残余胆固醇/高密度脂蛋白胆固醇比值在冠心病患者冠状动脉病变严重程度中的评估作用

目的 研究残余胆固醇/高密度脂蛋白胆固醇（RC/HDL-C）比值在冠心病患者冠状动脉病变严重程度中的评估作用。方法 回顾性分析2019年1月至2019年12月因胸闷胸痛至上海市第一人民医院住院行冠状动脉造影检查的418例冠心病患者的临床资料,记录患者性别、年龄、身高、体重、既往病史、血生化、冠状动脉造影结果等临床资料。采用Gensini积分系统评估冠状动脉粥样硬化病变的严重程度。根据Gensini积分四分位值将患者分为四组[Q1组（Gensini积分<14）,Q2组（14≤Gensini积分<32）,Q3组（32≤Gensini积分<50）,Q4组（Gensini积分≥50）],分析比较各组间临床资料的差异。根据RC/HDL-C比值四分位值将患者分为四组[A组（比值<0.28）,B组（0.28≤比值<0.49）,C组（0.49≤比值<0.76）,D组（比值≥0.76）],分析各组间Gensini积分和高Gensini积分（即Gensini积分≥32）患者比例的差异。将RC/HDL-C比值<0.49者定义为低RC/HDL-C比值组,RC/HDL-...     

残余胆固醇在急性缺血性卒中发病中的作用及其机制研究进展

残余胆固醇(RC)是指富含甘油三酯脂蛋白(TRLs)的总胆固醇含量,它是在TRLs被脂蛋白脂酶耗尽甘油三酯时形成的,由禁食状态下的极低密度脂蛋白胆固醇和中密度脂蛋白胆固醇以及非禁食状态下的乳糜微粒残余物组成,占血浆总胆固醇的三分之一,可以从标准血脂谱中计算出来.RC作为非传统的血脂指标,与AIS发病密切有关.RC水平升...     

血清载脂蛋白CⅢ、残余脂蛋白胆固醇水平与冠状动脉粥样硬化性心脏病合并2型糖尿病的关系

目的探讨冠状动脉粥样硬化性心脏病(冠心病,CAD)合并2型糖尿病(T2DM)患者血清载脂蛋白CⅢ(apoCⅢ)、残余脂蛋白胆固醇(RLP-C)的水平变化。方法入选2017年1月至2018年5月山西医科大学第二医院心血管内科住院患者816例,分为冠心病合并糖尿病组(T2DM+CAD组,n=192)、冠心病不合并糖尿病组(CAD组,n=198)、糖尿病不合并冠心病组(T2DM组,n=200)、非冠心病非糖尿病组(对照组,n=226)。采用析因设计方差分析比较CAD和T2DM交互作用对血清apoCⅢ水平的影响;Bootstrap法检验RLP-C对apoCⅢ和Gensini评分之间的中介效应;Logistic回归分析apoCⅢ对T2DM、CAD、T2DM+CAD发病的影响。结果与对照组相比,CAD、T2DM、CAD+T2DM组血清apoCⅢ、RLP-C水平较高。析因设计方差分析显示,CAD和T2DM在血清apoCⅢ、RLP-C水平升高方面存在交互作用。相关性分析结果显示,CAD和CAD+T2DM组血清apoCⅢ、RLP-C水平与Gensini评分呈正相关。Bootstrap法检验结果显示,RLP-C在apoCⅢ和Gensini评分之间发挥部分中介作用。多因素Logistic回归分析显示,apoCⅢ是CAD+T2DM组发病的独立危险因素[OR=1.890,95%CI(1.424～2.508),均P0.05]。结论 CAD和T2DM在apoCⅢ、RLP-C升高方面有交互作用,RLP-C在apoCⅢ和Gensini评分之间发挥部分中介作用,apoCⅢ是CAD合并T2DM的独立危险因素。     

高密度脂蛋白胆固醇流出能力在冠状动脉粥样硬化性心脏病中的作用

高密度脂蛋白是心血管保护因子,与冠状动脉粥样硬化性心脏病的发病和预后密切相关.高密度脂蛋白抗动脉粥样硬化的主要机制是介导胆固醇逆向转移,其逆向转移功能可能受糖代谢、炎性状态等多种因素影响,并成为潜在的脂代谢紊乱治疗及监测靶点.     

