上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (3): 312-321.doi: 10.3969/j.issn.1674-8115.2026.03.005

• 论著 · 临床研究 • 上一篇    

基于血管内超声分析载脂蛋白B控制水平对冠状动脉斑块进展影响的队列研究

阿布力克木·阿木提1,2, 李悠然1, 杨晨蝶1, GuanPoh Tay1, 冯硕1, 张瑞岩1, 王晓群1()   

  1. 1.上海交通大学医学院附属瑞金医院心内科，上海 200025
    2.新疆维吾尔自治区喀什市人民医院心内科，喀什 844000
  • 收稿日期:2025-06-23 接受日期:2026-01-08 出版日期:2026-03-28 发布日期:2026-03-30
  • 通讯作者: 王晓群，副教授，副主任医师，副研究员，博士；电子信箱：wangxq@shsmu.edu.cn。
  • 作者简介:第一联系人：为共同第一作者（co-first authors）。
  • 基金资助:
    国家重点研发计划(2022YFC2503502);国家自然科学基金(82170423);上海交通大学医学院“双百人”项目(2024-0801);上海市卫生健康委员会医学新技术研究与转化种子计划(2024ZZ2042);国家转化医学中心（上海）开放课题项目[NRCTM (SH)-2023-13]

Impact of apolipoprotein B control on coronary atherosclerotic plaque progression: a cohort study using intravascular ultrasound

Amuti Abulikemu1,2, Li Youran1, Yang Chendie1, GuanPoh Tay1, Feng Shuo1, Zhang Ruiyan1, Wang Xiaoqun1()   

  1. 1.Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    2.Department of Cardiology, Kashgar People's Hospital, Xinjiang Uygur Autonomous Region, Kashgar 844000, China
  • Received:2025-06-23 Accepted:2026-01-08 Online:2026-03-28 Published:2026-03-30
  • Contact: Wang Xiaoqun, E-mail: wangxq@shsmu.edu.cn.
  • Supported by:
    National Key Research and Development Program of China(2022YFC2503502);National Natural Science Foundation of China(82170423);“Two-hundred Talents” Program of Shanghai Jiao Tong University School of Medicine(2024-0801);Shanghai Municipal Health Commission Medical New Technology Research and Transformation Seed Program(2024ZZ2042);Opening Project of National Research Center for Translational Medicine, Shanghai [NRCTM (SH)-2023-13]

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摘要：

目的·探讨在稳定性冠状动脉粥样硬化性心脏病（冠心病）患者中，载脂蛋白B（apolipoprotein B，ApoB）控制水平与冠状动脉斑块进展的相关性。方法·回顾性连续纳入2020年1月—2023年5月期间在上海交通大学医学院附属瑞金医院心内科就诊的稳定性冠心病患者86例（146个病变）。于基线期，收集患者的人口学信息、体格检查结果、既往病史、用药情况等；于基线期和随访期，收集患者的心血管代谢指标（包括血脂、血糖等），并采用血管内超声（intravascular ultrasound，IVUS）对患者同一未处理的临界病变（狭窄率30%~70%）进行检查；于随访期，计算心血管代谢指标的时间平均值。对IVUS图像进行定量分析，检测患者基线、随访期的动脉粥样硬化斑块总体积（total atheroma volume，TAV）、斑块体积百分比（percent atheroma volume，PAV），并以PAV变化量≥5%为界定标准将患者分为斑块进展组和非进展组。采用Spearman相关性分析和多因素Logistic回归模型评估时间平均ApoB控制水平与冠状动脉斑块进展的相关性。结果·随访期间，患者的平均PAV变化量为3.6%（-2.7%，9.7%），其中65个病变（44.5%）出现斑块进展。Spearman相关性分析显示，时间平均ApoB控制水平与平均TAV变化量呈显著正相关（r=0.22，P=0.008）。多因素Logistic回归分析进一步表明，经校正后，时间平均ApoB控制水平每增加0.1 mmol/L，冠状动脉斑块进展的发生风险增加0.885倍（P=0.048）。结论·在校正多种心血管代谢指标后，较高的ApoB水平是冠状动脉斑块进展的独立预测因子；提示在临床实践中加强对ApoB在内的心血管代谢指标的全面管理，有助于延缓斑块进展并改善患者预后。

关键词: 冠状动脉粥样硬化性心脏病, 斑块进展, 载脂蛋白B, 血管内超声

Abstract:

Objective ·To investigate the correlation between apolipoprotein B (ApoB) control level and coronary plaque progression in patients with stable coronary atherosclerotic heart disease (CHD). Methods ·This study retrospectively enrolled 86 patients with stable CHD (146 lesions) who were treated in the Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, from January 2020 to May 2023. At baseline, demographic characteristics, physical examination finding, medical history, and medication use were collected. At baseline and follow-up, cardiometabolic parameters (including blood lipids and blood glucose) were measured, and intravascular ultrasound (IVUS) was performed to evaluate the same untreated intermediate coronary lesions (stenosis rate 30%‒70%). Time-averaged values of cardiometabolic parameters during follow-up were calculated. Quantitative analysis was performed on IVUS images to measure total atheroma volume (TAV) and percent atheroma volume (PAV) at baseline and follow-up. Patients were divided into a plaque progression group and a non-progression group according to a cutoff value of PAV change ≥5%. Spearman correlation analysis and multivariate Logistic regression were used to evaluate the association between time-averaged ApoB control level and coronary plaque progression. Results ·During follow-up, the mean change in PAV was 3.6% (-2.7%, 9.7%), and plaque progression was detected in 65 lesions (44.5%). A positive correlation was observed between time-averaged ApoB control level and mean change in TAV (r=0.22, P=0.008). Multivariate logistic regression analysis further demonstrated that, after adjustment, each 0.1 mmol/L increase in time-averaged ApoB control level was associated with a 0.885-fold increase in the risk of plaque progression (P=0.048). Conclusion ·Higher ApoB levels remain an independent predictor of coronary plaque progression after adjustment for potential confounders. These findings suggest that comprehensive management of cardiometabolic parameters, including ApoB, should be strengthened in clinical practice to delay plaque progression and improve patient prognosis.

Key words: coronary atherosclerotic heart disease (CHD), plaque progression, apolipoprotein B (ApoB), intravascular ultrasound (IVUS)

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