标题：冠心病患者血清 sd-LDL和hs-CRP与冠状动脉狭窄程度的相关性研究

      作者：戴雯，李艳    (武汉大学人民医院检验医学中心，湖北 武汉 430000)

      卷次： 2017年28卷7期

      【摘要】 目的 比较冠心病患者与健康人群中血清小而密低密度脂蛋白(sd-LDL)、超敏 C反应蛋白(hs-CRP)水平的差异，探讨血清sd-LDL、hs-CRP水平与冠状动脉狭窄程度的关系。方法 选取2015年11月至2016年5月期间在武汉大学人民医院住院的冠心病患者542例，其中稳定心绞痛(SA) 247例、不稳定性心绞痛(UA) 115例、急性心肌梗塞(AMI) 180例，同时期同龄来院体检的健康对照者231例，使用全自动生化分析仪检测血清中sd-LDL与hs-CRP的水平，同时根据冠脉造影结果计算冠心病患者Gensini评分，评价冠状动脉的狭窄程度，使用成组 t检验分析各组间的差异，使用Spearman's相关性分析法分析sd-LDL、hs-CRP水平与Gensini评分的相关性。结果 与对照组相比，sd-LDL的水平在SA [(1.09±0.55) mmol/L vs (0.71±0.43) mmol/L，P<0.01]、UA[(1.11±0.58) mmol/L vs (0.71±0.43) mmol/L，P<0.01]和AMI组[(1.41±0.61) mmol/L vs (0.71±0.43) mmol/L，P<0.01]中均显著升高；AMI组中 sd-LDL的水平较SA组[(1.41±0.61) mmol/L vs (1.09±0.55) mmol/L，P<0.01]和UA [(1.41±0.61) mmol/L vs (1.11±0.58) mmol/L，P<0.01]显著升高。Spearman's相关性分析结果显示，sd-LDL与Gensini积分呈显著正相关(r=0.520 2，P<0.01)，hs-CRP与Gensini积分呈显著正相关(r=0.236 1，P<0.01)。结论 小而密低密度脂蛋白是冠心病的危险因素，与冠心病的临床分型和冠状动脉的狭窄程度密切相关。sd-LDL与hs-CRP联合检测对冠心病的风险预测及严重程度的判断均有重要的临床意义。
      【关键词】 冠心病；小而密低密度脂蛋白；超敏 C反应蛋白；Gensini评分；相关性
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2017）07—1045—03

Relationship among small dense low density lipoprotein, high sensitive C-reaction protein and the degree ofcoronary artery stenosis in patients with coronary heart disease.
DAI WEN, LI YAN. Department of ClinicalLaboratory, Renmin Hospital of Wuhan University, Wuhan 430000, Hubei, CHINA
【Abstract】 Objective To compare the differences in the serum level of small and dense low density lipopro-tein (sd-LDL) and high sensitive C-reaction protein (hs-CRP) between patients with coronary heart disease (CHD) andhealthy controls, and to analyze the relationship among sd-LDL, hs-CRP and the degree of coronary artery stenosis inCHD patients. Methods A total of 542 CHD patients and 231 healthy controls were selected. According to the clinicalclassification of CHD, we divided the patients into 3 groups: 247 in stable angina group (SA group), 115 in unstable angi-na group (UA group), and 180 in acute myocardial infarction group (AMI group). To evaluate the degree of coronary ar-tery stenosis, we calculated the Gensini score for all of the patients. Serum sd-LDL and hs-CRP were detected by an auto-matic biochemistry analyzer. We used SPSS19.0 to analyze the data. Results Compared with controls, the serum levelof sd-LDL in SA group [(1.09±0.55) mmol/L vs (0.71±0.43) mmol/L, P<0.01], UA group [(1.11±0.58) mmol/L vs (0.71±0.43) mmol/L, P<0.01] and AMI group [(1.41±0.61) mmol/L vs (0.71±0.43) mmol/L, P<0.01] increased significantly. InAMI group, the level of sd-LDL was higher than that in SA group [(1.41±0.61) mmol/L vs (1.09±0.55) mmol/L, P<0.01]and UA group [(1.41±0.61) mmol/L vs (1.11±0.58) mmol/L, P<0.01]. Spearman's analysis showed that both sd-LDL andhs-CRP had a positive correlation with Gensini score (r=0.520 2，P<0.01; r=0.236 1，P<0.01). Conclusion sd-LDL is anovel risk factor to CHD. It has a strong relationship with the clinical classification of CHD and degree of coronary ar-tery stenosis in CHD patients. Combined detection of sd-LDL and hs-CRP play a significant clinical role in the risk pre-diction and the severity evaluation in CHD.
      【Key words】 Coronary heart disease; Small dense low density lipoprotein-cholesterol; High sensitive C-reactionprotein (hs-CRP); Gensini score; Relationship·论 著·doi:10.3969/j.issn.1003-6350.2017.07.005基金项目：国家自然科学基金青年基金（编号：81501815）；武汉大学自主科研人才-青年教师资助项目（编号：2042015kf0066）