极高水平高密度脂蛋白胆固醇患者的临床特征分析

孙璐璠; 贾大林

doi:10.16766/j.cnki.issn.1674-4152.002264

极高水平高密度脂蛋白胆固醇患者的临床特征分析

doi: 10.16766/j.cnki.issn.1674-4152.002264

孙璐璠^,,
贾大林

中国医科大学附属第一医院心血管内科，辽宁沈阳 110001

基金项目:

国家自然科学基金项目 81670320

详细信息

通讯作者:
孙璐璠，E-mail：lydia_1227@163.com

中图分类号: R589.2 R54
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出版历程
- 收稿日期: 2020-10-27
- 网络出版日期: 2022-03-03

Clinical characteristics of patients with extremely high level of high-density lipoprotein cholesterol

SUN Lu-fan^,,
JIA Da-lin

Department of Cardiology, the First Hospital of China Medical University, Shenyang, Liaoning 110001, China

摘要

摘要: 目的在高密度脂蛋白胆固醇(HDL-C)水平极度升高会增加心血管死亡的背景下，分析具有HDL-C极高水平的心血管患者的临床特征，为探索HDL-C与心血管疾病的关系及进一步知晓HDL的代谢机制提供依据。方法回顾分析2019年全年在中国医科大学附属第一医院心血管内科就诊并行血脂检测的成年患者信息。将HDL-C≥2.59 mmol/L(100 mg/dL)定义为极高水平HDL-C，评价此类人群性别、年龄、就诊方式与其他患者的区别，比较这些患者与年龄性别相匹配的同期健康体检人群血脂结果间的差异。结果在所有分析的20 655例患者中，极高水平HDL-C的患者比率仅为0.16%，以女性及门诊患者为主，年龄为(60.21±10.27)岁，高于HDL-C正常水平患者。极高水平HDL-C患者的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)及非高密度脂蛋白胆固醇(非HDL-C)水平分别为(6.22±0.95)mmol/L、(0.82±0.36)mmol/L、(3.05±0.75)mmol/L和(3.30±0.80)mmol/L。与年龄性别相匹配的健康人群比较，其TC及HDL-C/TC比值均增高(均P < 0.001)、TG降低(P < 0.001)，LDL-C(P=0.756)及非HDL-C(P=0.058)水平相当，而且这个结果与性别无关。结论具有极高水平HDL-C的患者以女性及门诊患者为主，年龄偏大。与年龄性别相匹配的健康人群比较，其TG水平偏低，且LDL-C及非HDL-C水平无明显差异，提示此类人群心血管死亡风险增加可能与LDL-C、TG、载脂蛋白B(apoB)不相关。
- 高密度脂蛋白胆固醇 /
- 极值 /
- 心血管 /
- 血脂
Abstract: Objective Extremely high level of high-density lipoprotein cholesterol (HDL-C) has been proven to increase cardiovascular mortality. This study aimed to investigate clinical characteristics of cardiovascular patients with extremely high level of HDL-C, providing information for further research concerning the relationship between HDL-C and cardiovascular diseases, as well as mechanisms of HDL metabolism. Methods All adult blood-lipid data in the Department of Cardiology in the First Hospital of China Medical University throughout the entire year of 2019 were retrospectively analysed. Extremely high level of HDL-C was defined as HDL-C ≥ 2.59 mmol/L (100 mg/dL). Gender, age, and medical information of each patient were evaluated. Their lipid profiles were compared with healthy individuals who underwent a checkup in the same hospital during the same period with matched gender and age. Results A total of 20 655 patients were included in the final analysis, and patients with an extremely high level of HDL-C covered only 0.16%; they were primarily females and outpatients. Their average age was (60.21±10.27) years, higher than those with normal HDL-C. Their average total cholesterol (TC) level, triglyceride (TG) level, low-density lipoprotein cholesterol (LDL-C) level, and non-high-density lipoprotein cholesterol (non HDL-C) were (6.22±0.95) mmol/L, (0.82±0.36) mmol/L, (3.05±0.75) mmol/L, and (3.30±0.80) mmol/L, respectively. Compared with matched healthy individuals, they had elevated TC and HDL-C/TC ratio (P < 0.001), reduced TG (P < 0.001), and comparable LDL-C (P=0.756) and non HDL-C (P=0.058), irrespective of gender. Conclusion Patients with extremely high HDL-C are primarily females and outpatients with elder age. Compared with matched healthy individuals, they have reduced TG and comparable LDL-C and non-HDL-C, probably indicating irrelevance between increased cardiovascular risks and LDL-C, TG, and apolipoprotein B.
- High-density lipoprotein cholesterol /
- Extreme /
- Cardiovascular /
- Blood lipid

