2021 年第 8 期 第 16 卷

小而密低密度脂蛋白胆固醇与35岁以下青年冠心病患者冠状动脉病变严重程度的关系

Association between small dense low-density lipoprotein cholesterol and the severity of coronary artery lesion among young coronary atherosclerotic heart disease patients below 35 years old

作者：孙佳音闫振娴郭永和赵迎新周玉杰

英文作者：Sun Jiayin Yan Zhenxian Guo Yonghe Zhao Yingxin Zhou Yujie

单位：首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease Clinical Center for Coronary Heart Disease Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；小而密低密度脂蛋白胆固醇；Gensini评分

英文关键词：Coronaryatheroscleroticheartdisease;Smalldenselow-densitylipoproteincholesterol;Gensiniscore

• 摘要：

• 目的 探讨小而密低密度脂蛋白胆固醇（sdLDL-C）与35岁以下青年冠心病（冠状动脉粥样硬化性心脏病）患者冠状动脉病变严重程度的相关性。方法 回顾性分析2018年1月至2019年6月因胸痛于首都医科大学附属北京安贞医院行冠状动脉造影检查，并被确诊为冠心病的18～35岁青年患者293例的临床资料。冠心病严重程度用改良Gensini评分评估，根据评分将患者分为轻度组（≤24分，102例）、中度组（25～49分，95例）、重度组（≥50分，96例）。用Spearman方法分析血清sdLDL-C水平与Gensini评分之间的相关性。用Logistic回归模型分析血清sdLDL-C水平与严重冠状动脉病变（Gensini评分≥50分）发生的关系。结果 入选的青年冠心病患者年龄33(31,34)岁，其中男性287例（98.0%）。重度组血清sdLDL-C水平明显高于中度组和轻度组［1.03(0.73,1.41)mmol/L比0.84(0.59,1.25)、0.66(0.45,1.10)mmol/L,均P＜0.05］。青年冠心病患者血清sdLDL-C水平与Gensini评分呈正相关(r=0.184，P=0.002)。Logistic回归分析显示，sdLDL-C是青年冠心病患者严重冠状动脉病变发生的独立危险因素(比值比=2.239，95%置信区间=1.047～4.788，P=0.038)。结论 血清sdLDL-C水平与35岁以下青年冠心病患者冠状动脉病变严重程度明显相关。

• Objective To investigate the association between small dense low-density lipoprotein cholesterol (sdLDL-C) and the severity of coronary artery lesion among young coronary atherosclerotic heart disease (CHD) patients below 35 years old. Methods Clinical data of 293 young patients aged 18-35 years old, diagnosed with CHD by coronary angiography in Beijing Anzhen Hospital, Capital Medical University from January 2018 to June 2019 were retrospectively analyzed. The severity of CHD was assessed by modified Gensini score, and the patients were divided into mild group(≤24, 102 cases), moderate group(25-49, 95 cases) and severe group(≥50, 96 cases) according to the score. Spearman analysis was used to evaluate the association between serum sdLDL-C level and Gensini score. Logistic regression model was used to analyze the association between serum sdLDL-C level and the occurrence of severe coronary artery lesion(Gensini score≥50). Results The age of young patients with CHD was 33(31,34) years old, and 287 cases (98.0%) were male. Serum sdLDL-C level in severe group was significantly higher than that in moderate group and mild group［1.03(0.73,1.41)mmol/L vs 0.84(0.59,1.25), 0.66(0.45,1.10)mmol/L, both P＜0.05］. The level of sdLDL-C was positively associated with Gensini score in young patients with CHD (r=0.184，P=0.002). Logistic regression analysis showed that sdLDL-C was an independent risk factor of severe coronary artery lesion in young patients with CHD (odds ratio=2.239， 95% confidence interval=1.047-4.788， P=0.038). Conclusion Serum sdLDL-C level is significantly associated with the severity of coronary artery lesion in young CHD patients below 35 years old.