| 柴黎黎,王磊.ApoB/ApoA1对伴高血压的冠状动脉临界病变粥样硬化易损性的鉴别价值[J].安徽医药,2025,29(6):1151-1156. |
| ApoB/ApoA1对伴高血压的冠状动脉临界病变粥样硬化易损性的鉴别价值 |
| Value of ApoB/ApoA1 in differential diagnosis of the vulnerability of borderline coronary lesion with hypertension |
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| DOI：10.3969/j.issn.1009-6469.2025.06.017 |
| 中文关键词: 冠状动脉狭窄 高血压 冠状动脉疾病 斑块，动脉粥样硬化 载脂蛋白 B 载脂蛋白 A1 斑块易损性 |
| 英文关键词: Coronary stenosis Hypertension Coronary artery disease Plaque, atherosclerotic Apolipoprotein B Apolipopro-tein A1 Atherosclerotic plaque |
| 基金项目:河南省医学科技攻关计划项目( LHGJ20220223) |
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| 中文摘要: |
| 目的探讨载脂蛋白 B(ApoB)/载脂蛋白 A1(ApoA1)对伴高血压的冠状动脉临界病变粥样硬化易损性的鉴别价值。方选取 2021年 6月至 2023年 2月河南省胸科医院接收的 118例伴高血压的冠状动脉临界病变病人作为疾病组，另选取同期于法该院体检的健康人群 118例作为对照组。检测两组血清 ApoB、ApoA1、脂蛋白( a)［Lp(a)］水平，并计算 ApoB/ApoA1。根据冠状动脉血管内超声检查结果将疾病组分为易损斑块组和稳定斑块组，比较两组血清 ApoB、ApoA1、Lp(a)水平和 ApoB/ ApoA1。疾病组血脂相关指标水平与 ApoB/ApoA1的相关性采用 Pearson相关性分析。采用多因素 logistic回归分析影响伴高血压的冠状动脉临界病变粥样硬化易损性的危险因素，并以受试者操作特征曲线( ROC曲线)分析 ApoB/ApoA1对伴高血压的冠状动脉临界病变粥样硬化易损性鉴别价值。结果疾病组血清 ApoB、Lp(a)水平和 ApoB/ApoA1(0.94±0.22比 0.62±0.14)均高于对照组(均 P<0.001)，血清 ApoA1水平低于对照组( P<0.001)； 118例伴高血压的冠状动脉临界病变病人中检出易损斑块 56例，稳定斑块 62例，易损斑块组斑块负荷、偏心指数、脂质斑块、钙化斑块、坏死斑块均高于稳定斑块组(均 P<0.001)纤维帽厚度、纤维斑块均低于稳定斑块组(均 P<0.001)；易损斑块组血清低密度脂蛋白胆固醇( LDL-C)、 Lp(a)、 ApoB水平和，ApoB/ ApoA1(1.06±0.18比 2.23±0.54)均高于稳定斑块组(均 P<0.05)，血清 ApoA1水平低于稳定斑块组( P=0.002)； Pearson分析结果显示， LDL-C、Lp(a)水平与 ApoB/ApoA1均呈正相关( r=0.64、0.68，均 P<0.001)；多因素 logistic回归分析显示，血清 LDL-C、Lp(a)、 ApoB水平和 ApoB/ApoA1升高均是伴高血压的冠状动脉临界病变粥样硬化易损性的危险因素( P<0.05)ApoA1水平升高是其保护因素( P<0.05)； ROC曲线分析结果显示， ApoB/ApoA1鉴别诊断伴高血压的冠状动脉临界病变粥样硬化，易损性的灵敏度和曲线下面积( AUC)分别为 85.71%、0.83，均高于 LDL-C、Lp(a)、 ApoB、ApoA1单项鉴别诊断( P<0.05)，特异度与 LDL-C、Lp(a)、ApoB、ApoA1单项鉴别诊断比较均差异无统计学意义( P>0.05)。结论伴高血压的冠状动脉临界病变粥样硬化易损斑块病人血清 LDL-C、Lp(a)、 ApoB水平和 ApoB/ApoA1均高于稳定斑块病人，血清 ApoA1水平低于稳定斑块病人，均对斑块性质具有一定的鉴别诊断价值，但 ApoB/ApoA1的鉴别诊断价值更高，能够辅助临床早期诊断斑块易损性。 |
| 英文摘要: |
| Objective To explore the value of apolipoprotein B (ApoB) / apolipoprotein A1 (ApoA1) in the differential diagnosis ofvulnerability of borderline coronary lesion with hypertension.Methods A total of 118 patients with borderline coronary lesion compli-cated with hypertension, who were admitted to He'nan Provincial Chest Hospital from June 2021 to February 2023, were selected asthe disease group, and another 118 healthy individuals who underwent physical examination at hospital during the same period were se-lected as the control group. The levels of serum ApoB, ApoA1 and lipoprotein (a) [Lp (a)] were detected in both groups, and the ApoB/ApoA1 was calculated. According to the results of coronary intravascular ultrasound, the disease group was divided into vulnerableplaque group and stable plaque group and the levels of serum ApoB, ApoA1, Lp (a) and ApoB/ApoA1 were compared between the twogroups. The correlation between the