高血脂成人血小板體積與脂質檢驗項目的相關性

Correlation of Mean Platelet Volume with Lipid Profiles in Hyperlipidemia Adults

曾致豪(Chih-Hao Tseng)

指導教授 ： 曾博修

中山醫學大學/醫學院/生化暨生物科技研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00033

摘要

背景：高血脂即血中存在多量的脂質，包括膽固醇與三酸甘油脂(或稱中性脂)。在台灣，國健署統計2007年國人高血脂盛行率為 18.5%。過多的膽固醇會堆積在心臟的冠狀動脈血管壁中，造成動脈粥樣硬化。脂蛋白(lipoprotein)負責運送膽固醇與三酸甘油脂到各組織器官。在近十年來的研究顯示，血小板與脂蛋白於動脈粥樣化形成的前期與後期皆扮演重要的角色。血小板除了與其他的血球細胞及血管細胞間互相作用外，與脂蛋白之間的交互作用似乎特別重要。一些研究也證實了低密度脂蛋白(low-density lipoprotein cholesterol, LDL)和血小板訊號路徑的啟動有關。高膽固醇血症的病人在in vitro的實驗顯示血小板高凝集力，而在in vivo實驗顯示血小板的活性增加。血小板體積是血小板功能與活性的標記，臨床血液分析儀量化為平均血小板體積 mean platelet volume (MPV)。血小板體積增加也被證明是在已知的心血管風險因子外，與心肌梗塞風險增加有關的獨立相關因子。因此，高血脂成人的心血管疾病風險高於一般人可能與LDL及MPV有關。本文研究主要是探討高血脂成人血小板體積與脂質檢驗項目的相關性。
方法：本回溯性研究針對2015年1月9日至2015年3月31日至中區某區域教學醫院門診並抽血檢驗脂質與血小板數值，年齡在18歲以上的民眾共2106人，依國民健康署「中華民國血脂異常分類之建議」區分高血脂與非高血脂成人：
分 類 血脂濃度mg/dl
高血脂 高膽固醇血症 總膽固醇（TC）≧200
混和型高脂血症 總膽固醇（TC）≧200且三酸甘油酯（TG）≧200
高三酸甘油酯血症 三酸甘油酯（TG）≧200且合併TC/HDL≧5 或
高密度脂蛋白膽固醇(HDL)＜40

如上表依不同類別的高血脂標準，並經排除如貧血、冠狀動脈疾病病史、HbA1c > 6.5%、ESR>10以及使用降血脂或抗血小板藥物如statin、aspirin等各種情形，最後共收案85人，其中包括實驗組50人和控制組35人(C組)，再將實驗組以LDL數值分成2組: A組23人(LDL≦140)與B組27人(LDL>140)，比較高血脂與非高血脂病人的MPV數值，並判定高血脂族群MPV與LDL、TC、TG、HDL、non-HDL、以及與脂質係數(lipid ratio) : TC/HDL、LDL/HDL 等脂質檢驗項目(lipid profile) 的相關性。統計方式以SPSS(Statistical Package for Social Science)統計套裝軟體來分析統計。所使用之統計方法包含：單因子變異數分析(One-way ANOVA)、皮爾森卡方檢定(Pearson's Chi-squared test)、與皮爾森相關分析(Pearson correlation coefficient)。
藉由以上統計分析方法，研究高血脂成人的血小板是否會被活化、與其心血管疾病與併發症的發生。
結果：B組MPV有顯著高值(10.2±0.7 fl)，無論是與非高血脂C組(9.0±0.4 fl; p<0.001)或與A組(9.6±0.6 fl; p=0.02)來相比。MPV與總膽固醇(TC) (r=0.634; p<0.001)、低密度脂蛋白(LDL) (r=0.570; p<0.001)、非高密度脂蛋白(non-HDL) (r=0.541; p<0.001)有高度正相關性。MPV與血脂係數TC/HDL ratio (r=0.228; p=0.036) 以及MPV與LDL/HDL ratio(r=0.285; p=0.008)皆呈顯著正相關性。此外，MPV與年齡大小(r=0.263; p=0.015)亦呈正相關性。
結論：MPV與年齡大小呈正相關，與先前其他研究的結果一致。我們的研究數據發現MPV與TC, LDL, non-HDL的相關性。且MPV與預測心血管風險之血脂係數TC/HDL與LDL/HDL ratio皆呈顯著正相關，也許可以證明高血脂成人的血小板因為有較高的平均血小板體積而有較強的凝集力與更具有反應活性。與高血脂有關的動脈粥樣硬化風險的增加也許即為高MPV的結果。因此，MPV或許可作為高血脂成人族群心血管疾病的一個有用的預後標誌。就發病機理而言需要更大樣本數的研究進一步來釐清這其中的關係。

