探究血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与颈动脉斑块的关系论文_铁崴

探究血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与颈动脉斑块的关系论文_铁崴

铁崴

黑龙江省佳木斯市妇幼保健院 154002

摘要:目的 探讨并分析血清同型半胱氨酸(Hcy)和小而密低密度脂蛋白胆固醇(sdLDL-C)对颈动脉粥样硬化斑块的影响。方法 此次研究的对象是选择2015年6月~2017年12月在我院住院的患者302例,将其临床资料进行回顾性分析,并按是否有颈动脉斑块分为正常组140例,斑块组162例。所有患者均行颈动脉超声检测,详细询问有无吸烟、饮酒、脑卒中、糖尿病、高血脂、冠心病等病史,检测患者血糖(GLU)、尿酸(UA)、三酰甘油(TG)、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)、sdLDL-C、Hcy水平。将斑块组中有一处斑块形成的患者纳入单发斑块组,有两处斑块形成的患者纳入双发斑块组,有大于两处斑块形成的患者纳入多发斑块组,进行三组间sdLDL-C、Hcy水平比较。结果 斑块组吸烟人数、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C水平较正常组高,差异有统计意义(P < 0.05);颈动脉斑块形成的独立危险因素为吸烟、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C(P < 0.05);组间Hcy、sdLDL-C水平由高到低排序依次为多发斑块组、双发斑块组、单发斑块组,差异有高度统计学意义(P < 0.01)。结论 Hcy、sdLDL-C为颈动脉粥样硬化的独立危险因素,两者与粥样硬化斑块的数量具有一致性。联合检测两者对心脑血管疾病的预防和干预有重要意义。

关键词:小而密低密度脂蛋白胆固醇;同型半胱氨酸;颈动脉粥样硬化;危险因素

Objective to investigate and analyze the effects of serum homocysteine(Hcy)and small dense low density lipoprotein cholesterol(sdLDL-C)on carotid atherosclerotic plaques. Methods the objective of this study was to select 302 patients hospitalized in our hospital from June 2015 to December 2017. The clinical data were analyzed retrospectively,and 140 cases in the normal group and 162 cases in the plaque group were divided into the carotid artery plaque. All patients were examined by carotid artery ultrasound,and the history of smoking,drinking,stroke,diabetes,hyperlipidemia,and coronary heart disease were examined in detail,and the blood glucose(GLU),uric acid(UA),three acylglycerol(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL)were examined. HDL-C),sdLDL-C,Hcy level. The patients with one plaque formation in the plaque group were included in the single plaque group. The patients with two plaque formation were included in the double hair plaque group. The patients with more than two plaque formation were included in the multiple plaque group,and the levels of sdLDL-C and Hcy were compared between the three groups. Results the level of smoking,systolic pressure,UA,GLU,Hcy,LDL-C and sdLDL-C in the plaque group was higher than that in the normal group,and the difference was statistically significant(P < 0.05). The independent risk factors for the formation of carotid artery plaque were smoking,systolic pressure,UA,GLU,Hcy,LDL-C,sdLDL-C(P < 0.05). The times were multiple plaque group,double plaque group and single plaque group. The difference was statistically significant(P < 0.01). Conclusion Hcy and sdLDL-C are independent risk factors for carotid atherosclerosis,and they are consistent with the number of atherosclerotic plaques. Combined detection is of great significance for prevention and intervention of cardiovascular and cerebrovascular diseases.

Small and dense low density lipoprotein cholesterol;homocysteine;carotid atherosclerosis;risk factors

随着我国人民生活水平的提高,心脑血管疾病日益增多。动脉粥样硬化(atherosclerosis,AS)是一种慢性、全身血管性疾病,其中,颈动脉粥样硬化(carotid atherosclerosis,CAS)为反映全身动脉粥样硬化的窗口已经得到证实。引起AS传统的危险因素包括高血压、高血脂、高血糖、年龄、性别、吸烟、饮酒等。近年来也有研究证实,血中同型半胱氨酸(homocysteine,Hcy)、小而密低密度脂蛋白胆固醇(small and dense low-density lipoprotein,sdLDL-C)可能与AS有关[1-2]。本文主要探讨Hcy、sdLDL-C与CAS的相关性,以期为临床预防及干预提供依据。

1 对象与方法

1.1 研究对象

选择2015年6月~2016年12月我院住院的患者302例,平均年龄(68.5±12.8)岁。按是否有颈动脉斑块分为正常组140例,其中男65例,女75例,平均年龄(64.8±10.5)岁;斑块组162例,其中男74例,女88例,平均年龄(65.2±10.1)岁。所有患者均行颈动脉超声检测;详细询问有无吸烟、饮酒、脑卒中、糖尿病、高血脂、冠心病等病史;检测患者血糖(glucose,GLU)、尿酸(uric acid,UA)、三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、Hcy、sdLDL-C水平。入选标准:有明确高血压病史,3次不同时间平均收缩压≥140 mmHg 和/或舒张压≥90 mmHg(1 mmHg=0.133 kPa);糖尿病诊断符合WHO诊断标准;近2个月未服用降脂药物。排除标准:甲状腺疾病、急慢性肝肾功能不全、免疫系统疾病、肿瘤、急性感染性疾病。本研究经我院伦理委员会通过,所有患者知情同意并签署知情同意书。