血清尿酸水平与冠状动脉粥样硬化性心脏病

冠状动脉粥样硬化性心脏病的危险因素众多,对于已明确的可控因素,应积极干预,对新的危险因素的探讨,有利于对冠状动脉粥样硬化性心脏病的早期干预治疗。该文对血清尿酸水平与血压、血糖、胰岛素抵抗、肥胖等冠状动脉粥样硬化性心脏病危险因素的关系及其是否为冠状动脉粥样硬化性心脏病的独立危险因素进行综述。     

家族性高胆固醇血症的诊疗进展

家族性高胆固醇血症（familial hypercholesterolemia,FH）是一种由于脂蛋白代谢异常所致的遗传疾病,绝大多数为常染色体显性遗传;其特点主要是血浆低密度脂蛋白胆固醇（low density lipoprotein cholesterol,LDL-C）增高。患者自幼年起因持续暴露于高LDL-C环境致使冠状动脉提前发生硬化,大幅度增加了动脉粥样硬化性心血管疾病(Atherosclerosis cardiovascular disease,ASCVD)的发生几率。FH目前尚无诊断的金标准,主要依靠临床症状,家族史,基因检测等进行综合评估;这就给我们带来了巨大的挑战,尽可能早地筛查、诊断并治疗对其预后有极大的帮助。本文将从FH的发病机制、筛查与诊断,治疗方法等方面综述。     

蛋类与心血管疾病

蛋类由于其富含优质蛋白质、维生素和矿物质,一直在机体营养中有重要的地位。然而,20世纪60年代,人类首次将膳食因素-胆固醇与心脏疾病联系起来。20世纪70年代,美国心脏病协会（AHA）首次对心脏疾病患者推荐限制膳食胆同醇的摄入（摄入量低丁300mg／d）,并明确提出限制膳食胆固醇含量比较高的蛋类、贝类食物的摄入。40多年来,因为关注冠状动脉粥样硬化性心脏病的冠心病风险,一直发出远离蛋类的警告。     

冠心病患者冠状动脉病变进展的相关危险因素的探讨

目的:探讨影响冠状动脉粥样硬化性心脏病患者冠状动脉病变进展的危险因素。方法:选择138例在航空总医院心内科复查冠状动脉造影的冠心病患者,根据2次冠状动脉造影情况,分为冠状动脉进展组(86例)和无进展组(52例)。比较两组患者性别、年龄、吸烟史、高血压病史、糖尿病史、BMI、LDL、TG、TC、HDL-C以及两组糖尿病患者Hb A1c水平。采用多元Logistic回归分析各相关因素对冠状动脉病变进展的影响。结果:与无进展组相比,进展组男性比例更高(70%vs.42%,P<0.05),吸烟者比例更高(34.9%vs.11.5%,P<0.05),糖尿病患者比例更高(65%vs.31%,P<0.001)。糖尿病患者糖化血红蛋白比无进展组明显升高[(8.2±1.0)%vs.(6.4±0.8)%,P<0.05]。两组LDL平均值无差异,但无进展组LDL-C<1.4 mmol/L的比例明显高于进展组(23%vs.9%,P=0.03)。Logistic回归分析显示,男性(OR=4.800,95%CI:4.250~5.160,P=0.021)、吸烟(OR=3.966,95%CI:3.345~4.532 P=0.046)、糖尿病史(OR=4.048,95%CI:3.827~4.324,P=0.008)、Hb Alc(OR=59.44,95%CI:56.34~62.56,P<0.001)是冠心病患者冠状动脉病变进展的危险因素。结论:男性、吸烟、糖尿病、Hb A1c水平是冠心病患者冠状动脉病变进展最主要的危险因素,LDL促进冠状动脉病变进展。戒烟、控制Hb A1c水平以及控制LDL-c<1.4 mmol/L对延缓冠状动脉病变进展意义重大。     

女性冠心病危险因素分析

近年来,男性冠心病患者的病死率已呈下降趋势,而女性冠心病的病死率却仍在上升,因此针对女性冠心病的危险因素对其进行预防和控制十分紧迫。现综述女性冠心病的主要易患因素,尤其是与男性迥异之处。其中不可逆的危险因素包括:年龄、家族史、身高、出生体重;可逆的危险因素包括:高血压、糖尿病、吸烟、血脂异常、肥胖和体力活动减少、雌激素减少与激素替代治疗、铁过多、生育孩子的数目等。高敏C反应蛋白等可能是女性冠心病的风险标记物。     

