of LDL C/HDL C ( 2.85 ± 1.21 ) were higher in children with a family history of premature CHD than those in children with a family history of non premature CHD [( 1.34 ± 0.58 ) mmol/L, ( 1.79 ± 0.87 ) mmol/L, ( 1.37±1.11 ),[JP] respectively]; and the HDL C level was lower ; and the HDL C level was lower [( 1.11 ± 0.26 ) mmol vs ( 1.59 ± 0.47 )](all P< 0.01 ). The incidence of abnormal lipid trigone in children with a family history of premature CHD or non premature CHD and the controls were 52.6% , 10.9% and 1.2% , respectively. A significant difference was noted among the three groups (P< 0.01 ). CONCLUSIONS: Lipids metabolism is abnormal in children with a family history of CHD; and more remarkable disorders may be found in those with a family history of premature CHD. In children with a family history of CHD, abnormal lipid metabolism is an obvious high risk index for developing CHD in later life.