摘要目的 分析小而密低密度脂蛋白胆固醇(sdLDL-C)水平及sdLDL-C与高密度脂蛋白胆固醇(HDL-C)比值对急性冠状动脉综合征(ACS)发生的预测作用.方法 选取中国医科大学附属盛京医院2017年11月至2018年4月因急性胸痛住院,根据临床症状、心电图改变、心肌酶变化,并行冠状动脉造影明确诊断为ACS的患者268例,其中不稳定型心绞痛(UA)134例,急性心肌梗死(AMI)134例.选取同时期住院各基线资料均与ACS患者相匹配的非ACS患者66例为对照组.观察各组血脂指标,对ACS影响因素采用Logistic回归分析,并与传统血脂指标比较,分析sdLDL-C及sdLDL-C/HDL-C对ACS的预测作用.结果 ACS组sdLDL-C水平及sdLDL-C/HDL-C较对照组明显升高[0.88(0.70,1.09)mmol/L比0.61(0.41,0.84)mmol/L、0.98(0.72,1.30)比0.58 (0.40,0.86)],AMI组的sdLDL-C水平及sdLDL-C/HDL-C高于UA组[0.94(0.82,1.21)mmol/L比0.78(0.61,0.98)mmol/L、1.10(0.79,1.40)比0.86(0.62,1.19)],而UA组亦高于对照组[0.78(0.61, 0.98)mmol/L比0.61(0.41,0.84)mmol/L、0.86(0.62,1.19)比0.58(0.40,0.86)],差异均有统计学意义(P＜0.01).Logistic回归分析显示sdLDL-C水平为预测ACS的独立危险因素,与对照组相比, ACS组、UA组、AMI组OR值分别为26.85、15.19、74.40.相关性分析显示,sdLDL-C与总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平呈显著正相关(r＝0.697、0.684,P＜0.01),而控制了TC及LDL-C水平,sdLDL-C水平仍与ACS发生呈显著正相关(r＝0.185,P＝0.001).sdLDL-C≥0.613 mmol/L时预测ACS的敏感度和特异度分别为86.6%和51.5%,sdLDL-C/HDL-C≥0.938时预测ACS的敏感度和特异度分别为53.7%和87.9%.对ACS组中发生AMI行ROC曲线分析,以sdLDL-C的最佳临界值0.732 mmol/L将病例分为低危组及高危组,行Logistic回归分析,校正其他指标后得出高危组出现AMI的风险是低危组的4.84倍.结论 sdLDL-C及sdLDL-C/HDL-C的升高与ACS的发生密切相关,作为独立危险因素是其风险评估预测因子.

abstractsObjective To investigate the predictive effects of small dense low density lipoprotein cholesterol (sdLDL-C) level and sdLDL-C/high density lipoprotein cholesterol (HDL-C) ratio on the occurrence in patients with acute coronary syndrome (ACS). Methods Two hundred and sixty-eight patients with acute chest pain and diagnosed as ACS according to the clinical symptoms, changes in electrocardiogram and myocardial enzymes, and coronary angiography from November 2017 to April 2018 were enrolled. One hundred and thirty-four cases of unstable angina (UA) and 134 cases of acute myocardial infarction (AMI) were included. Meanwhile, 66 patients with non-ACS were selected as the control group. They baseline data were matched with those of ACS in the same period. Results The sdLDL-C levels and sdLDL-C/HDL-C of ACS patients were significantly increased [0.88(0.70, 1.09) mmol/L vs. 0.61(0.41, 0.84) mmol/L, 0.98(0.72, 1.30) vs. 0.58(0.40, 0.86)]. The sdLDL-C levels and sdLDL-C/HDL-C of AMI group were higher than those of UA group [0.94(0.82, 1.21) mmol/L vs. 0.78 (0.61, 0.98) mmol/L, 1.10(0.79, 1.40) vs. 0.86 (0.62, 1.19)], while those of UA group were also higher than those of the control group [0.78(0.61, 0.98) mmol/L vs. 0.61(0.41, 0.84) mmol/L, 0.86(0.62, 1.19) vs. 0.58(0.40, 0.86)]. There were significant differences (P＜0.01). Logistic regression analysis showed that sdLDL-C level was an independent risk factor for ACS prediction. Compared with those of the control group, the OR values of ACS group, UA group and AMI group were respectively 26.85, 15.19 and 74.40. Correlation analysis showed that sdLDL-C was significantly positively correlated with TC and LDL-C levels (r＝0.697, 0.684, P＜0.01), while it controlled TC and LDL-C levels, and sdLDL-C levels were still significantly positively correlated with ACS (r＝0.185, P＝0.001). ROC analysis revealed that sdLDL-C≥0.613 mmol/L had a sensitivity of 86.6% and specificity of 51.5%, and a sdLDL-C/HDL-C≥0.938 mmol/L had a sensitivity of 53.7% and specificity of 87.9%. ROC curve was used to analyze AMI in ACS group, and the best threshold sdLDL-C＝0.732 mmol/L divided the cases into low-risk groups and high-risk groups. Logistic regression analysis showed that, compared with the low-risk groups, the relative risk estimates of the AMI in the high-risk group was 4.84, after other indicators were adjusted. Conclusions sdLDL-C levels and sdLDL-C/HDL-C are closely related to the occurrence of ACS. As independent risk factors, they are risk assessment predictors for ACS.