家族性高胆固醇血症一家系分析

目的高胆固血脂一家系调查。调查一家族性高胆固醇血症（FH）三代共20名成员，其中包括一对孪生兄弟的患病情况。结果提示HF患者共8例。总患病率为40％，男性患病率为54．5％（6／11），女性患病率为22．2％（2／9），符合常染色体显性遗传。结论本例FH的家系特点为：①血清总胆固醇（TC）从儿重期始有增高，且随年龄的增长有增高趋势；②家系中一对单卵双生的孪生同胞均为患病者，其后代亦有TC增高；③先证者41岁起即以典型的卧位型心绞痛起病，冠状动脉造影提示三支冠状动脉多处严重狭窄，似提示FH家系中的冠心病患者发病早且病变严重。     

血残粒胆固醇水平与冠心病和心肌梗死风险的两样本孟德尔随机化研究

[目的]探索血液中残粒胆固醇(RC)水平与冠心病(CHD)和心肌梗死(MI)的因果关系。[方法]采用两样本孟德尔随机化(MR)分析方法研究RC与CHD和MI的潜在因果关系。使用随机效应逆方差加权(IVW)法作为两样本MR分析的主要分析方法,并采用敏感性分析(包括异质性检验、多效性分析和逐个剔除检验)评估MR分析结果的稳健性。[结果] IVW法分析结果显示,RC与CHD和MI发生风险之间的关联具有统计学意义(CHD:OR=1.57,95%CI:1.40～1.76,P=2.01E-14;MI:OR=1.59,95%CI:1.40～1.79,P=1.26E-13)。MR-Egger回归结果提示筛选出的单核苷酸多态性(SNP)与CHD和MI不存在基因多效性(分别为P=0.924 1、P=0.740 5)。[结论]血液中RC水平升高与CHD和MI风险增加存在因果关系。     

血浆残余胆固醇水平与青年冠心病的远期不良心血管事件有关

目的]明确残余胆固醇(RC)与青年冠心病患者远期心血管风险的关系。 [方法]回顾性分析2013年5月—2015年11月住院行冠状动脉造影的冠心病患者3 200例,按照年龄分为三组:青年组(＜45岁)、中年组(45～70岁)和老年组(≥70岁);根据RC水平分为高组和低组。统计分析主要不良心血管事件(MACE)的发生率。用KM法评估无MACE事件的生存率,Cox回归评价临床终点的预测因子。采用限制性立方样条(RCS)模型展示RC与MACE风险之间的剂量-效应关系。 [结果]完成随访3 112例,随访率为97.25%。其中青年组(＜45岁)160例,中年组(45～70岁)2 390例,老年组(≥70岁)562例。随访时间中位数7.36年。其中864例(27.8%)经历了MACE事件。KM曲线显示,RC不是全年龄段冠心病患者远期发生MACE的预测因子(P＞0.05),也不是中年组和老年组的预测因子(P＞0.05);KM曲线和Cox回归发现,RC是青年冠心病患者远期发生MACE的独立预测因子,青年冠心病患者的RC每升高1 mmol/L其发生MACE的风险增加1.07倍(HR=2.7,5%CI:1.35~3.17,P＜0.01);通过计算及验证,发现预测青年冠心病患者发生MACE的RC最佳截断值为0.94 mmol/L,RC＞0.94 mmol/L的青年冠心病患者MACE风险增加1.98倍(HR=2.8,5%CI:1.41~6.32,P＜0.01);反之,RC＜0.94 mmol/L的青年冠心病患者MACE风险降低66%(HR=0.4,5%CI:0.16~0.71,P＜0.01)。 [结论]高血浆RC水平是青年冠心病患者远期(7.36年)发生MACE的独立预测因子,该人群RC水平的最佳截断值为0.94 mmol/L,在此水平以下可使青年冠心病患者的MACE风险降低66%。     

The relationship between fetuin-A and coronary atherosclerotic heart disease (CHD) and CHD-related risk factors: A retrospective study

