Process by prospective study of cardiovascular disease risk assessment based on postprandial lipid
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摘要: 目的 通过餐后血脂评估心血管疾病风险前瞻性研究，探讨检验采血流程的优化。方法 选择320例冠心病患者检测空腹及餐后的血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、血清脂蛋白a[LP(a)]、载脂蛋白A1(ApoA1)及载脂蛋白B(ApoB)血脂参数，分析个体间血脂用餐前后变化差异及空腹与餐后血脂水平的相关性，比较空腹血脂及餐后血脂浓度与Syntax评分的相关性，比较空腹和餐后血脂与心血管事件危险比的关系及差异，评估餐后采血检验的应用效果。结果 餐后血脂与空腹血脂7项指标中TC、HDL-C、LP(a)和ApoB比较，差异无统计学意义(均P>0.05)，TG、LDL-C和ApoA1比较差异有统计学意义(P< 0.05)，但7项指标均显著呈正相关性(r0.693~0.878，P< 0.001)；血脂水平与Syntax评分Spearman相关性分析中，餐后比空腹多出HDL-C和ApoA1 2个相关指标；血脂水平与心血管事件Cox比例风险回归危险比分析中，空腹血脂和餐后血脂危险比差异无统计学意义(P>0.05)。结论 餐后血脂更适合评估心血管疾病风险，心血管疾病筛查可以推广餐后采血检验流程。Abstract: Objective To explore the blood collection optimization process by the prospective study of cardiovascular disease risk assessment based on postprandial lipid.Methods Serum triglyceride(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), lipoprotein a[Lp(a)], ApoA1 and ApoB were measured in 320 patients with coronary heart disease, the differences in the changes of blood lipids between individuals before and after a meal and the correlation between fasting and postprandial blood lipid levels were analyzed, fasting blood lipids and the correlation between postprandial blood lipid concentration and Syntax score were compared, the relationship and difference between fasting and postprandial blood lipids and cardiovascular event risk ratio were compared, and the application effect of postprandial blood sampling was evaluated.Results There was no significant difference in TC, HDL-C, LP(a) and ApoB among 7 indexes of blood lipids after meal and fasting blood lipids(allP>0.05), there were significant differences in TG, LDL-C and ApoA1(allP< 0.05), but the 7 indexes were all significantly positively correlated(r0.693-0.878, allP< 0.001); In the analysis of the correlation between blood lipid level and Syntax score spearman, HDL-C and ApoA1 2 related indicators were more than fasting after meal; In the Cox proportional hazard regression analysis of blood lipid levels and cardiovascular events, there was no significant difference in fasting blood lipids and postprandial blood lipid hazards(allP>0.05).Conclusion Postprandial lipids may be more suitable for assessing cardiovascular disease risk, so cardiovascular disease screening can use postprandial blood test.
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表 1 相同个体血脂检测结果差异比较及相关性分析
X±S 血脂指标 例数 空腹 餐后 t P r(95%CI) P TG/(mmol·L-1) 320 1.86±1.33 2.28±1.78 3.381 0.001 0.693(0.717~0.737) < 0.001 TC/(mmol·L-1) 320 4.79±1.26 4.80±1.24 0.101 0.919 0.747(0.694~0.792) < 0.001 LDL-C/(mmol·L-1) 320 2.81±0.87 2.68±0.71 2.071 0.039 0.727(0.671~0.775) < 0.001 HDL-C/(mmol·L-1) 320 1.26±0.37 1.22±0.24 1.622 0.105 0.878(0.850~0.901) < 0.001 LP(a)/(mg·L-1) 320 389.17±97.21 403.69±111.68 1.754 0.080 0.872(0.843~0.896) < 0.001 ApoA1/(g·L-1) 320 1.38±0.55 1.27±0.48 2.696 0.007 0.737(0.683~0.783) < 0.001 ApoB/(g·L-1) 320 1.17±0.46 1.11±0.35 1.857 0.064 0.715(0.657~0.765) < 0.001 
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表 2 血脂水平与Syntax评分的相关性
血脂指标 空腹 餐后 r(95%CI) P r(95%CI) P TG 0.098(-0.012，0.205) 0.080 0.078(-0.032，0.186) 0.164 TC 0.225(0.118，0.327) < 0.001 0.253(0.147，0.353) < 0.001 LDL-C 0.307(0.204，0.403) < 0.001 0.284(0.180，0.382) < 0.001 HDL-C -0.105(-0.212，0.005) 0.061 -0.228(-0.32，-0.121) < 0.001 LP(a) 0.330(0.229，0.424) < 0.001 0.335(0.234，0.429) < 0.001 ApoA1 -0.103(-0.210，0.007) 0.066 -0.214(-0.316，-0.107) < 0.001 ApoB 0.091(-0.019，0.199) 0.104 0.095(-0.015，0.202) 0.090
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表 3 空腹和餐后血脂与心血管事件HR分析
血脂指标 Unadjusted HR(95%CI) Wald χ2 P Adjusted HR(95%CI) Wald χ2 P 空腹TG 1.015(0.785~1.327) 1.025(0.788~1.342) 餐后TG 1.035(0.798~1.341) 0.001 0.980 1.055(0.798~1.348) 0.001 0.970 空腹TC 1.086(0.911~1.282) 1.158(0.963~1.352) 餐后TC 1.184(0.964~1.445) 0.014 0.907 1.257(1.032~1.543) 0.014 0.907 空腹LDL-C 1.242(1.033~1.492) 1.305(1.072~1.554) 餐后LDL-C 1.265(0.031~1.542) 0.001 0.980 1.348(1.080~1.611) 0.001 0.980 空腹HDL-C 0.576(0.342~0.953) 0.592(0.343~1.012) 餐后HDL-C 0.665(0.401~1.092) 0.021 0.886 0.693(0.408~1.187) 0.021 0.886 空腹LP(a) 1.256(1.032~1.523) 1.338(1.080~1.584) 餐后LP(a) 1.325(1.051~1.652) 0.006 0.938 1.396(1.113~1.734) 0.006 0.938 空腹ApoA1 0.567(0.348~0.947) 0.525(0.118~0.327) 餐后ApoA1 0.656(0.398~1.089) 0.021 0.886 0.623(0.118~0.327) 0.003 0.958 空腹ApoB 1.141(1.001~1.400) 1.235(1.045~1.462) 餐后ApoB 1.262(1.043~1.536) 0.020 0.888 1.335(1.091~1.615) 0.013 0.911 所示数值为Cox模型风险比(95%CI)，Adjusted HR根据年龄、性别、体重指数、吸烟状况、糖尿病、高血压和服用他汀类药物治疗进行调整。
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