Preliminary study on the changes of residual lipoprotein-cholesterol after three meals in patients with coronary heart disease
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摘要:目的 比较冠心病组及对照组三餐后残粒脂蛋白-胆固醇(RLP-C)水平的变化, 探讨检测餐后RLP-C水平的最佳时间点。方法 选择在心内科住院的冠心病患者及对照者共31例，分为冠心病组、对照组。2组患者在日常饮食习惯下于空腹、早餐、中餐及晚餐后第4小时采取静脉血，检测血清胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)值。使用公式法计算估测的RLP-C浓度。结果 2组空腹血清TG、TC、LDL-C、非HDL-C、RLP-C浓度无显著差异(P>0.05), 冠心病组血清HDL-C浓度显著低于对照组(P < 0.05)。冠心病组患者三餐后血清TG、RLP-C水平均显著高于其空腹水平(P < 0.01), 并在晚餐后第4小时达到峰值。冠心病组患者中餐、晚餐后RLP-C升高程度显著高于对照组(P < 0.05); 冠心病组中餐后血清TG升高程度显著高于对照组(P < 0.05)。结论 2组患者空腹血清RLP-C浓度无显著差异，但冠心病组中餐、晚餐后第4小时相较空腹时RLP-C的浓度变化程度显著高于对照组，故中餐、晚餐后第4小时估测的RLP-C水平在临床中实用性可能更高。Abstract:Objective To explore the changes of residual lipoprotein-cholesterol(RLP-C)after three meals in coronary heart disease group and control group, to explore the best time point for detecting post-prandial RLP-C levels.Methods Thirty-one patients andcontrols were recruited and divided into coronary heart disease group and control group. Vein blood samples were collected at 4 hours of fasting and three meals, and serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) concentrations were measured. Serum RLP-C levels was calculated according to the equation.Results There were no significant differences in serum fasting TC, TG, LDL-C, non-HDL-C and RLP-C levels between CHD patients and controls(P>0.05). The CHD patients had lower HDL-C concentrations than controls(P < 0. 05). Postprandial serum TG and RLP-C levels increased significantly in CHD patients after each meal(P < 0.01), and reached the peak at 4 hours after dinner. The CHD patients had higher postprandial serum RLP-C levels after lunch and dinner, and higher serum TG level after lunch than the controls(P < 0.05).Conclusion There was no significant difference in the concentration of fasting serum RLP-C between the two groups. However, its concentration changed more significantly at 4 hours after lunch and dinner compared to that of fasting. Therefore, the RLP-C level measured at 4 hours after lunch and dinner may be more practical in clinic.
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图 2 2组患者三餐后血脂的浓度变化
CON: 对照组; CHD: 冠心病组; TC: 血清胆固醇; LDL-C: 低密度脂蛋白胆固醇;
HDL-C: 高密度脂蛋白胆固醇; TG: 甘油三酯; RLP-C: 残粒脂蛋白-胆固醇。
与对照组比较, *P < 0.05; 与同组空腹时比较, #P < 0.05; 与同组空腹时比较, ☆P < 0.01。表 1 2组研究对象的一般临床特征比较(x±s)[n(%)]
指标 对照组(n=12) 冠心病组(n=19) 年龄/年 45.75±10.80 48.00±10.10 男性 3(25.00) 12(63.16) 女性 9(75.00) 7(36.84) 吸烟 7(58.33) 10(52.63) 酗酒 4(33.33) 11(57.89) ACS - 15(78.95) 稳定型心绞痛 - 4(21.05) BMI/(kg/m2) 22.01±7.57 25.78±3.16 HR/(次/min) 70.30±8.17 80.89±15.10* SBP/mmHg 121.30±11.80 132.20±31.40* DBP/mmHg 75.80±10.90 81.00±16.90 Hb/(g/L) 141.33±20.13 143.67±22.36 Pt/(×109/L) 210.67±12.70 222.61±63.92 FBS/(mmol/L) 4.64±0.41 5.93±1.42* ALT/(U/L) 28.54±4.17 27.87±5.09 ALB/(g/L) 36.23±1.94 39.90±5.73 Cr/(μmol/L) 80.33±15.19 83.12±19.01 ACS: 急性冠脉综合征; BMI: 体质量指数; HR: 心率;
SBP: 收缩压; DBP: 舒张压; Hb: 血红蛋白; Pt: 血小板;
FBS: 空腹血糖; ALT: 谷丙转氨酶; ALB: 白蛋白;
Cr: 血清肌酐。与对照组比较, *P < 0.05。
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表 2 2组空腹血脂浓度比较(x±s)
mmol/L 组别 n TG TC HDL-C LDL-C 对照组 12 1.02(0.89, 1.25) 4.15(3.64, 4.61) 1.32(1.03, 1.49) 1.76(2.01, 2.32) 冠心病组 19 1.42(1.15, 1.77) 4.16(3.49, 4.75) 0.97(0.67, 1.11)* 2.51(1.95, 2.95) TG: 甘油三酯；TC: 血清胆固醇；LDL-C: 低密度脂蛋白胆固醇；HDL-C: 高密度脂蛋白胆固醇。与对照组相比，*P < 0.05
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表 3 2组各时点残粒脂蛋白-胆固醇增长值比较
组别 n Δ早餐后 Δ中餐后 Δ晚餐后 对照组 12 0.03(-0.11, 0.11) 0.09(-0.03, 0.23) 0.04(-0.25, 0.18) 冠心病组 19 0.26(0.10, 0.40) 0.38(0.05, 0.74)* 0.38(0.04, 1.85)* 与对照组相比，*P < 0.05。
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表 4 2组各时点甘油三酯增长值比较
组别 n Δ早餐后 Δ中餐后 Δ晚餐后 对照组 12 0.16(0.04, 0.40) 0.27(0.15, 0.16) 0.28(0.06, 0.78) 冠心病组 19 0.28(0.11, 1.02) 0.62(0.23, 1.12)* 0.33(-0.18, 1.83) 与对照组相比, *P < 0.05。
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