Fetuin-A plays an important role in antivascular calcification and inflammatory response, it is necessary to explore the relationship between fetuin-A and coronary atherosclerotic heart disease (CHD) and CHD-related risk factors.A total of 92 patients with CHD as the research group, and 60 healthy persons as the control group were enrolled from May 2019 to May 2020. Fetuin-A levels were determined by enzyme-linked immunosorbent assay, and the characteristics and clinical data were collected and compared. Logistic regression was used to analyze the factors influencing CHD.The age, proportion of males, patients with hypertension and diabetes, as well as fetuin-A level in the research group were significantly higher than those in the control group, but the high-density lipoprotein cholesterol level was significantly lower than that in the control group (P < .05). Logistic regression analysis and correction showed that gender, age, blood pressure, and diabetes were related to the onset of CHD, and there was a significant correlation between the level of fetuin-A and age (P < .05).Serum fetuin-A was related to the onset risk of CHD, and showed a significant correlation with age.     

Serumlipoprotein cholesterol in sedentary and trained male patients with coronary heart disease

To demonstrate the influence of exercise training on the lipoprotein cholesterol fractions (high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) cholesterol) in patients with coronary heart disease (CHD), 65 male patients were examined for cardiovascular function and lipid metabolism, before starting or after having participated in a coronary training group for more than one year. There were notable improvements not only in the physical performance data of the trained patients in reference to the tested maximal performance capacity per body weight (MPC/W) as well as the calculated heart volume performance ratio (HVPR) (MPC/W, +26.0%; HVPR, +18.0%), but also in the lipoprotein cholesterol values and the calculated risk quotient of HDL and total cholesterol (HDL cholesterol, +5.1 mg/dl; LDL cholesterol, +23.3 mg/dl; VLDL cholesterol, +12.5 mg/dl; HDL/total cholesterol, +0.038). The results indicate the positive effect of physical training on lipoprotein cholesterol concentrations, and also in CHD patients in coronary training groups.     

Triglyceride to high-density lipoprotein cholesterol ratio and risk of atherosclerotic cardiovascular disease in a Chinese population

Background and aimsTriglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio may play a role in predicting cardiovascular events. We aimed to prospectively explore the association between the TG/HDL-C ratio and atherosclerotic cardiovascular disease (ASCVD), ischemic stroke, as well as coronary heart disease (CHD) in a Chinese population.Methods and resultsThis prospective cohort study included 9368 participants from four Chinese populations in the People's Republic of China–United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology. Over a follow-up period of 20 years, 624 cases of ASCVD events including 458 ischemic stroke events and 166 CHD events were recorded. The relationship between the TG/HDL-C ratio and the endpoints was evaluated through multivariate Cox proportional hazard models adjusted for potential confounding variables, including age, sex, urban or rural residence, northern or southern China, occupational type, education, physical exercise, smoking status, drinking status, body mass index, hypertension, high low-density lipoprotein cholesterol, diabetes, and antihypertensive medication use at baseline. With the lowest TG/HDL-C tertile as the reference, the middle and highest tertiles had the hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.13 (0.91, 1.40), 1.36 (1.10, 1.67) respectively for ASCVD (p for trend = 0.0028), and 1.19 (0.93, 1.54),1.47 (1.15, 1.87) respectively for ischemic stroke (p for trend = 0.0016). However, no significant association was found for CHD events.ConclusionTG/HDL-C ratio was positively associated with the risk of ASCVD and ischemic stroke events in the Chinese population.     

胆固醇酯转运蛋白抑制剂对动脉粥样硬化性心血管疾病影响的研究进展

大量临床流行病学资料证实血浆低密度脂蛋白胆固醇水平升高及高密度脂蛋白胆固醇水平降低均是动脉粥样硬化性心血管疾病的独立危险因素。在生理过程中抑制胆固醇酯转运蛋白可以升高血浆高密度脂蛋白胆固醇水平,理论上可能具有抗动脉粥样硬化的作用。然而迄今为止,调节胆固醇酯转运蛋白的动物模型和临床研究结果不尽一致,以抑制胆固醇酯转运蛋白为基础的相关药物治疗选择带来了不确定性。文章从胆固醇酯转运蛋白在脂质代谢中的生理作用、部分动物研究中与动脉粥样硬化的关系以及临床应用对动脉粥样硬化性心血管疾病的影响等方面的最新研究进展进行综述。     

