[1]李才信a,马志强a,马云珊a,等.血清残余脂蛋白胆固醇定量检测对动脉粥样硬化性心血管疾病诊断的临床价值研究[J].现代检验医学杂志,2023,38(04):16-21.[doi:10.3969/j.issn.1671-7414.2023.04.003]
　LI Caixina,MA Zhiqianga,MA Yunshana,et al.Clinical Value of Quantitative Serum Residual Lipoprotein Cholesterol in the Diagnosis of Atherosclerotic Cardiovascular Disease[J].Journal of Modern Laboratory Medicine,2023,38(04):16-21.[doi:10.3969/j.issn.1671-7414.2023.04.003]
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血清残余脂蛋白胆固醇定量检测对动脉粥样硬化性心血管疾病诊断的临床价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年04期
页码:
16-21
栏目:
论著
出版日期:
2023-07-15

文章信息/Info

Title:
Clinical Value of Quantitative Serum Residual Lipoprotein Cholesterol in the Diagnosis of Atherosclerotic Cardiovascular Disease
文章编号:
1671-7414（2023）04-016-06
作者:
李才信1a; 马志强1a; 马云珊1a; 黄本林2; 胡爱萍1b; 王 霖1a
（1. 昆明市第三人民医院/ 云南省传染性疾病临床医学中心a. 长坡检验科；b. 综合内科，昆明 650301；2. 曲靖市第二人民医院医学检验科，云南曲靖 655000）
Author(s):
LI Caixin1a; MA Zhiqiang1a; MA Yunshan1a; HUANG Benlin2; HU Aiping1b; WANG Lin1a
（1a.Department of Clinical Laboratory, Chang Po;1b.Department of General Internal Medicine, the Third People’s Hospital of Kunming/Yunnan Clinical Medical Center for Infectious Diseases, Kunming 650301, China; 2. Department of Clinical Laboratory, the Second People’s Hospital of Qujing, Yunnan Qujing 655000, China）
关键词:
残余脂蛋白胆固醇; 动脉粥样硬化性心血管疾病（ASCVD）; 冠心病
分类号:
R541.4；R446.112
DOI:
10.3969/j.issn.1671-7414.2023.04.003
文献标志码:
A
摘要:
目的　探索血清测量残余脂蛋白胆固醇（residual lipoprotein cholesterol，RLP-C）定量检测对动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease，ASCVD）诊断的临床价值。方法　选取2019 年3 月～ 2020 年1 月在曲靖市第二人民医院就诊的ASCVD 患者671 例及同期无动脉粥样硬化的健康人群325 例作为研究对象，根据动脉粥样硬化发生部位进一步将ASCVD 组分为外周动脉粥样硬化组（n=339）和冠心病组（n=332）。采用酶法定量测定血清RLP-C（measured RLP-C，RLP-Cm），通过受试者工作特征（ROC）曲线分析探索RLP-Cm 筛查该地区ASCVD 的切点，并对比分析RLP-Cm，估算的RLP-C（estimated RLP-C，RLP-Ce）、低密度脂蛋白- 胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）、总胆固醇（TC）和三酰甘油（TG）在外周动脉粥样硬化和冠心病筛查中的诊断效能差异。结果　ASCVD 组与对照组相比，两组间体重指数、血小板计数、血尿酸和血总胆红素的差异均无统计学意义（χ2= -1.508，z = -0.951，-0.798，-1.158，均P >0.05）；性别构成、高血压病史、糖尿病史、吸烟史、年龄、白细胞计数、血红蛋白、总胆固醇等的差异均有统计学意义（χ2=49.436，84.568，53.301，72.443，-7.456，z =-5.485，4.878，-2.812，均P<0.05）。与对照组相比，ASCVD 组 RLP-Cm 升高[10.3（6.4，15.5）mg/dl vs 9.2（6.8，11.9）mg/dl]，差异具有统计学意义（z= -3.200，P ＜ 0.001）。亚组分析结果显示，与对照人群相比，外周动脉硬化患者血清RLP-Cm 浓度[9.9（5.9，15.9）mg/dl] 升高，差异无统计学意义（z= -1.926，P=0.057），冠心病患者RLP-Cm 水平升高[10.7（6.6，15.4）mg/dl]，差异具有统计学意义（z= -3.785，P=0.001），外周动脉粥样硬化组和冠心病组之间的RLP-Cm 差异无统计学意义（z=-0.624，P=0.416）。RLP-Cm 诊断外周动脉粥样硬化的最佳cut-off 值为11.75mg/dl，曲线下面积（AUC）为0.686（P<0.05），敏感度和特异度分别为59.8%，76.6%。RLP-Cm 诊断冠心病的最佳cut-off 值为12.70mg/dl，AUC 为0.711（P<0.05），灵敏度和特异度分别为58.4% 和76%。RLP-Cm 的诊断效能仅次于HDL-C，高于RLP-Ce，LDL-C，TC 和TG。结论　定量测定RLP-C 在筛查ASCVD 患者中的诊断效能优于估算法，具有重要的临床指导价值。
Abstract:
