脂蛋白残粒胆固醇在血脂管理中的临床价值

doi:10.3969/j.issn.1673-8640.2019.05.003

摘要/Abstract

摘要：

目的探讨脂蛋白残粒胆固醇（RLP-C）与心血管疾病（CVD）相关生物标志物的关联和差异及其在血脂管理中的价值。方法检测437名体检者的血糖（Glu）、RLP-C、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、小而密低密度脂蛋白胆固醇（sd-LDL-C）、载脂蛋白（apo）A1、apo B、脂蛋白（a）[Lp（a）]、脂蛋白相关磷脂酶A₂（Lp-PLA₂）和C反应蛋白（CRP）,将直接测得的RLP-C记为RLP-C-m,将计算得到的RLP-C记为RLP-C-calc,同时计算非高密度脂蛋白胆固醇（non-HDL-C）。通过相关性分析和分层比较探讨RLP-C与其他脂类风险因子的关联和差异以及不同方法对测得的RLP-C水平的影响。结果男性与女性比较,除年龄、Glu、LDL-C、sd-LDL-C和Lp-PLA2外,其他各项指标差异均有统计学意义（P<0.05）。RLP-C与年龄、Glu、HDL-C、apo A1、Lp（a）、Lp-PLA₂和CRP的r值均较小,呈弱相关（P<0.05）。RLP-C-m、RLP-C-calc与non-HDL-C、TC、TG、LDL-C、apo B和sd-LDL-C均呈正相关（P<0.001）。RLP-C-m与TG呈强正相关（r=0.899,P<0.001）。RLP-C-calc与non-HDL-C和TC呈强正相关（P<0.001）。RLP-C-m与RLP-C-calc、non-HDL-C均呈强正相关（P<0.001）。RLP-C-m结果随RLP-C-calc结果的升高而升高,但总体结果低于RLP-C-calc。将437名研究对象按TG水平（<1.00、1.00~1.99、2.00~2.99、≥3.00 mmol/L）进行分组。结果显示,RLP-C-m、RLP-C-calc、non-HDL-C、TC、sd-LDL-C水平以及RLP-C-m占RLP-C-calc的百分比均随TG水平的升高而升高,单因素分析显示不同TG水平各组间RLP-C-m和RLP-C-calc差异有统计学意义（P<0.001）。结论 RLP-C与TG呈强正相关,是较为恒定的生物标志物。不同方法学测得的RLP-C值互不相同,但有关联性。检测RLP-C水平或可为CVD患者的血脂管理和风险控制提供帮助,但是否能作为独立的CVD风险预测因子尚需进一步研究。

关键词: 脂蛋白残粒胆固醇, 富三酰甘油脂蛋白, 血脂管理, 心血管疾病

Abstract:

Objective To investigate the role of remnant lipoprotein cholesterol （RLP-C） in the management of blood lipid and the correlation between RLP-C and cardiovascular disease（CVD） associated biomarkers. Methods Serum levels of RLP-C,glucose （Glu）,triglyceride （TG）,total cholesterol （TC）,low-density lipoprotein cholesterol （LDL-C）,high-density lipoprotein cholesterol （HDL-C）,small-density low-density lipoprotein cholesterol （sd-LDL-C）,apolipoprotein （apo） A1, apo B,lipoprotein（a） [Lp（a）],lipoprotein-associated phospholipase A₂ （Lp-PLA₂） and C-reactive protein （CRP） of 437 healthy subjects were determined. The levels of RLP-C determined directly were marked RLP-C-m, and those calculated were marked RLP-C-calc,and non-HDL-C was calculated. Correlation analysis and stratified analysis were used to investigate the correlation and discrepancy between RLP-C and other CVD associated biomarkers and the influence of methodology on the level of RLP-C acquired. Results There was statistical significance in biomarkers between females and males,except ages,Glu,LDL-C,sd-LDL-C and Lp-PLA₂ （P<0.05）. The correlations between RLP-C and ages,Glu,HDL-C,apo A1,Lp（a）,Lp-PLA₂ and CRP were relatively weak with small r （P<0.05）. RLP-C-m and RLP-C-calc were positively correlated with non-HDL-C,TC,TG,LDL-C,apo B and sd-LDL-C （P<0.001）. RLP-C-m was positively correlated with TG （r=0.899,P<0.001）. RLP-C-calc and non-HDL-C were strongly and positively correlated with TC（P<0.001）,and RLP-C-m was positively correlated with RLP-C-calc and non-HDL-C （P<0.001）. The RLP-C-m level was elevated with the increase of RLP-C-calc,but it was constantly lower than RLP-C-calc. The 437 healthy subjects were stratified according to the levels of TG （<1.00,1.00-1.99,2.00-2.99 and ≥3.00 mmol/L）. The levels of RLP-C-m,RLP-C-calc, non-HDL-C, TC,sd-LDL-C and RLP-C-m were elevated with the increase of TG. The analysis of variance（ANOVA） suggested that,among the biomarkers,RLP-C-m and RLP-C-calc showed statistical significance among all the groups （P<0.001）. Conclusions RLP-C is a constant biomarker with strong and positive correlation with TG. The levels of RLP-C determined by different methods differs from each other, but they are correlated. The determination of RLP-C might help blood lipid management and risk control in CVD patients,but further researches are required to regard it as an independent factor for predicting CVD risk.