残余胆固醇对血压正常高值冠心病患者发生MACCE的临床预后价值

[目的]探讨残余胆固醇对血压正常高值冠心病患者发生主要不良心脑血管事件(MACCE)的预测价值。[方法]回顾性分析2004年—2014年在北部战区总医院心内科进行冠状动脉造影且血压处于血压正常高值的患者共421例。选取该队列中发生MACCE的血压正常高值患者97例为病例组,采用随机数字表筛选同队列中未发生MACCE的血压正常高值患者97例为对照组,并进行病例对照研究。[结果]病例组高盐饮食人数、糖尿病患者人数、左心室舒张期末内径、Gensini评分均高于对照组(分别为对照组的2.6、6.28、1.14、1.67倍),差异有统计学意义(P<0.05)。在血脂相关的指标中,病例组残余胆固醇、甘油三酯及总胆固醇水平均高于对照组(分别为对照组的1.41、1.38、1.07倍),差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,糖尿病(OR=14.84,95%CI为5.13～42.89,P<0.01)、高盐饮食(OR=6.46,95%CI为3.00～13.90,P<0.01)、残余胆固醇水平(OR=10.07,95%CI为2.89～35.05,P&l...     

Coronary risk factors,endothelial function,and atherosclerosis: A review

The traditional risk factors for coronary heart disease, which include hypercholesterolemia, hypertension, cigarette smoking, diabetes mellitus, and high-fat diet, have all been associated with impairments in endothelial function. Impaired endothelium function may promote the development of atherosclerosis through its effects on vasoregulation, platelet and monocyte adhesion, vascular smooth muscle cell growth, and coagulation. Increased oxidative stress may be another mechanism by which endothelial dysfunction contributes to atherosclerosis, although controversy exists on this issue. Risk factor modification, particularly lowering elevated concentrations of low-density lipoprotein cholesterol, improves endothelial function. At least seven clinical studies have demonstrated improved endothelial function with cholesterol reductions in patients with markedly elevated or even borderline elevations in cholesterol concentrations, whether or not coronary heart disease is present. Other interventions that improve endothelial function include blood pressure reduction, smoking cessation, and administration of estrogen to postmenopausal women.     

低水平高密度脂蛋白——冠心病独立危险因素

许多临床资料、流行病学研究发现,高密度脂蛋白与冠心病事件的发生率呈负相关,且支持低水平高密度脂蛋白是冠心病的独立危险因素。低水平高密度脂蛋白患者经药物治疗可以明显减少冠心病事件的发生率。     

Menopausal status and risk factors for cardiovascular disease

OBJECTIVES: Changes in cardiovascular risk factors with menopausal status are difficult to study, owing to the high correlation of menopausal status with age. Therefore we examined cardiovascular risk factors in a meticulously selected population in which the contrast in oestrogen status between pre- and postmenopausal women of the same age was maximized. DESIGN: Risk factors were compared in 93 premenopausal and 93 postmenopausal women who were matched on age (range 43-55 years). SETTING: The women were selected from respondents to a mailed questionnaire about the menopause, which was sent to all women aged 40-60 years in the Dutch town of Zoetermeer (n = 12 675; response 54%). SUBJECTS: Postmenopausal women who were at least 3 years after menopause or whose menses had stopped naturally before age 48 were age-matched with premenopausal women with regular menses and without menopausal complaints. RESULTS: Compared to premenopausal women, postmenopausal women had significantly increased levels of total cholesterol (10.0%, 95% confidence interval 5.1-14.0), low density lipoprotein (LDL) cholesterol (14.0%, 6.9-19.9), and apolipoprotein B (8.2%, 0.6-15.5). The difference was present within 3 years after onset of menopause and did not show a trend towards an increase with the number of postmenopausal years. No differences were found in high density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1, blood glucose, insulin, body mass index, waist-to-hip ratio, and systolic and diastolic blood pressure. CONCLUSIONS: The results of this study add to the evidence that total cholesterol, LDL cholesterol and apolipoprotein B are the primary cardiovascular risk factors affected by menopause.