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目的分析正常血浆高密度脂蛋白胆固醇(HDL-C)水平的冠心病患者的高密度脂蛋白(HDL)亚类组成含量的变化,为临床选择性调整血浆HDL亚类的组成含量,减少冠心病患者发生主要心血管事件(MACE)提供理论依据。方法选取2014年1月至2015年12月于中山大学孙逸仙纪念医院心内科住院、经冠状动脉造影诊断为冠心病且出院时血浆HDL-C水平在正常范围(0.80~1.96 mmol/L)的184例冠心病患者为研究对象,以是否发生MACE分为MACE组和非MACE组。另随机抽取该院体检中心健康体检者20例作为对照组。所有患者出院后给予冠心病二级预防规范治疗,并随访1年,观察出院后1年内首发的MACE情况。于出院当天和出院后1年检测患者血脂水平并测定HDL分类,对照组检测血脂水平并测定HDL亚类。用SPSS 10.0软件进行统计学分析,同组治疗前后比较用配对t检验,两组间比较用独立样本t检验,HDL与血脂水平间相关关系采用直线相关分析。结果出院后1年内,184例患者中发生MACE 58例,占31.5%。两组患者出院时HDL-C、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)水平,差异均无统计学意义(P>0.05)。与对照组比较,患者出院时HDL亚类中小颗粒的前β1-HDL、前β2-HDL水平明显上升,大颗粒的HDL2a、HDL2b水平明显下降,差异均有统计学意义(P<0.05)。出院当天,MACE组的前β1-HDL、前β2-HDL水平较非MACE组明显上升,HDL2b水平明显下降,差异均有统计学意义(P<0.05)。出院当天MACE组的HDL-C水平与各HDL亚类水平无相关性(P>0.05)。出院后1年,两组冠心病患者的TC、LDL-C、TG水平分别与出院当天比较,均明显下降,差异均有统计学意义(P<0.05)。出院后1年,两组冠心病患者的HDL各亚类水平分别与出院当天比较,差异均无统计学意义(P>0.05)。结论血浆HDL-C水平正常1年内再发MACE的冠心病患者的HDL亚类组成含量明显异常,使胆固醇转运及清除障碍,可导致MACE发生。对冠心病患者进行1年的他汀类治疗可明显改善血脂水平,但未明显调整患者HDL亚类分布。
Objective To analyze the changes of the content of HDL subclasses in patients with coronary heart disease (HDL-C) with normal plasma concentrations of HDL-C for the purpose of selectively adjusting the content of plasma HDL subclasses and reducing the incidence of coronary heart disease Patients with major cardiovascular events (MACE) provide a theoretical basis. Methods From January 2014 to December 2015, patients were hospitalized in Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, and were diagnosed as coronary heart disease by coronary angiography. The plasma HDL-C levels in the normal range (0.80-1.96 mmol / L) Patients with coronary heart disease as the research object, whether MACE is divided into MACE group and non-MACE group. Another randomly selected physical examination center in the hospital 20 cases of physical examination as a control group. All patients were given secondary preventive treatment of coronary heart disease after discharge and were followed up for 1 year to observe the first episode of MACE within 1 year after discharge. On the day of discharge and 1 year after discharge, the levels of serum lipids were measured and the HDL classification was determined. The control group was tested for serum lipid levels and HDL subclasses. SPSS 10.0 software was used for statistical analysis. The paired t-test was used to compare the two groups before and after treatment. The independent sample t-test was used to compare the two groups. The correlation between HDL and blood lipid level was analyzed by linear correlation analysis. Results Within 1 year after discharge, MACE occurred in 184 patients (31.5%). HDL-C, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels were not significantly different between the two groups at discharge (P> 0.05). Compared with the control group, the levels of pre-β1-HDL and pre-β2-HDL of small particles in HDL subclasses were significantly increased at the time of discharge, and the levels of HDL2a and HDL2b in large particles were significantly decreased (P <0.05). On the day of discharge, the levels of pre-β1-HDL and pre-β2-HDL in MACE group were significantly higher than those in non-MACE group, while the levels of HDL2b were significantly decreased in MACE group (P <0.05). On the day of discharge, HDL-C level in MACE group had no correlation with each HDL subclass (P> 0.05). One year after discharge, the levels of TC, LDL-C and TG in two groups of patients with coronary heart disease were significantly lower than those on the day of discharge, respectively, and the differences were statistically significant (P <0.05). One year after discharge, there was no significant difference in HDL subclass levels between the two groups of patients with coronary heart disease and discharge day (P> 0.05). Conclusion HDL-C levels in patients with normal coronary heart disease within one year after re-development of MACE are significantly abnormal in terms of HDL subclass composition, which may result in the occurrence of MACE in cholesterol transport and clearance disorders. One-year statin treatment of patients with coronary heart disease can significantly improve blood lipid levels, but did not significantly adjust the patient’s HDL subclass distribution.