载脂蛋白对无症状非糖尿病人群冠状动脉粥样硬化的预测价值

目的 分析无症状非糖尿病人群载脂蛋白(Apo)水平及ApoB/ApoA1比值,研究其与冠状动脉粥样硬化发生的相关性及对冠状动脉病变的预测价值。方法 回顾性分析2013年4月至2014年3月在中国人民解放军总医院行冠状动脉CT血管成像和血生化检查的无症状体检者401例,根据检查结果分为粥样硬化组(n=224)和对照组(n=177),比较两组相关危险因素、脂质及Apo水平,找出预测冠状动脉粥样硬化的最佳血脂指标。结果 粥样硬化组ApoB、ApoC2、ApoC3、ApoE水平及ApoB/ApoA1比值均显著高于对照组(P均＜0.01),ApoA1、ApoA2及脂蛋白a水平两组间差异无统计学意义(P均＞0.05)。Logistic回归分析结果显示,年龄、男性、高血压病史、ApoC3(OR=1.572,95%CI 1.200～2.061)及ApoB/ApoA1(OR=1.767,95%CI 1.335～2.338)是本研究人群冠状动脉粥样硬化的独立危险因素(P均＜0.01)。预测冠状动脉病变的受试者工作特征曲线分析结果显示,ApoB的曲线下面积最大,最佳截断点为1.005 g/L。结论 ApoC3与亚临床期冠状动脉粥样硬化关系密切,这一时期ApoA1降低并不明显,ApoB较其他脂类指标对无症状非糖尿病人群冠状动脉病变有很强的预测价值。

Predictive Value of Apolipoprotein for Coronary Atherosclerosis in Asymptomatic Non-diabetic Population

Objective To explore the potential correlation between apolipoprotein(Apo) levels and coronary atherosclerosis and investigate its predictive value for coronary artery lesions in asymptomatic population without diabetes. Methods We performed a retrospective analysis of data collected from 401 asymptomatic patients who took health check-ups. They were divided into atherosclerosis group(n=224)and control group(n=177)based on the outcome of CT angiography and blood biochemical findings. The risk factors,lipid profiles,and Apo levels were compared between these two groups. The best biochemical indicators for predicting the coronary atherosclerosis were explored. Results The levels of ApoB,ApoC2,ApoC3,and ApoE and ApoB/ApoA1 ratio were significantly higher in the atherosclerosis group than in the control group(all P＜0.01),whereas the ApoA1,ApoA2,and lipoprotein a levels showed no such significant difference(all P>0.05). Logistic regression analysis revealed that age,male,hypertension,ApoC3(OR=1.572,95%CI 1.200-2.061)and ApoB/ApoA1 ratio(OR=1.767,95%CI 1.335-2.338)were independently correlated with coronary atherosclerosis(all P＜0.01). In the prediction of the presence of plaque,ApoB had the largest area under curves,and the optimal cutoff point was 1.005 g/L. Conclusions ApoC3 is closely associated with subclinical coronary atherosclerosis,while the decrease of ApoA1 level is not obvious during this period. Compared with other lipid indicators,ApoB is the strongest predictor for coronary atherosclerosis in asymptomatic non-diabetic population.