载脂蛋白A5、载脂蛋白C3及载脂蛋白A5/C3比值与冠心病的关系

doi:10.3969/j.issn.1004-583X.2020.04.005

摘要/Abstract

摘要： 目的研究载脂蛋白A5（apolipoprotein A5，ApoA5）、载脂蛋白C3（apolipoprotein C3，ApoC3）及载脂蛋白A5/C3（ApoA5/ApoC3）比值与血脂水平、冠心病的发生及冠状动脉病变支数的关系，通过调节载脂蛋白浓度水平预防冠心病的发生和发展。方法统计冠心病患者与非冠心病患者年龄、性别、体重指数（body mass index, BMI）及吸烟情况，测定两组血清总胆固醇（total cholesterol, TC）、甘油三酯（triglyceride, TG）、高密度脂蛋白（high density lipoprotein, HDL)、低密度脂蛋白(low density lipoprotein, LDL)浓度水平，采用酶联免疫吸附法(enzyme linked immunosorbent assay，ELISA）测定血清载脂蛋白A5（ApoA5）、载脂蛋白C3（ApoC3）浓度水平，并计算ApoA5/ApoC3比值。按照TG水平进行危险因素分层，比较非冠心病组、冠心病组TG高值组与冠心病组TG正常值组ApoA5、ApoC3、ApoA5/ApoC3比值水平有无差异；研究血清ApoA5、ApoC3、ApoA5/ApoC3比值水平与冠心病病变支数及各项指标的相关性。结果两组性别、TG水平差异有统计学意义（P<0.01）。冠心病组TG高值组和TG正常值组ApoA5/C3比值、ApoA5浓度水平均明显低于非冠心病组，TG高值组ApoC3浓度水平明显高于非冠心病组（P<0.01）。TG高值组ApoA5/C3比值、ApoA5浓度水平低于TG正常值组，TG高值组ApoC3浓度水平明显高于TG正常值组（P<0.01）。多因素二元Logistic回归分析表明，TG是ApoA5/C3比值、ApoA5浓度水平降低的独立危险因素［OR=0.074，95%CI（0.023，0.134），Wald 19.650, SE 0.588, P<0.01; OR=0.039，95%CI（0.009，0.157），Wald 20.641, SE 0.716, P<0.01］，TG是ApoC3浓度水平升高的独立保护因素(OR=9.084，95%CI（3.054，27.022），Wald 15.736, SE 0.556, P<0.01)；血清ApoA5/C3比值、ApoA5浓度水平与TG呈负相关，ApoC3浓度水平与TG呈正相关。结论 ①血清ApoA5/ApoC3比值、ApoA5浓度水平与冠心病的发生呈负相关；血清ApoC3浓度水平与冠心病的发生呈正相关；血清ApoA5和ApoC3分别是冠心病的保护因子和危险因素，ApoA5/ApoC3比值在一定程度上反映冠状动脉病变程度，可作为推测冠状动脉病变程度的依据。②TG水平是血清ApoA5/ApoC3比值、ApoA5浓度水平降低的独立危险因素，与血清ApoA5/ApoC3比值、ApoA5浓度水平呈负相关，TG水平是ApoC3浓度水平升高的保护因素，与ApoC3浓度水平呈正相关。

关键词: 冠心病, 载脂蛋白A5, 载脂蛋白C3, 载脂蛋白A5/C3比值, 相关性

Abstract: Objective To study the effects of apolipoprotein A5(ApoA5), apolipoprotein C3(ApoC3) and apolipoprotein A5/C3(ApoA5/ApoC3) on the blood lipid level, occurrence of coronary heart disease (CHD) and the number of CHD branch, so as to prevent the occurrence and progress of CHD by adjusting the apolipoprotein level.Methods The age, gender, body mass index(BMI) and smoking status of patients of CHD and nonCHD group were counted, the total cholesterol (TC), triglyceride(TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) levels of two groups were measured.The serum levels of ApoA5 and ApoC3 were determined by enzymelinked immunosorbent assay(ELISA), respectively, and ApoA5/ApoC3 ratio was calculated. Risk factors were stratified according to TG level, and the differences in ApoA5, ApoC3, and ApoA5/ApoC3 ratio among nonCHD group, high TG group and normal TG group of CHD group were compared. The correlations between serum ApoA5, ApoC3, ApoA5/ApoC3 ratio and the number of CHD branch and various indexes were studied.Results There were statistically significant differences in gender and TG level between two groups (P<0.01). ApoA5 and ApoA5/C3 ratio of high TG group and normal TG group were obviously lower than those of nonCHD group, and the level of ApoC3 of high TG group was significantly higher than that of nonCHD group (P<0.01). ApoA5 and ApoA5/C3 ratio of high TG group were lower than those of normal TG group, and ApoC3 of high TG group was significantly higher than that of normal TG group (P<0.01). Multivariate binary Logistic regression analysis showed that TG was an independent risk factor for the reduction of ApoA5 and ApoA5/C3 levels（OR=0.039，95%CI［0.009，0.157］，Wald 20.641, SE 0.716, P<0.01; OR=0.074，95%CI［0.023，0.134］，Wald 19.650, SE 0.588, P<0.01）, TG was the independent protective factor for the rise of ApoC3 level(OR=9.084，95%CI［3.054，27.022］，Wald 15.736, SE 0.556, P<0.01); Serum level of ApoA5 and ApoA5/C3 ratio were negatively correlated with TG, while the level of ApoC3 was positively correlated with TG. Conclusion ①Serum ApoA5 level and ApoA5/ApoC3 ratio were negatively correlated with the CHD occurrence, while the level of ApoC3 was positively correlated with CHD occurrence.Serum ApoA5 and ApoC3 were respectively protective factor and risk factor for CHD. And ApoA5/ApoC3 ratio reflected the degree of coronary artery lesion to a certain extent and could be used as a basis for estimating the CHD severity. ②TG level was an independent risk factor for the decrease of serum ApoA5 level and ApoA5/ApoC3 ratio, which was negatively correlated with serum ApoA5 level and ApoA5/ApoC3 ratio. However, TG level was a protective factor for the increase of ApoC3 level, which was positively correlated with ApoC3 level.

Key words: coronary disease, apolipoprotein A5, apolipoprotein C3, apolipoprotein A5/C3 ratio;correlation

吴美美，王虹，肖双，孙雪，韩婷婷. 载脂蛋白A5、载脂蛋白C3及载脂蛋白A5/C3比值与冠心病的关系[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2020.04.005.

Wu Meimei, Wang Hong, Xiao Shuang, Sun Xue, HanTingting. Relationship among apolipoprotein A5, apolipoprotein C3, apolipoprotein A5/C3 ratio and coronary heart disease[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2020.04.005.

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https://huicui.hebmu.edu.cn/CN/Y2020/V35/I4/312

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载脂蛋白A5、载脂蛋白C3及载脂蛋白A5/C3比值与冠心病的关系

Relationship among apolipoprotein A5, apolipoprotein C3, apolipoprotein A5/C3 ratio and coronary heart disease

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