【作者】 陈永；

【导师】 崔连群；

【作者基本信息】 山东大学 ， 内科学， 2009， 硕士

【摘要】 目的:探讨在男性无糖尿病史、吸烟史、家族史人群中,血脂水平与冠状动脉狭窄程度的相关关系,了解血脂水平在此类患者中的对冠状动脉狭窄程度的预测价值,为冠心病的预防与治疗提供依据。方法:采用回顾性病例分析,查阅2007年1月至2007年12月在山东省立医院介入中心行冠状动脉造影检查患者共计842例,选择符合条件的患者96例。取空腹血浆,测定TC、TG、HDL-C、LDL-C、ApoAI、ApoB、Lp(a)、FBG、DB、TB、UA,并记录年龄、血压等临床资料,采用GS计算冠状动脉狭窄程度。依据狭窄程度大于50%的主要血管支数,分为对照组、单支、双支、多支病变组;依据GS值由低到高排序,以四分位数为节点分为0-16、17-40、41-72及74以上组。分析在各分组中血脂各成份与冠状动脉病变程度的相关关系及各血脂间,血脂与其他因素间相互作用对冠状动脉狭窄程度的影响。结果:TC、LDL-C、年龄在多支病变组均显著高于其他各组,并与冠状动脉狭窄支数成显著性正相关(P＜0.001);DB在多支病变组显著低于其他各组,并与冠状动脉狭窄支数成显著性负相关(P=0.010);ApoB、Lp(a)与冠状动脉狭窄支数成正相关,P值分别为0.014、0.024,但两者在不同冠状动脉狭窄支数间差异均未达到统计学显著性;TG、HDL-C、ApoAI、FBG、TB、UA及血压与冠状动脉狭窄支数间相关性无统计学意义。不同GS组间,TC、LDL-C均存在显著性差异(P＜0.05),在偏相关分析中与GS成显著性正相关,P值分别为0.036,0.001;Lp(a)、年龄在不同GS组间差异明显(P＜0.05),但随分值的增加表现出先增加后降低趋势,最高值分别位于17-40及41-74组,与GS的偏相关关系未达到统计学意义;TG、HDL-C、ApoAI、ApoB、FBG、DB、TB、UA及血压在不同GS组间差异均无统计学意义,且偏相关关系均未达到统计学显著性。多元线性回归显示:男性GS受年龄、脉压、FBG、HDL-C、LDL-C影响显著,回归方程为:GS=1.061年龄-0.799脉压+9.401 FBG-15.657 HDL-C+18.992 LDL-C-58.466。结论:TC、LDL-C、Lp(a)、ApoB与冠状动脉狭窄程度之间存在正相关关系,HDL-C与冠状动脉狭窄程度呈负相关,TG、ApoAI在本研究中未得出与冠状动脉狭窄程度间存在相关性;血脂水平可以预测冠状动脉狭窄的严重程度,尤其是TC及LDL-C。更多还原

【Abstract】 Objectives Investigating the correlation between serum lipids concentration and existence as well as severity of coronary atherosclerosis in the men with no diabetes mellitus, Cigarette smoking and family history, to help identify the predicting value of serum lipids concentration in these people and provide evidence for the prevention and therapeutics of coronary artery disease.Methods A retrospective study was conducted on 96 patients fitting the admission standards from the 842 ones who underwent their first angiography in the Intervention Center of Shandong Provincial Hospital between January and December in 2007. Fasting serum concentrations of TC,TG,HDL-C,LDL-C, Lp(a),ApoAI,ApoB, FBG,DB,TB,UA were measured, also the Age, Blood pressure and other clinical data were collected; the severity of coronary artery stenosis was evaluated by the GS. All patients were classified as control group, single-vessel group, double-vessel group and multiple-vessel group, according to the number of main coronary arteries which stenosis was more than 50% diameter; and were assigned into the following quartiles: 0-16,17-40, 41-72,and above 74, according to the GS. The correlativity between every serum lipids concentration and the extent of coronary artery stenosis were analyzed and the interaction between serum lipids and other factors were also studied to identify the their influence to the severity of coronary artery stenosis.Results TC, LDL-C and Age were significantly higher in the multiple-vessel group than in the other group, and were demonstrated to be highly significantly (P<0.001) associated with the number of stenotic coronary arteries; DB was significantly lower in the multiple-vessel group than in the other group and had a significant negative correlation with the number of stenotic coronary arteries (P=0.010); ApoB, Lp(a) had positive correlation with the number of stenotic coronary arteries(P=0.014 and 0.024, respectively), but the differences between the groups had no significance; There were no relationship between the number of stenotic coronary arteries and TG,HDL-C, ApoAI, FBG,TB,UA, Blood Pressure. TC and LDL-C had no significant difference between different GS groups, but significant positive correlation with the GS in the partial correlation analysis (P=0.036 and 0.001, respectively); The partial correlativity between Lp(a),Age and the GS had no significance, but the differences between distinct GS groups were significant, and highest value were located in 17-40 and 41-74 group respectively; Other observed factors had no significance not only in the comparison between different GS groups, but also in the partial correlation analysis with the GS. By multiple linear regression, there were significant relationships between Age, pulse pressure, FBG, HDL-C, LDL-C and GS in men. The regression equation was: GS=1.061age-0.799pulse pressure+9.401FBG-15.657HDL-C+18.992LDL-C-58.466.Conclusions There was a negative correlation for HDL-C, and positive correlations for TC, LDL-C, Lp(a), ApoB, and no significant correlation for TG, ApoAI, with the severity of coronary stenosis; The serum lipids concentration can predict the severity of coronary, especially the TC and LDL-C.更多还原