Key words: Remnant lipoprotein cholesterol, Triglyceride-rich lipoprotein, Blood lipid management, Cardiovascular disease

中图分类号:

R446.1

宋云霄, 葛雯, 张海晨, 袁文华, 戴珺, 尤闻世. 脂蛋白残粒胆固醇在血脂管理中的临床价值[J]. 检验医学, 2019, 34(5): 394-400.

SONG Yunxiao, GE Wen, ZHANG Haichen, YUAN Wenhua, DAI Jun, YOU Wenshi. Role of remnant lipoprotein cholesterol in the management of blood lipid[J]. Laboratory Medicine, 2019, 34(5): 394-400.

图/表 5

参考文献 21

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组别	例数	年龄（岁）	Glu（U/L）	TC（mmol/L）	TG（mmol/L）	HDL-C（mmol/L）
男性	228	72（62~85）	5.94（4.82~6.37）	4.28±1.08	1.25（0.86~1.77）	0.99（0.83~1.23）
女性	209	77（65~85）	5.96（4.69~6.32）	4.69±1.09^***	1.39（0.91~1.97）^***	1.13（0.95~1.43）^***
合计	437	74（64~85）	5.95（4.74~6.36）	4.47±1.11	1.32（0.88~1.89）	1.05（0.89~1.30）
组别	LDL-C（mmol/L）		non-HDL-C（mmol/L）	apo A1（g/L）	apo B（g/L）	Lp（a）（g/L）
男性	2.30（1.77~2.61）		3.23±1.05	1.17±0.21	0.86±0.30	0.23（0.13~0.38）
女性	2.30（1.93~2.81）		3.48±1.01^*	1.32±0.23^***	0.92±0.29^*	0.27（0.17~0.40）^*
合计	2.30（1.88~2.71）		3.35±1.04	1.24±0.23	0.89±0.29	0.24（0.15~0.39）
组别	sd-LDL-C（mmol/L）		RLP-C-m（mmol/L）	RLP-C-calc（mmol/L）	Lp-PLA2（U/L）	CRP（mg/L）
男性	0.46（0.36~0.63）		0.21（0.13~0.33）	0.90（0.66~1.15）	439（341~548）	2.25（0.80~10.55）

组别	例数	年龄（岁）	Glu（U/L）	TC（mmol/L）	TG（mmol/L）	HDL-C（mmol/L）
男性	228	72（62~85）	5.94（4.82~6.37）	4.28±1.08	1.25（0.86~1.77）	0.99（0.83~1.23）
女性	209	77（65~85）	5.96（4.69~6.32）	4.69±1.09^***	1.39（0.91~1.97）^***	1.13（0.95~1.43）^***
合计	437	74（64~85）	5.95（4.74~6.36）	4.47±1.11	1.32（0.88~1.89）	1.05（0.89~1.30）
组别	LDL-C（mmol/L）		non-HDL-C（mmol/L）	apo A1（g/L）	apo B（g/L）	Lp（a）（g/L）
男性	2.30（1.77~2.61）		3.23±1.05	1.17±0.21	0.86±0.30	0.23（0.13~0.38）
女性	2.30（1.93~2.81）		3.48±1.01^*	1.32±0.23^***	0.92±0.29^*	0.27（0.17~0.40）^*
合计	2.30（1.88~2.71）		3.35±1.04	1.24±0.23	0.89±0.29	0.24（0.15~0.39）
组别	sd-LDL-C（mmol/L）		RLP-C-m（mmol/L）	RLP-C-calc（mmol/L）	Lp-PLA2（U/L）	CRP（mg/L）
男性	0.46（0.36~0.63）		0.21（0.13~0.33）	0.90（0.66~1.15）	439（341~548）	2.25（0.80~10.55）

