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目的探讨血浆低密度脂蛋白胆固醇(LDL-C)和氧化型低密度脂蛋白(ox-LDL)与冠状动脉粥样硬化病变严重程度的关系。方法病例选择:冠状动脉痉挛组(CAS,n=31),临床上具有胸痛表现、冠状动脉造影无显著狭窄并经过乙酰胆碱试验确诊的患者,根据痉挛血管形态分为节段性痉挛组和弥漫性痉挛组;稳定性心绞痛组(SAP,n=35),为稳定的劳力型心绞痛患者,根据冠状动脉造影结果分为单支病变组和多支病变组;对照组(n=24),为健康体检患者。各组于清晨空腹采取静脉血,采用全自动生化分析仪测定血浆 LDL-C,用 ELISA 法检测血浆 ox-LDL 含量,分组比较其 LDL-C及 ox-LDL 水平。结果血浆 LDL-C 水平 SAP 亚组[单支病变组(2.6±0.9)mmol/L,多支病变组(2.8±0.9)mmol/L]和 CAS 亚组[弥漫性痉挛组(3.2±0.5)mmol/L,节段性痉挛组(2.9±0.8)mmol/L]间差异无统计学意义,但均高于对照组[(2.2±0.5)mmol/L,P<0.05];SAP 组血浆 ox-LDL含量[(575±219)μg/L]高于对照组[(218±35)μg/L,P<0.01]和 CAS 组[(299±117)μg/L,P<0.01],CAS 组与对照组比较,差异无统计学意义(P>0.05);弥漫性痉挛组[(225±63)μg/L]、节段性痉挛组[(328±123)μg/L]、单支血管病组[(462±72)μg/L]、多支血管病变组[(672±92)μg/L]的血浆 ox-LDL 浓度逐步上升,各组间差异有统计学意义(P<0.05),与冠状动脉硬化程度呈一致趋势,而血浆 LDL 水平组间差异无统计学意义。结论血浆 ox-LDL 比 LDL-C 更能准确地预测冠状动脉粥样硬化的严重程度,调脂治疗应该更为重视降低 ox-LDL,而不应单纯控制 LDL 水平。
Objective To investigate the relationship between plasma levels of low-density lipoprotein cholesterol (LDL-C) and oxidized low-density lipoprotein (ox-LDL) and the severity of coronary atherosclerosis. Methods: The patients were divided into two groups according to the spasm of blood vessels: segmental spasm group and diffuse spondylolisthesis group (CAS, n = 31), clinical manifestations of chest pain, coronary angiography without significant stenosis and confirmed by acetylcholine test Spasm group, stable angina pectoris group (SAP, n = 35), patients with stable angina pectoris were divided into single vessel disease group and multiple vessel disease group according to coronary angiography results; control group (n = 24) Physical examination patients. The fasting blood samples were taken from the rats in each group. Plasma LDL-C was measured by automatic biochemical analyzer. The levels of ox-LDL in plasma were detected by ELISA. The levels of LDL-C and ox-LDL were compared between groups. Results The levels of plasma LDL-C were significantly higher in the SAP subgroup (2.6 ± 0.9 mmol / L in the single vessel disease group and 2.8 ± 0.9 mmol / L in the multi-vessel disease group) and in the CAS subgroup (diffuse spasticity group (3.2 ± 0.5) (2.9 ± 0.8) mmol / L], but both were significantly higher than those in the control group [(2.2 ± 0.5) mmol / L, P <0.05] The level of -LDL [(575 ± 219) μg / L] was higher than that in the control group [(218 ± 35) μg / L, P <0.01] (225 ± 63) μg / L in diffuse spasm group, [328 ± 123 μg / L] in segmental spasm group, and no significant difference between control group and control group (P> 0.05) (462 ± 72) μg / L in the angiocardiopathy group and 672 ± 92 μg / L in the multivessel disease group, and the difference was statistically significant ), Consistent with the degree of coronary atherosclerosis trend, but no significant difference between the plasma LDL levels. Conclusions Plasma ox-LDL can predict the severity of coronary atherosclerosis more accurately than LDL-C. Lipid-lowering therapy should pay more attention to reducing ox-LDL instead of simply controlling the level of LDL.