急性心肌梗死不同危险因素人群血脂异常特点

目的分析急性心肌梗死患者的血脂水平,探讨合并不同危险因素的急性心肌梗死患者的血脂水平有无差异及各自的血脂异常特点。方法 2009年5月至2010年5月收集符合入选标准的急性心肌梗死患者110例,检测血脂水平。根据不同危险因素分别将其分为:低龄组与高龄组;男性组与女性组;高血压组与非高血压组;空腹血糖正常组与空腹血糖异常组,将各组内的血脂指标进行对照分析。结果低龄组共73例,其中男51例,女22例;高龄组共37例,其中男17例,女20例。二者的性别比差异有统计学意义(P<0.05)。低龄组TG(1.47±1.04)mmol/Lvs.(1.05±0.41)mmol/L]、LDL/HDL(2.69±0.92vs.2.32±0.85)和TG/HDL(1.41±1.19vs.0.93±0.45)较高龄组高(P值均<0.05),而其他血脂指标包括TC、HDL、LDL、TC/HDL、N-HDL、脂蛋白(a)、载脂蛋白A、载脂蛋白B]两组比较差异无统计学意义(P值均>0.05)。急性心肌梗死的男性发病年龄明显早于女性(63.18±15.04)岁vs.(74.36±11.23)岁,P<0.01]。女性组TC(4.84±1.25)mmol/Lvs.(4.41±0.94)mmol/L]和HDL(1.28±0.36)mmol/Lvs.1.09±0.24)mmol/L]均高于男性组(P值均<0.05),其他血脂指标两组比较差异无统计学意义(P>0.05)。急性心肌梗死患者中有58.18%合并有高血压。高血压组与非高血压组比较在性别比和平均年龄上差异均无统计学意义(P>0.05)。高血压组的TC(4.81±1.09)mmol/Lvs.(4.25±0.99)mmol/L]、LDL(3.00±0.89)mmol/Lvs.(2.63±0.87)mmol/L]、TG(1.47±1.10)mmol/Lvs.(1.13±0.46)mmol/L]及N-HDL(3.61±1.04)mmol/Lvs.(3.13±0.94)mmol/L]均明显高于非高血压组(P值均<0.05),其他血脂指标两组比较差异无统计学意义(P值均>0.05)。空腹血糖正常组与空腹血糖异常组比较在性别比和平均年龄差异无统计学意义,但TC(4.87±1.18)mmol/Lvs.(4.38±0.97)mmol/L],TG(1.63±1.24)mmol/Lvs.(1.12±0.50)mmol/L]和TG/HDL(1.52±1.41vs.1.07±0.61),N-HDL(3.70±1.04)mmol/Lvs.(3.22±0.98)mmol/L]在空腹血糖异常组明显高于空腹血糖正常组(P值均<0.05)。结论合并与不合并某种危险因素的急性心肌梗死患者间的血脂水平(包括常规血脂四项TC、HDL、LDL、TG和"总坏胆固醇"及"胆固醇比")存在差异,高血压和空腹血糖升高能增高急性心肌梗死患者"坏胆固醇"水平及"胆固醇比",从而有间接促进动脉粥样硬化的作用。

Association of dyslipidemia and concomitant risk factors in patients of acute myocardial infarction

Objective To test whether there were statistical differences in lipid levels between groups with and without certain risk factor,and further to investigate the association of dyslipidemia and concomitant risk factors in patients of acute myocardial infarction（AMI）.Methods 110 cases of acute myocardial infarction were collected from May 2009 to May 2010.Serum lipid parameters were assayed,such as total cholesterol（TC）,high density lipoprotein（HDL）,low density lipoprotein（LDL）,lipoprotein（a）,apolipoprotein A and apolipoprotein B.All patients were separately divided into four kinds of group according to different risk factors,Younger group and elder group,Male group and female group,Hypertension group and non-hypertension group,Normal fasting blood-glucose（FBG）group and impaired fasting blood-glucose group.Contrast analysis of serum lipid parameters were performed on each group independently.Results Group Younger contained 51 male and 22 female patients,but Group Elder contained 17 males and 20 females.Significant difference（P0.05）were observed in sex ratio between these two groups.Lipid parameters like TG（1.47±1.04）mmol/L vs.（1.05±0.41）mmol/L,LDL/HDL（2.69±0.92 vs.2.32±0.85）and TG/HDL（1.41±1.19 vs.0.93±0.45）were higher in Group Younger than those in Group Elder（P values0.05）,whereas other lipid parameters including TC,HDL,LDL,TC/HDL,N-HDL,lipoprotein（a）,apolipoprotein A and apolipoprotein B showing no difference（P values 0.05）.The onset age of AMI was significantly earlier in Group Male than that in Group Female（63.18 ±15.04）mmol/L vs.（74.36±11.23）mmol/L,P0.01.TC（4.84±1.25）mmol/L vs.（4.41±0.94）mmol/L and HDL（1.28±0.36）mmol/L vs.（1.09±0.24）mmol/L were higher in Group Female than those in Group Male（P values 0.05）,while the other lipid parameters had no statistical difference between the two groups（P values 0.05）.58.18% of AMI patients were concomitant with high blood pressure.There weren＇t statistical differences in sex ratio and average age between Group Hypertension and Group Non-Hypertension,but TC（4.81±1.09）mmol/L vs.（4.25±0.99）mmol/L,LDL（3.00±0.89）mmol/L vs.（2.63±0.87）mmol/L,TG（1.47±1.10）mmol/L vs.（1.13±0.46）mmol/L and N-HDL（3.61±1.04）mmol/L vs.（3.13±0.94）mmol/L were significantly higher in Group Hypertension（P values 0.05）.Comparing with Group Normal FBG,Group Impaired FBG had higher levels of TC（4.87±1.18）mmol/L vs.（4.38±0.97）mmol/L,TG（1.63±1.24）mmol/L vs.（1.12±0.50）mmol/L,TG/HDL（1.52±1.41 vs.1.07±0.61）and N-HDL（3.70±1.04）mmol/L vs.（3.22±0.98）mmol/L（P values 0.05）,without statistical difference in either sex ratio or average age.Conclusions There were statistical differences in lipid parameters（i.e.TC,HDL,LDL,TG,＂total bad cholesterol＂ and ＂cholesterol ratio＂）between groups with and without certain risk factor.Hypertension and impaired FBG increased ＂bad cholesterol＂ and ＂cholesterol ratio＂,subsequently contributing to atherosclerosis.