levels of blood lipid related indicators and ApoB/ApoA1 in the disease group was analyzed usingPearson's correlation coefficient. The risk factors that affect the vulnerability of borderline coronary lesion with hypertension were ana-lyzed by multivariate logistic regression, and the value of ApoB/ApoA1 in identifying the vulnerability was analyzed by the receiver op-erator characteristic (ROC) curve.Results The levels of serum ApoB, Lp (a) and ApoB/ApoA1 [(0.94±0.22) vs. (0.62±0.14)] in the dis-ease group were higher than those in the control group (all P<0.001), and the serum ApoA1 level in the disease group was lower than that in the control group (P<0.001). Among 118 patients with borderline coronary lesion accompanied by hypertension, vulnerableplaques were found in 56 cases and stable plaques 62 cases. The plaque load, eccentricity index, lipid plaque, calcified plaque, and ne-crotic plaque in vulnerable plaque group were higher than those in stable plaque group (all P<0.001), while the thickness of fiber cap and fiber plaque were lower than those in the stable plaque group (all P<0.001). The levels of serum low density lipoprotein cholesterol (LDL-C), Lp (a), ApoB and ApoB/ApoA1 [(1.06±0.18) vs. (2.23±0.54)] in the vulnerable plaque group were higher than those in the sta-ble plaque group (all P<0.005), while the serum ApoA1 level was lower than that in the stable plaque group (P=0.002). Pearson analy-sis results showed that the levels of LDL-C and Lp (a) were positively correlated with ApoB/ApoA1 (r=0.64, 0.68, both P<0.001). Multi-variate logistic regression analysis results showed that the increased serum LDL-C, Lp (a), ApoB and ApoB/ApoA1 were risk factors for vulnerability of borderline coronary lesion with hypertension (P<0.05), and the increased ApoA1 was a protective factor (P<0.05). TheROC curve analysis results showed that the sensitivity and area under curve of ApoB/ApoA1 in differential diagnosis of vulnerability ofborderline coronary lesion with hypertension were 85.71% and 0.83, respectively, which were higher than those in the individual diag-nostic discrimination of LDL-C, Lp (a), ApoB and ApoA1 (P<0.05), but there was no statistically significant difference in specificity in comparison with LDL-C, Lp (a), ApoB and ApoA1 in single differential diagnosis (P>0.05).Conclusions The levels of serum LDL-C,Lp (a), ApoB and ApoB/ApoA1 in patients with vulnerable atherosclerotic plaque with hypertension are higher than those in patientswith stable plaque, while the serum ApoA1 level is lower than those in patients with stable plaque, all of which have certain value in dif-ferential diagnosis of plaque nature. The value of ApoB/ApoA1 in differential diagnosis is higher, which can assist in the early clinicaldiagnosis of plaque vulnerability. |
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