1.2 标本采集和检测

采集患者清晨空腹静脉血5 mL,3000 r/min离心30 min分离血清,离心半径为13.5 cm。全自动生化分析仪立即检测GLU、UA、Hcy、TG、TC、LDL-C、HDL-C、sdLDL-C,试剂盒和校准品由日本积水株式会社提供;全自动生化分析仪为日立7600-020。

1.3 颈动脉超声检查

应用飞利浦iU22双功能彩色多普勒超声仪,L9-3超宽频带线阵探头,频率3~9 MHz,轴分辨率为0.01 mm,以颈总动脉作为测量部位。患者取平卧位,头部偏向检查对侧,充分暴露颈部,从锁骨内侧端横向检查颈总动脉,发现局限性回声结构突出管腔(回声结构可不均匀或伴声影),厚度> 1.5 mm为斑块形成。检测部位一般为颈总动脉的远端、颈内动脉起始部和颈动脉分叉处。仔细观察有无斑块,斑块的部位、形态、大小、数量及性质。3处检查部位任一处有斑块形成纳入单发斑块组,有两处斑块形成纳入双发斑块组,大于两处斑块形成纳入多发斑块组。

1.4 统计学方法

采用SPSS 17.0统计学软件进行数据分析,计量资料数据用均数±标准差(x±s)表示,两组间比较采用t检验;多组间比较采用单因素方差分析,组间两两比较采用LSD-t检验;而对于未满足正态分布的计量资料,采用非参数统计分析,描述以中位数(M)、25%和75%区间(P25,P75)表示;计数资料用率表示,组间比较采用χ2检验;以Logistic回归分析筛选颈动脉斑块的独立危险因素。以P < 0.05为差异有统计学意义。

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2 结果

2.1 两组一般资料比较

两组年龄、性别、饮酒、舒张压、TG、TC、HDL-C等一般资料比较,差异均无统计学意义(P > 0.05);斑块组吸烟人数、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C水平较正常组高,差异有统计学意义(P < 0.05)。

2.2 颈动脉斑块影响因素的多因素Logistic回归分析

以吸烟、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C为自变量,采用多因素Logistic回归分析,结果显示,吸烟、收缩压、UA、GLU、Hcy、LDL-C、sdLDL-C均是颈动脉斑块形成的独立危险因素(P < 0.05)。

2.3 不同斑块组间Hcy、sdLDL-C比较

采用方差分析比较不同斑块组间Hcy、sdLDL-C水平,结果显示,差异均有高度统计学意义(P < 0.01);三组间两两比较发现,Hcy、sdLDL-C浓度由高到低依次为多发斑块组、双发斑块组、单发斑块组,差异有高度统计学意义(P < 0.01)。

3 讨论

随着人们生活水平的提高和饮食习惯的改变,AS已成为我国死亡的首要原因。AS是一种慢性、累及全身血管的疾病,颈动脉也是最容易受影响的大血管之一。有研究表明,CAS与脑血管病的发生明显相关[3-4]。CAS斑块数目与冠脉病变数目密切相关。因此,CAS斑块可作为冠状动脉心脏疾病的可靠预测指标。CAS斑块的传统危险因素包括血脂异常、糖尿病、高血压、吸烟、年龄和性别、遗传因素、饮酒、高尿酸血症等。我国心脑血管疾病发病率逐年上升,可能传统的危险因素难以解释,因此,本文探讨Hcy、sdLDL-C与CAS的相关性,以期为临床预防提供依据。

Hcy是一种反应性血管损伤性氨基酸。血浆中高含量的Hcy可能与AS有关。正常生理情况下,Hcy的代谢处于动态平衡状态,维持体内含硫氨基酸的平衡。任何原因引起上述代谢途径障碍时,都会出现体内Hcy的蓄积,发生高同型半胱氨酸血症。随着Hcy水平的增高,发生脑梗死的危险性及严重程度增加[5-7]。sdLDL-C被认为是致AS的脂蛋白。颈动脉斑块是预测心脑血管疾病的主要因素之一,因而,寻找颈动脉斑块形成的相关危险因素,给予及早干预,减少斑块的形成,对预防心脑血管疾病的发生有重要意义[8-10]。

本研究发现,斑块组Hcy、sdLDL-C水平明显高于正常组,差异有统计学意义(P < 0.05);多因素Logistic回归分析表明,Hcy、sdLDL-C为颈动脉斑块形成独立危险因素,提示Hcy、sdLDL-C有致CAS的作用。本研究结果与其他国内外研究结果一致[11-15]。比较多发斑块组、双发斑块组、单发斑块组间Hcy、sdLDL-C水平,结果显示,Hcy、sdLDL-C水平依次为多发斑块组>双发斑块>单发斑块组,差异有高度统计学意义(P < 0.01),提示Hcy、sdLDL-C水平与斑块数量具有一致性。

综上所述,Hcy、sdLDL-C为CAS的独立危险因素,两者与斑块数量具有一致性。联合检测Hcy和sdLDL-C对心脑血管疾病的预防和干预有重要意义。

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论文作者:铁崴

论文发表刊物:《中国误诊学杂志》2018年6月17期

论文发表时间:2018/8/21

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探究血清小而密低密度脂蛋白胆固醇和同型半胱氨酸与颈动脉斑块的关系论文_铁崴
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