残粒脂蛋白胆固醇及非高密度脂蛋白胆固醇之间的不一致性与冠状动脉狭窄严重程度的相关性研究

Background? Discordance between blood lipids has been shown to be associated with the occurrence of serious coronary events in patients with coronary artery diseaseCADwhich may lead to the overestimation or underestimation of the risk of coronary events. The clinical significance of discordance between residual lipoprotein cholesterolRLP-Cand non-high-density-lipoprotein cholesterolnon-HDL-Cstill remains unclear in present. Objective? To determine the correlation of discordance between RLP-C and non-HDL-C and the severity of coronary artery stenosis in patients with CAD. Methods? A total of 421 patients with complete coronary angiographic records and Gensini score which can be fully calculated from a previous normal high blood pressure cohort study database were retrospectively analyzed and divided into 4 groups based on the median RLP-C and non-HDL-C levels in the cohortincluding concordantly low RLP-C groupRLP-C<medianRLP-C and non-HDL-C<mediannon-HDL-Cdiscordantly low RLP-C groupRLP-C<medianRLP-C and non-HDL-C ≥ mediannon-HDL-Cdiscordantly high RLP-C groupRLP-C ≥ medianRLP-C and non-HDL-C< mediannon-HDL-Cconcordantly high RLP-C groupRLP-C ≥ medianRLP-C and non-HDL-C ≥ mediannon-HDL-C. The severity of coronary stenosis was evaluated by using the Gensini scoring system. The baseline data was compared among the 4 groups and the correlation between RLP-C and non-HDL-C was analyzed by Pearson's linear correlation. The correlation of discordance between RLP-C and non-HDL-C and severity of coronary stenosis was explored by Logistic regression analysis. Results? Discordance were observed in 34%136/398 of the included patients. Severe coronary stenosis was observed in 15%19%32%and 25% of patients in the concordantly low RLP-C groupdiscordantly low RLP-C groupdiscordantly high RLP-C group and concordantly high RLP-C group. Logistic regression analysis results showed that there was no significant correlation of discordance between RLP-C and non-HDL-C and severity of coronary artery stenosisP<0.05. Logistic regression analysis results of the patients in discordantly low RLP-C group and discordantly high RLP-C group showed that after adjusting for confounders such as sexagesmokingalcohol consumptionstatin application and presence of diabetesthe low RLP-C level was not associated with the development of severe coronary stenosis OR=0.95895%CI0.473-1.939P=0.905high RLP-C was associated with the development of severe coronary artery disease OR=2.08495%CI0.1.110-3.912P=0.022 in patients in the discordantly groups. In additionRLP-C remained a strong predictor of the risk of severe coronary artery diseaseOR=1.91195%CI 1.253-2.914after multivariate Logistic regression model adjustment. Conclusion? The discordance between RLP-C and non-HDL-C is correlated with severity of coronary stenosis in patients with high RLP-C and low non-HDL-C levelswhich has the potential to be a novel risk factor for predicting severe coronary stenosis in CAD patients on the basis of traditional lipid indicatorsindependent of agesex and other risk factors.