關鍵字

高血脂 ； 血小板體積 ； 脂質檢驗

並列摘要

Background: Hyperlipidemia means elevated lipid levels in the blood, including cholesterol and triglycerol (neutral fat). The Ministry of Health and WelfareIn statistics indicate the prevalences of hyperlipidemia is 18.5% in the year 2007 in Taiwan. Excessive cholesterol accumulate in the wall of the coronary artery in heart, resulting in the formation of atherosclerosis. Lipoprotein is responsible for transporting cholesterol and triglyceride to tissues and organs of the body. In the last decade, it was recognized that platelets and lipoproteins play a pivotal role in both early and late atherogenesis. Beside cellular interactions of platelets with other blood cells and vascular cells, interactions with lipoproteins seem to be quite important. Several studies have already shown that low density lipoproteins (LDL) are involved in the initiation of platelet signalling pathways. Platelets of hypercholesterolemic patients show hyperaggreg -ability in vitro and enhanced activity in vivo. Platelet volume is a marker of platelet function and activation. It can be quantified as mean platelet olume (MPV) by clinical hematology analyzers. Increased MPV is associated with increased risk of MI independent of known cardio- vascular risk factors. Hyperlipidemia associated cardiovascular risk higher than normolipidemic healthy persons may be associated with LDL and MPV. The aim of this studywas to investigate the correlation of mean platelet volume with lipid profiles in hyperlipidemia Adults.
Methods: The retrospective study involed in the adults who went to the outpatient department and took blood for serum lipid tests and platelet count in a regional teaching hospital in midland of Taiwan from January 9, 2015 to March 31, 2015, totally 2106 adults age above 18 and were divided into hyperlipidemia and normolipidemic group according to suggestion of ROC Dislipidemia Classification of Health Promotion Adminstration. Among 685 adults, we excluded anemia, having history of coronary artery disease, HbA1c > 6.5%, ESR>10, using lipid –lowing agent such as statin or antiplatelet drugs such as aspirin that might affect the lipid or MPV levels. Of 85 adults were eventually included, fifty Control Group (Group C) and 35 Experimental Group. Experimental Group was further divided base on LDL levels into Group A (LDL≦140) 23 and Group B (LDL>140) 27 subjects to compare MPV of hyperlipidemia with normolipidemic adults, and to determine the correlations between MPV with lipid profiles: LDL, T-chol, TG, HDL, non-HDL, TC/HDL and LDL/HDL. The results were analyzed using SPSS (Statistical Package for Social Science). Statistical methods including One-way ANOVA, Pearson's Chi-squared test and Pearson correlation coefficient were performed in this study to investigate if platelets were activated in hyperlipidemia group and its associated vascular complications by measuring the MPV in the hyperlipidemia compared to the normolipidemic adults.
Results: MPV was significantly higher (10.2±0.7 fl) in Group B as compared to both nomolipidemic Group C (9.0±0.4 fl; p<0.001) and Group A (9.6±0.6 fl; p=0.02). MPV had a high positive Pearson Correlation with TC (r=0.634; p<0.001), LDL (r=0.570; p<0.001) and non-HDL(r=0.541; p<0.001). MPV had significant positive Pearson correlations with both TC/HDL ratio (r=0.228; p=0.036) and LDL/HDL ratio (r=0.285; p=0.008). Besides, MPV also showed positive Pearson correlation with age(r=0.263; p=0.015).
Conclusions: In the current study, Our data showed MPV had positive correlation with age, which was consistant with the reaults of other previous study; our findings showed a relationship between MPV and TC, LDL as well as non-HDL.Also, MPV had significant positive Pearson correlations with both TC/HDL ratio (r=0.228; p=0.036) and LDL/HDL ratio (r=0.285; p=0.008).It may be suggested that platelets of hyperlipidemia adults become more aggregable and reactive due to increased MPV. Increased risk of atherosclerosis in regard with hyperlipidemia may be a result of high MPV. Therefore, MPV might be a useful prognostic marker of cardio-vascular disease in patients with hyperlipidemia. Further studies with the larger samples are needed to clarify these relations in terms of the pathogenesis.

並列關鍵字

Hyperlipidemia ； Mean Platelet Volume ； Lipid Profiles

參考文獻

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