北京社区体检人群餐后与空腹血脂水平的比较分析及意义

目的:探讨非空腹血脂异常判定标准在北京社区人群中应用的可行性。方法:采用自身对照研究。中国中医科学院广安门医院检验科于2018年1至10月招募社区体检者839名(男性292名,女性547名),年龄中位数(四分位间距)为60(54, 66)岁,同时检测空腹和标准餐后4 h血脂谱水平,采用配对 t检验或者配对非参数检验比较空腹和餐后4 h血脂水平,空腹血脂分层下的餐后4 h血脂水平变化和餐后血脂异常百分比分别采用方差分析和卡方检验分析。 结果:与空腹相比,餐后4 h血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、载脂蛋白A1(ApoA1)降低和载脂蛋白B(ApoB)轻微降低,残粒脂蛋白胆固醇(RLP-C)升高0.27 mmol/L、甘油三酯(TG)升高0.72 mmol/L,差异均有统计学意义( t值或 Z值分别为10.26, 22.94, 24.22, 4.71, 16.61, 26.92, -23.58, -19.35, P<0. 05)。参照国外非空腹血脂异常截断值标准,空腹合适水平组TC、LDL-C、HDL-C、non-HDL-C、TG和RLP-C分别有10.0%、16.6%、10.1%、12.3%、30.0%和34.9%的人群处于餐后血脂异常升高水平。TC、LDL-C、non-HDL-C和HDL-C的餐后4 h变化程度均随空腹水平的升高而增加( F值分别为9.50, 6.18, 8.07, 3.86, P<0.01),最大变化程度TC≤3.5%、LDL-C≤6.8%、non-HDL-C≤2.9%、HDL-C≤6.3%;RLP-C的餐后4 h变化程度随空腹水平的升高而减少(50.8% vs. 33.2%, F=10.40, P<0.01),TG的餐后4 h变化程度随空腹水平的升高先增加后减少(51.3% vs. 57.9% vs. 39.2%, F=19.05, P<0.01)。在空腹血脂异常分层标准基础上建立餐后4 h血脂异常浓度截断值为TC≥5.1 mmol/L、LDL-C≥3.2 mmol/L、HDL-C≤0.9 mmol/L、non-HDL-C≥4.0 mmol/L和RLP-C≥1.0 mmol/L,TG边缘升高和升高组截断值分别为≥2.2 mmol/L和≥3.4 mmol/L。 结论:初步建立社区人群餐后TC、LDL-C、HDL-C、non-HDL-C和RLP-C的异常浓度截断值,可应用于体检人群常规血脂谱评价;建议餐后TG采取不同水平的异常浓度截断值进行分层管理。

Comparison and application of postprandial and fasting blood lipid levels in 839 physical examinees in Beijing

Objective To investigate the feasibility of application of non-fasting dyslipidemia cutoff values in community population.Methods Self-control study was used.839 physical examinees(292 males and 547 females)were recruited in clinical laboratory of Guang′an men Hospital from January to October 2018.The median(interquartile range)of age was 60(54,66)years.Blood samples were collected before and at 4 h after a standard breakfast.Comparison of fasting and postprandial lipoprotein levels was performed using Paired-Samples T Test or Two-Related-Samples Wilcoxon.The changes of 4-hour postprandial blood lipid levels and the percentages of postprandial dyslipidemia according to different stratification of fasting dyslipidemia were performed using one-way ANOVA and χ² test,respectively.Results Compared with fasting,4-hour postprandial total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),non-high density lipoprotein cholesterol(non-HDL-C),apolipoprotein A1(ApoA1)and apolipoprotein B(ApoB)decreased slightly,postprandial triglyceride(TG)increased by 0.72 mmol/L,and postprandial remnant-like lipoprotein cholesterol(RLP-C)increased by 0.27 mmol/L(t or Z values=10.26,22.94,24.22,4.71,16.61,26.92,-23.58,-19.35,P<0.05,respectively).According to the non-fasting dyslipidemia cut-off values recommended by the European consensus,there were 10%,16.6%,10.1%,12.3%,30%and 34.9%of the population in the appropriate levels of fasting TC,LDL-C,HDL-C,non-HDL-C,TG and RLP-C distributed in elevated levels of postprandial,respectively.The changes of 4-hour postprandial TC,LDL-C,non-HDL-C and HDL-C increased with the elevation of fasting level(F=9.50,6.18,8.07,3.86,P<0.01),and the maximum changes of TC≤3.5%,LDL-C≤6.8%,non-HDL-C≤2.9%,HDL-C≤6.3%;the change of 4-hour postprandial TG increased slightly first and then decreased significantly(51.3%vs.57.9%vs.39.2%,F=19.05,P<0.01);the change of 4-hour postprandial RLP-C decreased(50.8%vs.33.2%,F=10.40,P<0.01).The cut-off values of 4-hour postprandial dyslipidemia were TC≥5.1 mmol/L,LDL-C≥3.2 mmol/L,HDL-C≤0.9 mmol/L,non-HDL-C≥4.0 mmol/L and RLP-C≥1.0 mmol/L.The cut-off values of borderline elevated and elevated TG levels were≥2.2 mmol/L and≥3.4 mmol/L,respectively.Conclusions The cut-off values of postprandial dyslipidemia including TC,LDL-C,HDL-C,non-HDL-C and RLP-C were preliminarily established in community population,which could be applied to the routine lipid profile evaluation in the physical examination population.And it might be needed that postprandial TG was managed hierarchically according to different cut-off values.