HDL-C/ApoA1、MCP-1水平与中青年冠心病患者病变程度及炎症反应的相关性

Correlation of the HDL-C/ApoA1 ratio and the level of MCP-1 with severity of coronary heart disease and inflammatory response in young and middle-aged people

摘要:

目的 探讨高密度脂蛋白胆固醇（HDL-C）/载脂蛋白A1（ApoA1）及单核细胞趋化蛋白-1（MCP-1）水平与中青年冠状动脉粥样硬化性心脏病（以下简称冠心病）病变程度及炎症反应的相关性。方法 选取2021年10月—2022年10月在南通大学附属医院和如皋市人民医院就诊的中青年冠心病患者130例作为观察组，其中稳定型心绞痛（SAP）42例，不稳定型心绞痛（UAP）50例，急性心肌梗死（AMI）38例；病变支数：单支病变59例，双支病变39例，三支病变32例；按照狭窄程度分为轻度46例，中度54例，重度30例。另取同期该院冠状动脉CT血管造影或冠状动脉造影正常者130例作为对照组。比较各组HDL-C/ApoA1、MCP-1、肌酸激酶同工酶MB（CK-MB）、肌酸激酶（CK）、心肌肌钙蛋白Ⅰ（cTnⅠ）、白细胞计数（WBC）、超敏C反应蛋白（hs-CRP）、生长刺激表达基因2蛋白（ST2）及Gensini评分。结果 观察组HDL-C/ApoA1低于对照组（P <0.05），MCP-1、CK-MB、CK、cTnⅠ、WBC、hs-CRP、ST2高于对照组（P <0.05）。AMI和UAP患者的HDL-C/ApoA1低于SAP患者（P <0.05），MCP-1、CK-MB、CK、cTnⅠ高于SAP患者（P <0.05）。SAP、UAP、AMI患者的WBC、hs-CRP、ST2比较，差异均无统计学意义（P >0.05）。双支和三支病变患者的HDL-C/ApoA1低于单支病变患者（P <0.05），MCP-1、CK-MB、CK、cTnⅠ高于单支病变患者（P <0.05）。不同病变支数患者的WBC、hs-CRP、ST2比较，差异均无统计学意义（P >0.05）。中、重度患者的HDL-C/ApoA1低于轻度患者（P <0.05），MCP-1、CK-MB、CK、cTnⅠ、WBC、hs-CRP、ST2高于轻度患者（P <0.05）。观察组HDL-C/ApoA1与CK-MB、CK、cTnⅠ、WBC、hs-CRP、ST2及Gensini评分均呈负相关（P <0.05）；MCP-1与CK-MB、CK、cTnⅠ、WBC、hs-CRP、ST2及Gensini评分均呈正相关（P <0.05）。结论 中青年冠心病患者HDL-C/ApoA1降低，MCP-1升高。HDL-C/ApoA1、MCP-1水平与疾病类型、病变支数及病情严重程度有关，其水平与患者炎症反应有相关性。

Abstract:

Objective To investigate the correlation of the high-density lipoprotein cholesterol (HDL-C)/apolipoprotein A1 (ApoA1) ratio and the level of monocyte chemoattractant protein-1 (MCP-1) with the severity of coronary heart disease and inflammatory response in young and middle-aged people.Methods A total of 130 young and middle-aged patients with coronary heart disease treated in Affiliated Hospital of Nantong University and Rugao People’s Hospital from October 2021 to October 2022 were selected as the observation group, including 42 patients with stable angina pectoris (SAP), 50 patients with unstable angina pectoris (UAP) and 38 patients with acute myocardial infarction (AMI). Regarding the number of branches of the coronary artery involved, 59 cases had one branch involvement, 39 cases two branches involvement, and 32 cases three branches involvement. Besdies, 46, 54 and 30 patients showed mild, moderate and severe stenosis of the coronary artery. At the same time, 130 patients with normal findings on coronary computed tomography angiography (CTA) or coronary angiography in the hospitals were selected as the control group. The HDL-C/ApoA1 ratio, and the levels of MCP-1, creatine kinase MB (CK-MB), creatine kinase (CK), cardiac troponin I (cTnI), high-sensitivity C-reactive protein (hs-CRP), and growth stimulating expressed gene 2 (ST2), the white blood cell (WBC) count, and Gensini scores were compared among the groups.Results The HDL-C/ApoA1 ratio in the observation group was lower than that in the control group (P < 0.05), while the levels of MCP-1, CK-MB, CK, cTnI, hs-CRP and ST2 as well as the WBC count in the observation group were significantly higher than those in the control group (P < 0.05). The HDL-C/ApoA1 ratio in AMI and UAP patients was lower than that in SAP patients (P < 0.05), whereas the levels of MCP-1, CK-MB, CK, and cTnI in AMI and UAP patients were higher than those in SAP patients (P < 0.05). There was no different in the WBC count and the levels of hs-CRP and ST2 among AMI, UAP and SAP patients (P > 0.05). The HDL-C/ApoA1 ratio in patients with two and three branches involvement was lower than that in patients with one branch involvement (P < 0.05), while the levels of MCP-1, CK-MB, CK, and cTnI in patients with two and three branches involvement were higher than those in patients with one branch involvement (P < 0.05). There was no different in the WBC count and the levels of hs-CRP and ST2 among patients with different number of branches involved (P > 0.05). The HDL-C/ApoA1 ratio in patents with moderate and severe stenosis of the coronary artery was lower than that in patients with mild stenosis of the coronary artery (P < 0.05), whereas the levels of MCP-1, CK-MB, CK, cTnI, hs-CRP and ST2 as well as the WBC count in patents with moderate and severe stenosis of the coronary artery were higher than those in patients with mild stenosis of the coronary artery (P < 0.05). In the observation group, the HDL-C/ApoA1 ratio was negatively correlated with the levels of CK-MB, CK, cTnI, hs-CRP, and ST2, the WBC count, and Gensini scores (P < 0.05), while the level of MCP-1 was positively correlated with the levels of CK-MB, CK, cTnI, hs-CRP, and ST2, the WBC count, and Gensini scores (P < 0.05).Conclusions The HDL-C/ApoA1 ratio is decreased while the level of MCP-1 is increased among young and middle-aged patients with coronary heart disease. The HDL-C/ApoA1 ratio and the level of MCP-1 are associated with the type of diseases, number of branches of the coronary artery involved, and the disease severity. Meanwhile, the HDL-C/ApoA1 ratio and the level of MCP-1 are related to the inflammatory response in these patients.