动脉粥样硬化患者高同型半胱氨酸血症与胆固醇逆向转运的关系

目的　探讨高同型半胱氨酸（high homocysteine, HHcy）对动脉粥样硬化（atherosclerosis, AS）患者血脂和卵磷脂胆固醇酰基转移酶（lecithin cholesterol acyl transferase, LCAT）的影响。方法　选取2018 年9 月~2019 年6 月诊断有颈动脉粥样硬化的185 例患者作为研究对象。根据患者是否存在HHcy，分为HHcy 组和对照组。测定同型半胱氨酸（homocysteine, Hcy）、血脂水平和LCAT 浓度，分析Hcy 水平与血脂水平及LCAT 浓度的相关性。结果　HHcy 组高密度脂蛋白胆固醇（high density lipoprotein cholesterol, HDL-C）、载脂蛋白A Ⅰ（apolipoprotein A Ⅰ , ApoA Ⅰ）水平和LACT 浓度显著低于对照组，差异均具有统计学意义（t =2.318，2.405，2.484，均P ＜ 0.05）；HHcy 组Hcy 水平显著高于对照组，差异具有统计学意义（t =11.266，P ＜ 0.001）。Hcy 水平与HDL-C，ApoA Ⅰ水平和LCAT 浓度均呈负相关（r = － 0.197，P =0.008；r = － 0.212，P =0.006；r = － 0.221，P =0.005）。结论　HHcy 是AS 的一个独立危险因素。HHcy 可能通过降低ApoA Ⅰ，HDL 和LCAT 水平，影响它们在胆固醇逆向转运（reverse cholesterol transport, RCT）中的作用，从而促进AS 的发生与发展。

Relationship between Hyperhomocysteinemia and Reverse CholesterolTransport in Patients with Atherosclerosis

Objective　To investigate the effect of high homocysteine (HHcy) on blood lipid and lecithin cholesterol acyltransferase (LCAT) in patients with atherosclerosis (AS). Methods　185 cases of patients with carotid artery AS plaquediagnosed by neck doppler ultrasound in the department of neurology of Xi’an Central Hospital from September 2018 to June2019 were selected as the research objects. According to the presence or absence of HHcy, the patients were divided into HHcygroup and control group. The levels of homocysteine (Hcy) and blood lipid and the concentration of LCAT were detected. Thecorrelations between the level of Hcy and the level of blood lipid and the concentration of LCAT were analyzed. Results　Thelevels of high density lipoprotein cholesterol (HDL-C) and apolipoprotein A Ⅰ (ApoA Ⅰ ) and the concentration of LACT in theHHcy group were significantly lower than that in the control group,and the differences were statistically significant (t =2.318, 2.405,2.484, all P ＜ 0.05). The level of Hcy was significantly higher than that in the control group, and the difference was statisticallysignificant (t =11.266，P ＜ 0.001). The level of Hcy was negatively correlated with the levels of HDL-C, ApoA Ⅰ and theconcentration of LACT (r = － 0.197，P =0.008；r = － 0.212, P =0.006；r = － 0.221, P =0.005). Conclusion　HHcy is anindependent risk factor for AS. HHcy may affect the function of ApoA Ⅰ , HDL and LCAT in reverse cholesterol transport (RCT)by reducing their levels, thereby promoting the occurrence and development of AS.