指标	RLP-C-m	RLP-C-calc	non-HDL-C	TC	TG	HDL-C	LDL-C	sd-LDL-C	Lp-PLA₂
RLP-C-m		0.687^***	0.623^***	0.486^***	0.899^***	-0.280^***	0.460^***	0.649^***	0.286^***
RLP-C-calc			0.809^***	0.745^***	0.585^***	-0.014	0.557^***	0.615^***	0.358^***
non-HDL-C				0.947^***	0.455^***	0.039	0.922^***	0.679^***	0.509^***
TC					0.282^***	0.340^***	0.881^***	0.618^***	0.444^***
TG						-0.437^***	0.285^***	0.581^***	0.164^***
HDL-C							0.088	-0.067	-0.090
LDL-C								0.566^***	0.498^***
sd-LDL-C									0.378^***
年龄	-0.136^**	-0.139^**	-0.207^**	-0.179^**	-0.120^*	0.013	-0.223^**	-0.165^**	-0.026
Glu	0.170^**	0.148^**	0.083	0.016	0.276^**	-0.200^**	0.017	0.235^**	0.008
apo A1	0.052	0.207^**	0.200	0.463^**	-0.090^*	0.869^**	0.186^**	0.183^**	-0.029
apo B	0.483^**	0.679^**	0.914^**	0.856^**	0.357^**	0.028	0.923^**	0.589^**	0.510**
Lp（a）	-0.102^*	0.028	0.091	0.118^*	-0.091	0.076	0.134^**	-0.081	0.031
CRP	-0.172^**	-0.079^**	-0.053	-0.102^*	-0.107^*	-0.213^**	-0.034	-0.146^**	0.014

指标	RLP-C-m	RLP-C-calc	non-HDL-C	TC	TG	HDL-C	LDL-C	sd-LDL-C	Lp-PLA₂
RLP-C-m		0.687^***	0.623^***	0.486^***	0.899^***	-0.280^***	0.460^***	0.649^***	0.286^***
RLP-C-calc			0.809^***	0.745^***	0.585^***	-0.014	0.557^***	0.615^***	0.358^***
non-HDL-C				0.947^***	0.455^***	0.039	0.922^***	0.679^***	0.509^***
TC					0.282^***	0.340^***	0.881^***	0.618^***	0.444^***
TG						-0.437^***	0.285^***	0.581^***	0.164^***
HDL-C							0.088	-0.067	-0.090
LDL-C								0.566^***	0.498^***
sd-LDL-C									0.378^***
年龄	-0.136^**	-0.139^**	-0.207^**	-0.179^**	-0.120^*	0.013	-0.223^**	-0.165^**	-0.026
Glu	0.170^**	0.148^**	0.083	0.016	0.276^**	-0.200^**	0.017	0.235^**	0.008
apo A1	0.052	0.207^**	0.200	0.463^**	-0.090^*	0.869^**	0.186^**	0.183^**	-0.029
apo B	0.483^**	0.679^**	0.914^**	0.856^**	0.357^**	0.028	0.923^**	0.589^**	0.510**
Lp（a）	-0.102^*	0.028	0.091	0.118^*	-0.091	0.076	0.134^**	-0.081	0.031
CRP	-0.172^**	-0.079^**	-0.053	-0.102^*	-0.107^*	-0.213^**	-0.034	-0.146^**	0.014

组别	例数	TC（mmol/L）	HDL-C（mmol/L）	LDL-C（mmol/L）
TG<1.00 mmol/L组	136	4.12±1.13	1.28（1.01~1.58）	2.06±0.71^***
TG 1.00~1.99 mmol/L组	209	4.48±1.04^*	1.04（0.90~1.24）^***	2.43±0.77^***
TG 2.00~2.99 mmol/L组	57	4.86±1.07^***	0.99（0.79~1.09）^***	2.62±0.74^***
TG≥3.00 mmol/L组	35	5.20±0.94^***#	0.85（0.76~0.97）^***##	2.53±0.57^**
组别	sd-LDL-C（mmol/L）		RLP-C-calc（mmol/L）	RLP-C-m（mmol/L）	non-HDL-C（mmol/L）
TG<1.00 mmol/L组	0.36（0.28~0.47）		0.74±0.34	0.12（0.10~0.16）	2.80±0.91
TG 1.00~1.99 mmol/L组	0.47（0.39~0.62）^**		0.96±0.31^***	0.23（0.19~0.30）^***	3.39±0.95^***
TG 2.00~2.99 mmol/L组	0.68（0.52~0.95）^***#		1.25±0.31^***##	0.43（0.38~0.53）^***##	3.88±0.99^***#
TG≥3.00 mmol/L组	1.08（0.78~1.38）^***##△		1.82±0.50^***##△△	0.95（0.71~1.30）^***##△△	4.35±0.85^***##