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表 1 不同水平高密度脂蛋白胆固醇患者一般临床情况

组别	例数	性别[例(%)]		年龄(x±s，岁)	来源[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	门诊	住院
正常HDL-C组	10 132	4 594(45.34)	5 538(54.66)	58.34±12.84	6 826(67.37)	3 306(32.63)
高HDL-C组	2 882	767(26.61)	2 115(73.39)	59.30±12.69	2 367(82.13)	515(17.87)
极高HDL-C组	34	12(35.29)	22(64.71)	60.21±10.27	33(97.06)	1(2.94)
统计量		325.391^a		6.615^b	247.433^a
P值		＜0.001		0.001	＜0.001
注：^a为χ²值，^b为F值。

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表 2 极高水平高密度脂蛋白患者与对照组血脂指标比较(x ±s, mmol/L)

组别	HDL-C	LDL-C	TC	TG	HDL-C/ TC	HDL-C/ LDL-C	HDL-C/ TG	非HDL-C
总体(34对)
极高HDL-C组	2.92±0.45	3.05±0.75	6.22±0.95	0.82±0.36	0.47±0.06	1.01±0.26	4.06±1.48	3.30±0.80
对照组	1.34±0.43	3.11±0.85	5.06±1.10	1.78±1.22	0.27±0.08	0.46±0.19	1.18±0.89	3.72±1.00
t值	16.806	-0.314	4.938	-4.265	11.751	10.476	9.125	-1.966
P值	＜0.001	0.756	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	0.058

组别	HDL-C	LDL-C	TC	TG	HDL-C/ TC	HDL-C/ LDL-C	HDL-C/ TG	非HDL-C
女性(22对)
极高HDL-C组	2.92±0.45	3.18±0.69	6.36±0.89	0.85±0.41	0.46±0.06	0.96±0.25	3.94±1.36	3.45±0.74
对照组	1.46±0.44	3.25±0.86	5.29±1.08	1.58±1.05	0.28±0.09	0.49±0.21	1.40±0.99	3.83±1.05
t值	14.748	-0.395	4.259	-3.041	9.258	8.470	7.063	-1.566
P值	＜0.001	0.697	< 0.001	0.006	＜0.001	＜0.001	＜0.001	0.132

组别	HDL-C	LDL-C	TC	TG	HDL-C/ TC	HDL-C/ LDL-C	HDL-C/ TG	非HDL-C
男性(12对)
极高HDL-C组	2.92±0.45	2.82±0.81	5.95±1.05	0.76±0.24	0.50±0.07	1.10±0.26	4.27±1.73	3.03±0.85
对照组	1.10±0.30	2.84±0.78	4.62±1.05	2.15±1.45	0.24±0.06	0.40±0.13	0.76±0.48	3.52±0.91
t值	9.885	-0.058	2.680	-3.061	8.285	7.047	6.017	-1.156
P值	＜0.001	0.955	0.021	0.011	＜0.001	＜0.001	＜0.001	0.272
注：HDL-C为高密度脂蛋白胆固醇；LDL-C为低密度脂蛋白胆固醇；TC为总胆固醇；TG为甘油三酯；非HDL-C为非高密度脂蛋白胆固醇。

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