Objective　To explore the clinical value of quantitative determination of serum residual lipoprotein cholesterol （RLP-C）in atherosclerotic cardiovascular disease（ASCVD）. Methods　671 patients with ASCVD in the Second People’s Hospital of Qujing from March 2019 to January 2020 and 325 healthy controls were enrolled. The ASCVD group was further divided into peripheral artery atherosclerosis group (n=339) and coronary heart disease group (n=332) according to the site of atherosclerosis occurrence. The cut-off of RLP-Cm screening for ASCVD in the region were explored by ROC curve analysis based on serum RLP-C (RLP-Cm) quantitatively measured by enzymes. The diagnostic efficacy of RLP-Cm, estimated RLP-C (RLP-Ce), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides (TG) in the diagnosis of peripheral atherosclerosis and coronary heart disease was compared. Results　There were no significant differences in BMI， platelet count, blood uric acid and total bilirubin between ASCVD group and control group （χ2= -1.508，z = -0.951，-0.798，-1.158，all P >0.05）. There were significant differences in gender composition, history of hypertension, diabetes, smoking history, age, white blood cells count, hemoglobin and total cholesterol (χ2=49.436, 84.568, 53.301, 72.443, -7.456, z =-5.485, 4.878, -2.812, all P<0.05). RLP-Cm in ASCVD group was higher than the control group[10.3 （6.4，15.5）mg/dl vs 9.2（6.8，11.9）mg/dl]，the difference was statistically significant(z=-3.200，P<0.001). Compared with the control, there was no significant difference in the increase in patients with peripheral arteriosclerosis[9.9 (5.9, 15.9) mg/ dl], the difference was statistically significant(z= -1.926, P=0.057). Elevated RLP-C in patients with coronary heart disease statistically significant[10.7（6.6，15.4）mg/dl]，the difference was statistically significant（z= -3.785，P=0.001），but there was no significant difference between the peripheral atherosclerosis group and the coronary heart disease group（z=-0.624， P=0.416）.The optimal cut-off value for the diagnosis of peripheral atherosclerosis was 11.75mg/dl, area under the curve(AUC) was 0.686 (P<0.05), with the sensitivity and specificity was 59.8% ，76.6%，respectively. The optimal cut-off value for the diagnosis of coronary heart disease by RLP-C was 12.70 mg/dl, and AUC was 0.711 (P<0.05), with the sensitivity and specificity was 58.4%，76% respectively. RLP-Cm was second to HDL-C and higher than RLP-Ce，LDL-C, TC and TG. Conclusion　The efficacy of quantitative RLP-C in screening patients with ASCVD was better than that of estimation method, and it may have important affect on clinical practice.

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备注/Memo

备注/Memo:
基金项目： 昆明市卫生科技人才培养项目暨“十百千”工程培养“千”工程后备人选（项目号：2019‐SW（后备）-25）2020-sw（后备-72）。
作者简介：李才信（1982-），男，本科，副主任技师，主要研究方向：临床微生物，E-mail:954003892@qq.com。
通讯作者： 王霖（1979-），男，本科，主任技师，主要从事生化免疫及分子生物学研究工作，E-mail:626182669@qq.com
胡爱萍(1990-)，女，本科，主管护师，主要从事综合内科学护理研究工作，E-mail:385598014@qq.com。
更新日期/Last Update: 2023-07-15